Stroke is a leading cause of long-term disability worldwide and frequently results in persistent upper limb impairment, particularly affecting hand dexterity and motor function. These impairments significantly restrict the performance of activities of daily living, reduce functional independence, and negatively affect quality of life.
Task-oriented rehabilitation has become an important component of stroke management because it promotes motor relearning through repetitive practice of meaningful functional activities. Among these approaches, task-specific drawing exercises and fine motor hand training have demonstrated potential to improve upper limb function; however, evidence directly comparing their effectiveness remains limited.
This randomized controlled trial will compare the effects of task-specific drawing exercises and fine motor hand training on hand dexterity and hand motor function in individuals with subacute stroke. Twenty-six participants will be randomly allocated to one of two intervention groups. Both groups will receive conventional wrist and finger range-of-motion exercises before participating in their assigned intervention. Participants in the task-specific drawing exercise group will perform a progressively graded drawing program, whereas participants in the fine motor hand training group will complete a structured program of functional object-manipulation activities. Both interventions will be administered on alternate days for 30-45 minutes over a four-week period.
The primary outcome will be hand dexterity, and the secondary outcome will be hand motor function. Outcome assessments will be performed at baseline and following completion of the intervention period using standardized assessment tools.
The findings of this study are expected to provide comparative evidence regarding the effectiveness of task-specific drawing exercises and fine motor hand training for improving hand function after stroke. The results may contribute to evidence-based neurological rehabilitation and assist physiotherapists in selecting effective intervention strategies to enhance upper limb recovery, functional independence, and quality of life in individuals with subacute stroke.
Adults aged 40-70 years.
Diagnosed with MCA ischemic or hemorrhagic stroke, confirmed by medical records.
Sub-acute stroke patients and to perform minimal voluntary finger or wrist movement in the affected hand (_>30 pronation supination and wrist flexion)
Ability to understand and follow simple verbal instructions.
Aphasia, cognitive deficits
Modified Ashworth Scale >3 in the wrist or fingers of the affected hand.
History of Parkinson's disease, multiple sclerosis, traumatic brain injury, or recurrent stroke.
Fracture, arthritis, tendon injury, or deformity affecting the upper limb or hand.
Parallel
Task-specific drawing exercises
Procedure/SurgeryParticipants allocated to the task-specific drawing exercise group will receive a structured four-week progressive drawing intervention. Both groups will first perform standardized wrist and finger range-of-motion exercises, including wrist circles, wrist flexion and extension, finger abduction and adduction, and thumb opposition. The drawing intervention will be delivered on alternate days for 30-45 minutes, with 15 repetitions of each activity. 7 Week 1 will include geometric drawing and shading activities, including parallel vertical, horizontal, and diagonal lines, curved and semicircular lines, concentric circles and ovals, spirals, repeated curved patterns, cone-like forms, nested squares, rectangles, parallelogram-like forms, and triangles. Week 2 will progress to combined forms such as a house, table, chair, bowl or cup, and bicycle. Week 3 will include irregular natural forms, particularly leaf patterns. Week 4 will progress to freehand drawings, including trees and human eyes
Fine motor training
Procedure/SurgeryParticipants allocated to the fine motor training group will receive a structured four-week progressive program targeting coordinated finger movements, grasp, release, precision, and object manipulation. Both groups will first perform standardized wrist and finger range-of-motion exercises, including wrist circles, wrist flexion and extension, finger abduction and adduction, and thumb opposition. Fine motor training will be delivered on alternate days for 30-45 minutes, with 15 repetitions of each activity. Week 1 will include rolling paper pieces into wads, transferring large beads into a small jar, and rolling a pencil between the thumb and fingers. Week 2 will include paper folding, stacking medium cubes, card manipulation, opening and closing a jar, pen twirling, and transferring medium beads. Week 3 will include tearing paper, paper-clip placement, stacking small cubes, transferring small beads, and buttoning. Week 4 will include tearing small paper pieces, coin picking, bottle-c
Dexterity
Hand dexterity will be assessed using the Nine-Hole Peg Test (NHPT), a standardized performance-based measure of dexterity. The outcome will be recorded as the time in seconds required to complete the task, with a lower completion time indicating better dexterity. For interpretation, the study protocol will classify completion times as \<30 seconds: normal dexterity; 30-60 seconds: mild impairment; 60-120 seconds: moderate impairment; and \>120 seconds or inability to complete the test: severe fine motor impairment
Hand motor Function
Hand motor function will be assessed using the Fugl-Meyer Assessment-Hand (FMA-Hand), which evaluates motor control of the paretic hand. The hand section consists of 7 items with a maximum score of 14. It assesses motor control involving finger flexion and extension, thumb adduction, finger opposition, hook grip, cylindrical grip, and spherical grip. Each item is scored from 0 to 2, with higher scores indicating better motor control of the affected hand.
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