Comparison of Motor Relearning and Neurodevelopmental Therapy in Stroke Patients

Study Overview
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Brief Summary
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The purpose of the study is to find out the comparison of motor relearning and neurodevelopmental therapy on motor performance and quality of life in stroke patients.As motor relearning program and neurodevelopmental therapy have different effects on lower limb motor functions and quality of life. Therefore, there is need to find out the best treatment approach either MRP, neurodevelopmental therapy or both to improve motor function of lower limb and quality of life as it will help the patient to gain functional independency. This study will provide the health professionals the evidence to use these techniques according to patient interest in the clinical setup.

Detailed Description
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Stroke is one of the leading causes of death and the commonest cause of long-term disability in adults. In Pakistan it is also prevalent with prevalence of 1.24%, having common risk factor hypertension, diabetes, dyslipidemia and smoking. The focus of stroke rehabilitation is largely on the recovery of impaired movements and functions as it often leads to balance impairment and impaired postural control and mobility. The diagnosis and management of acute ischemic stroke are limited by the lack of rapid diagnostic assays for use in an emergency setting. Computed tomography (CT) scanning is used to diagnose hemorrhagic stroke but quite ineffective (<33% sensitive) to diagnose ischemic stroke. Among patients with acute ischemic stroke with a proximal vessel occlusion, a small infarct core, and moderate-to-good collateral circulation, rapid endovascular treatment improved functional outcomes and reduced mortality. Stroke is a common, serious, and disabling worldwide health-care problem and rehabilitation is a major part of patient care. Many evidences support the concept of rehabilitation of stroke which involve multidisciplinary team.Stroke have adverse effect on mobility and activity of daily livings depending upon which vessel is being effected. If ACA is involved then there will be contralateral hemiparesis and hemisensory loss more effecting the lower limb with mobility issues and dependency of stroke patients on their relatives in ADLs and if MCA involve then upper extremities will be affected with speech related impairments. Stroke patients must get rehabilitation despite of which vessel is being involved in the cerebrovascular accident CVS. Stroke patients get benefit from the physical therapy rehabilitation. A well planned rehabilitation program can reduce the catastrophic events from stroke. Motor relearning is a specialized program rehabilitation focused on motor function recovery. Many studies have been conducted to check the effectiveness of MRP on physical performance of stroke patients. The motor relearning program has found to be useful to increase functional recovery of patients with strok. Peroneal nerve stimulation (PNS) for motor relearning have significant role in improving functional mobility and quality of life. Berta Bobath gave the concept of Bobath or neurodevelopmental therapy (NDT). Bobath therapy or neurodevelopmental therapy NDT is use as an adjunct in stroke rehabilitation which is based on the principal of encouragement of normal movement pattern and discouragement of compensatory movements (11). Bobath therapy is based on inhibition of spasticity and facilitation of normal movement. Bobath therapy has become the heart of neurorehabilitation approach. Different strategies had been used for this purpose, which includes motor relearning program (MRP) and neurodevelopmental therapy. MRP involves active participation from patients because MRP involve relearning of functional activities that are very beneficial for patients whereas, neurodevelopmental therapy include performance that facilitated by the therapist; spasticity that was inhibited, thus permitting more normal movement. This randomized clinical trial will recruit patients through consecutive sampling. Diagnosed patients of stroke will be included. The patients will be divided into 2 groups, 1 and 2 and MRP therapy will be given to group 1 and neurodevelopmental therapy will be given to group 2. Session of 1 hour per day for 5 days a week will be given to both groups. The study will be based on pre-test post-test assessment of patients through Fugl Meyer assessment scale, Modified Barthel Index and Time Up and Go test. The data will be analyzed using SPSS 25 version software

Official Title
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Comparison of Motor Relearning and Neurodevelopmental Therapy on Motor Performance and Quality of Life in Stroke Patients

Conditions
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Stroke

Intervention / Treatment
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* Other: Motor relearning program
* Other: Neurodevelopmental therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Both male and female, with age between 45-70 years First-time unilateral stroke confirmed by magnetic resonance imaging or computed axial tomography scan. Clinically stable with fully oriented and conscious. Subacute stroke patients. Patients having lower limb dysfunction. Patients with Mini Mental State Examination MMSE score ≥ 24 Exclusion Criteria: Recurrent stroke. Foot drop Cardiac disease that limit function by exertional dyspnea, angina or severe fatigue. Any visual and hearing problem Subarachnoid or extradural hemorrhage, progressive hydrocephalus, previous history of brain injury

Ages Eligible for Study
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Minimum Age: 45 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Motor relearning program<br>Emphasis of MRP is on practice of specific activities, the training of cognitive control over muscles & movement. Components of activities & conscious elimination of unnecessary muscle activity.• Based on 3 factors - Elimination of unnecessary muscle activity Feedback Practice | Other: Motor relearning program<br>* Treatment session of one hour per day for five days a week, for four weeks for each participant until 20 sessions<br>|
| Experimental: Neurodevelopmental therapy<br>The abnormal patterns must be stopped not by modifying the sensory input, but by giving back to the patient the • The hemiplegic side should be incorporated into all treatment activities to reestablish symmetry and increased functional use Treatment should produce a change in the quality of movement and functional performance of the involved side Increase active use of the involved side Provide practice to improve motor performance that led to motor learning lost or undeveloped control over his output in developmental sequence | Other: Neurodevelopmental therapy<br>* Treatment session of one hour per day for five days a week, for four weeks for each participant until 20 sessions.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fugl Meyer Assessment Scale | Use: The Fugl-Meyer Assessment (FMA) is a stroke-specific, performance-based impairment index. It is designed to assess motor functioning, balance, sensation and joint functioning in patients with post-stroke hemiplegia. Criterion Validity: total score correlations (r = 0.96), Test-retest reliability r = (ICC = 0.97). | 6th week | 
| Modified Barthel Index | Use: The MBI was used to measure functional performance in basic activities of daily living (ADL). Inter-rater reliability (ICC ¼ 0.979), Cronbach's coefficient alpha of internal consistency=0.93. | 6th week | 
| TIME UP AND GO TEST | Use: The 'timed up and go' test (TUG) is a simple, quick and widely used clinical performance-based measure of lower extremity function, mobility and fall risk. Intra-tester and inter-tester reliability (ICC) = 0.92-0.99, Construct validity (Pearson r = -0.79). | 6th week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Stroke