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Rhythmic Initiation vs Isometric Training for Arm Recovery After Stroke

ConditionsStrokeUpper Extremity Paresis
Trial statusRecruiting
Trial phaseNot applicable
Trial typeInterventional
Biological sexAll
Age40-60
SponsorUniversity of Faisalabad

About this trial

Stroke is a leading cause of long-term disability worldwide. Many stroke survivors experience persistent weakness, loss of motor control, and poor coordination in their upper limb, which limits their ability to perform daily activities and return to independent living. This study compares two physical therapy approaches for patients in the subacute stage of stroke recovery (1 to 6 months after stroke). The first approach is Rhythmic Initiation, a technique from Proprioceptive Neuromuscular Facilitation (PNF) that uses smooth, guided movement patterns progressing from passive to active movement. The second approach is Isometric Resistance Training, which involves holding static muscle contractions against resistance without moving the joint. The study will enroll 40 patients aged 40 to 60 years with unilateral upper limb weakness from a first-time stroke. Participants will be randomly assigned to receive either Rhythmic Initiation or Isometric Resistance Training for 30 minutes per session, 5 days per week, for 4 weeks. The researchers will measure changes in motor function, muscle strength, coordination, and spasticity before and after the 4-week intervention. The results will help physiotherapists understand which approach is more effective for upper limb rehabilitation in subacute stroke patients.

Eligibility criteria

This trial does not accept healthy volunteers

Qualifiers

Clinically diagnosed subacute stroke (1 to 6 months post-onset)

Unilateral upper limb involvement

Age 40 to 60 years

Both genders

Disqualifiers

Severe spasticity (Modified Ashworth Scale score >3)

Recurrent or bilateral stroke

Shoulder subluxation

Shoulder or upper limb pain limiting active movement

Trial design

Design model

Parallel

Treatments tested in this trial

  • Rhythmic Initiation (PNF technique)

    Other intervention

    What: Rhythmic Initiation technique from PNF. How: Therapist guides patient's affected upper limb through a four-step sequence-passive movement (therapist moves limb), active-assistive movement (patient helps with therapist assistance), active movement (patient moves independently), and light resisted movement (therapist adds gentle resistance). The movement follows PNF diagonal pattern D1 (flexion-adduction-external rotation to extension-abduction-internal rotation) or D2. Verbal cues emphasize smooth, rhythmic motion. When: 30 minutes per session, 5 days per week. How long: 4 weeks total. By whom: Trained physical therapist. Where: Outpatient rehabilitation department.

  • Isometric Resistance Training

    Other intervention

    What: Isometric Resistance Training (static muscle contractions without joint movement). How: Patient contracts target muscle against resistance provided by therapist or stationary object. Target muscles include shoulder abductors, elbow flexors, elbow extensors, wrist flexors, and wrist extensors. Each contraction held 6-10 seconds at 60-70% of maximum voluntary contraction. Patient performs 10 repetitions per muscle group, completing 3 sets. Rest 30-60 seconds between sets. When: 30 minutes per session, 5 days per week. How long: 4 weeks total. By whom: Trained physical therapist. Where: Outpatient rehabilitation department.

Treatment groups

40 Participants
are divided into 2 treatment groups
Group A: Rhythmic Initiation GroupExperimental treatment 1 intervention
Group B: Isometric Resistance Training GroupExperimental treatment 1 intervention

Trial outcomes

Primary outcomes

1

Change in Upper Extremity Motor Function

Measured by the Fugl-Meyer Assessment Upper Extremity (FMA-UE) scale. The FMA-UE evaluates motor function, sensation, coordination, and reflex activity in the upper limb. Scores range from 0 to 66, with higher scores indicating better motor function. The assessment is performed by a blinded outcome assessor.

Time frame
Baseline (week 0) and post-intervention (week 4)

Secondary outcomes

1

Change in Upper Limb Muscle Strength

Measured using a handheld dynamometer. Maximum isometric strength recorded for shoulder abductors, elbow flexors, elbow extensors, wrist flexors, and wrist extensors. Three trials per muscle group; best score recorded in kilograms or Newtons.

Time frame
Baseline (week 0) and post-intervention (week 4)
2

Change in Upper Limb Coordination

Measured by the timed finger-to-nose test. Patient seated, asked to alternately touch examiner's finger (held at shoulder height with arm fully extended) and then their own nose as quickly as possible. Time to complete 10 repetitions recorded in seconds.

Time frame
Baseline (week 0) and post-intervention (week 4)
3

Change in Spasticity

Measured by the Modified Ashworth Scale (MAS). Spasticity graded from 0 (no increase in muscle tone) to 4 (rigid in flexion or extension). Assessed at shoulder, elbow, and wrist.

Time frame
Baseline (week 0) and post-intervention (week 4)

Other outcomes

Locations

1

Map coordinates are unavailable for these locations. Locations are shown below instead.

The University of FaisalabadRecruiting3800, Faisalābad, Punjab ProvincePakistanPakistan

Sponsors and contacts

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University of Faisalabad

Lead sponsor

Source ClinicalTrials.gov
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