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

CVA (Cerebrovascular Accident) Clinical Trial

Official title:

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

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT05847595
• Other study ID #: P.T.REC/012/004192
• Status: Recruiting
• Phase: N/A
• Start date: June 10, 2023
• Est. completion date: November 10, 2023

Study information

• Verified date: April 2023
• Source: Egyptian Chinese University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 66
• Est. completion date: November 10, 2023
• Est. primary completion date: October 10, 2023
• Accepts healthy volunteers: No
• Gender: All
• Age group: 50 Years to 65 Years

Eligibility

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.

Related Conditions & MeSH terms

• CVA (Cerebrovascular Accident)
• Stroke

Intervention

Other:
• Implicit motor training program
The implicit motor training aims to create a learning situation in which the learner is not (or minimally) aware of the underlying rules of the practiced motor skill. Cognitive-motor dual-task training will be used, which involves practicing hand-reaching and grasping in different locations in space while performing cognitive tasks associated with attention, memory, and executive function. The cognitive tasks include naming words, counting backwards, counting tones, counting days and months backwards, listening to a number and counting backwards by twos and threes, telling daily stories, spelling words backward, continuous subtraction of 7 from 100, and the Stroop task. The training will be tailored to the participant's abilities.
• Explicit motor training program
The explicit motor training aims to create a learning situation in which the learner is very aware of the learning process by providing detailed explicit instructions on each exercise. The Motion Guidance Shoulder Kit will be used for this intervention, which involves four exercises: "Around the clock" in flexion and abduction, "Locate the Target" in active range of motion, "Butterfly" in tracing small and large butterfly patterns, and "Test your positional awareness" in locating circles with eyes open and closed. The kit involves a strap around the forearm with a laser to guide the movement of the arm during the exercises.
• Selected physical therapy program
The selected physical therapy program, which includes shoulder joint mobilization, graduated active exercises for shoulder muscles, hand weight bearing exercises, Approximation of the upper limb joints. While, the conventional physical therapy program for the lower extremity which includes gait training, strengthening exercises and balance training .

Locations

Country	Name	City	State
Egypt	Egyptians Chinese University	Cairo

Sponsors (1)

Lead Sponsor	Collaborator
Ahmed Anwar

Country where clinical trial is conducted

Egypt, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Upper extremity motor ability	Wolf Motor Function Test	4-weeks
Primary	ADL functions of the upper extremity	Arm Motor Ability Test	4-weeks
Secondary	Shoulder joint proprioception	laser-pointer assisted angle reproduction test	4-weeks