Cognitive Multi-sensory Rehabilitation on Upper Limb Function and Fatigue in Stroke

Not Applicable

Recruiting

Interventions: Other: selected traditional physical therapy program.
Other: Cognitive multi-sensory Rehabilition

Brief Summary: This interventional study aims to investigate the therapeutic efficacy of Cognitive multi-sensory rehabilitation (CMR) on upper limb function and fatigue in chronic stroke patients. The main question is:

• Does cognitive multi-sensory rehabilitation significantly affect upper limb function and fatigue in stroke patients? Participants will be assigned into two groups. They will receive 12 sessions of study group CMR and traditional physical therapy and control group traditional physical Therapy rehabilitation. CMR 40 minutes immediately followed by 20 minutes of selected physical therapy program, three sessions per week for four weeks.

Detailed Description: About 70% of people with stroke are unable to use their affected hand efficiently in activities of daily living. Further, post-stroke fatigue affects up to 92% of post-stroke patients. Post-stroke fatigue is a multifaceted motor and cognitive process, in which the patient experiences tiredness and lack of energy that develops during physical or mental activity which may persist for years. Post-stroke fatigue impacts the mental/physical functions of the patient through decreased energy, and thus, is a significant barrier to recovery.

Preliminary evidence indicates sensory rehabilitation may enhance motor recovery in people with stroke. Cognitive Multisensory Rehabilitation (CMR) is a therapist-guided sensorimotor rehabilitation approach, that targets the patients' ability to solve sensory discrimination exercises, where the patient compares the sensations felt by the hand to the shapes observed with the eyes. Cognitive processes are encouraged by asking the patient to determine the limb movement or its position, how the movement was felt in the body, how the limb moved in relation to other parts of the body, and to spatial parameters in the environment. Because CMR integrates cognitive processes with sensory and motor tasks, it may be a novel method to address post-stroke fatigue, and it may increase connectivity in sensory and motor areas of the brain.

Recruitment & Eligibility

Inclusion Criteria

Age between 45 and 65 years.
6-18 months after ischemic stroke
living in the community (i.e., not in a long-term care home).
medically stable.
normal score in the Montreal Cognitive Assessment (MoCA: 25 to 30, maximum score = 30).
Spasticity of upper limb muscles ranged from (grade 1:2) according to the Modified Ashworth scale.

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Group 2 (GB)	selected traditional physical therapy program.	20 Egyptian ischemic stroke patients receive 12 sessions of traditional physical therapy each session lasts for 30 minutes.
Group 1 (GA)	Cognitive multi-sensory Rehabilition	20 Egyptian ischemic stroke patients receive 12 sessions of CMR and traditional physical therapy each session lasts for 40 minutes of CMR and 30 minutes of traditional physical therapy.
Group 1 (GA)	selected traditional physical therapy program.	20 Egyptian ischemic stroke patients receive 12 sessions of CMR and traditional physical therapy each session lasts for 40 minutes of CMR and 30 minutes of traditional physical therapy.

Primary Outcome Measures

Name	Time	Method
Serum levels of Brain-Derived Neurotrophic Factor (BDNF)	from baseline to four weeks after the beginning of intervention	Changes in serum levels of neural plasticity factors
Fugl-Meyer Assessment for upper extremity (FMT-UE).	from baseline to four weeks after the beginning of intervention	Changes in upper limb function.
Changes in hand grip strength	from baseline to four weeks after the beginning of intervention	Hand grip strength was measured by an electronic hand dynamometer device.
Fatigue Assessment Scale (FAS)	from baseline to four weeks after the beginning of intervention	determine the degree of self-reported fatigue in daily living activities. Each item of the FAS is answered using a fi ve-point, Likert-type scale ranging from 1 ("never") to 5 ("always"). Items 4 and 10 are reverse-scored. Total scores can range from 10, indicating the lowest level of fatigue, to 50, denoting the highest.

Secondary Outcome Measures

Name	Time	Method
Box and Blocks Test (BBT)	from baseline to four weeks after beginning of the intervention.	Changes in gross hand function intervention.

Locations (1): Faculty of Physical Therapy Cairo University
🇪🇬
Cairo, Giza, Egypt