Implicit Versus Explicit Motor Training for Upper Extremity Rehabilitation in Chronic Stroke Patients

Ahmed Anwar

Status: Completed

Conditions: CVA (Cerebrovascular Accident)

Treatments: Other: Implicit motor training program; Other: Selected physical therapy program; Other: Explicit motor training program

Study type: Interventional

Funder types: Other

Identifiers

NCT05847595

P.T.REC/012/004192

Details and patient eligibility

About

Training methods that improve proprioception of the shoulder joint involve specific tasks targeting joint position sense, kinesthesia, or sense of force. These exercises can involve explicit or implicit motor learning. Explicit learning involves verbal knowledge of movement performance, while implicit learning involves minimal verbal knowledge and learning in a less conscious manner. The purpose of the study is to identify the efficacy and difference between implicit and explicit motor training in improving upper extremity functions in chronic stroke patients. The study will use laser pointer pattern tracking exercises and precise repositioning tasks for explicit motor training and a cognitive-motor dual-task training for implicit motor training. The laser-pointer assisted angle reproduction test, Wolf Motor Function Test and Arm Motor Ability Test will be used for evaluation.

Enrollment: 66 patients

Sex: All

Ages: 50 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Age is ranging between 50 to 65 years
2. Diagnosis of a single stroke 6 months to 2 years prior to study entry confirmed by neuroimaging reports (to minimize the chance that improvements occur because of spontaneous recovery).
3. Sufficient cognitive and language abilities to understand and follow multiple-step instructions (a score of 24 or more on the mini mental state examination).
4. Adequate vision to track the laser beam.
5. Muscle strength of ≥ 3/5 for all upper extremity joints on manual muscle testing.
6. Subjects are able at least to partially move outside of synergies at the affected elbow (Brunnstrom recovery stage in the upper limb following stroke is 4 or greater)
7. Spasticity at the paretic elbow, wrist, or fingers, defined as a score less than 2 on the modified Ashworth scale.

Exclusion criteria

1. Uncontrolled seizure disorders.
2. Additional neurological impairments, for example, Parkinson disease that (severely) influence their upper limb functions.
3. Excessive spasticity at the paretic upper limb muscles defined as a score equal or more than 2 on the modified Ashworth scale.
4. Excessive pain in the affected UE, as measured by a score of 5 or higher on a 10-point visual analog scale.
5. Patients with musculoskeletal disorders of upper limb joints, such as severe arthritis, fractures, or fixed deformities.
6. Patients with cognitive, visual, or auditory impairments.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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66 participants in 3 patient groups

Control group A

Sham Comparator group

Description:

will be treated by selected physical therapy program only for 60 minutes.

Treatment:

Other: Selected physical therapy program

Study group B

Experimental group

Description:

will be treated by implicit motor training program for 30 minutes, in addition to the conventional physical therapy program for the lower extremity for 30 minutes ,total duration 60 minutes.

Treatment:

Other: Selected physical therapy program

Other: Implicit motor training program

Study group C

Experimental group

Description:

will be treated by explicit motor training program for 30 minutes, in addition to the conventional physical therapy program for the lower extremity for 30 minutes, total duration 60 minutes.

Treatment:

Other: Explicit motor training program

Other: Selected physical therapy program