This randomized clinical trial will examine upper limb rehabilitation in individuals recovering from stroke. The study will compare unilateral and bilateral task-oriented training approaches to determine their relative effectiveness. Thirty-two medically stable participants with active shoulder movement and adequate cognition will be enrolled into two groups. Both groups will receive structured training for four weeks. Outcomes related to motor function and dexterity will be measured using standardized assessment tools. The aim is to identify the more effective strategy for improving upper extremity function after stroke.
• Age between 40 and 75 years
Clinically diagnosed stroke (no more than three lifetime episodes)
Stroke duration between 6 to 24 months
Ability to perform antigravity shoulder movement with the paretic limb
• Uncontrolled systemic conditions (e.g. Unstable cardiac conditions)
Major orthopedic issues affecting the involved upper limb
Hearing deficits
Allergy to electrodes
Parallel
Unilateral task oriented training (UTOT) with baseline EMS
Procedure/SurgeryBaseline: EMS applied to target muscles (depending on requirement of patient like wrist and finger extensors) with 15-20 minutes duration Treatment: Task oriented functional exercises performed only with affected arm. Task progress from simple to complex e.g. drinking form a cup, lifting a glass to 90° flexion of shoulder, polishing a table, and hair combing. Visual, verbal, or proprioceptive feedback provided to support motor learning. Sessions conducted 4 times/week for 4 weeks.
Bilateral task oriented training (BTOT) with baseline EMS
Procedure/SurgeryBaseline: EMS applied to target muscles (depending on requirement of patient like wrist and finger extensors) with 15-20 minutes duration Treatment: Same tasks previous group, but performed by both upper limbs, simultaneously in a coordinated manner. Intensity, duration and task complexity matched with UTOT group to ensure comparability. Therapist provides cueing and feedback to maintain proper movement and progression. Sessions conducted 4 times/week for 4 weeks.
Motor recovery and upper extremity function
Motor recovery and upper extremity performance will be assessed using Fugl-Meyer Assessment for Upper Extremity (FMA-UE). This scale assesses upper limb motor function by examining reflex activity, voluntary movements and movement synergy patterns. It allows systemic tracking of recovery over time.
Hand dexterity
Modified Box and Block test, a customized adaptation of the original test, will assess hand dexterity. It has been validated for use in individuals with stroke and demonstrates high reliability. It supports excellent test-retest reliability meaning strong consistency.
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