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NCT Number: NCT07273201

Isolated Versus Synergetic Muscle Facilitation on Upper Limb Functional Performance in Acute Stroke

This study is a randomized controlled clinical trial that will be carried out to investigate the effect of isolated versus synergetic muscle facilitation on upper limb functional performance in patients with acute stroke.

RESEARCH QUESTION:

Is there a difference between isolated and synergetic muscle facilitation on upper limb functional performance in patients with acute stroke?

It will be hypothesized that:

There will be no difference between isolated and synergetic muscle facilitation on upper limb task-oriented training in patients with acute stroke.

Treatment procedures:

Study group (A): patients will receive a physical therapy program in the form of a range of motion exercise, electrical muscle stimulation, stretching exercise, mental practice with motor imagery, and isolated muscle facilitation using electromyography (EMG) biofeedback for six weeks and followed by task-oriented training of the upper limb for six weeks control group (B): will receive a standard physical therapy program including range of motion exercise, electrical muscle stimulation, Mental practice with motor imagery and stretching exercise, synergetic muscle facilitation for six weeks, and followed by task-oriented training of the upper limb for six weeks.

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Key information

Conditions

Acute Stroke Brain Diseases Cardiovascular Diseases Central Nervous System Diseases Cerebrovascular Disorders Nervous System Diseases Stroke Vascular Diseases

Age range

50 year–60 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

faculty of Physical Therapy, Cairo University, and El kasr El-Einy hospitals

Cairo, Egypt

Location status: Recruiting

Location contact

Abeer Abo-Bakr Elwishy, professor

PRINCIPAL_INVESTIGATOR

Ebtesam Mohamed fahmy, professor

PRINCIPAL_INVESTIGATOR

Shaimaa mohamed Abd Elmageed, assistant professor

SUB_INVESTIGATOR

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Unilateral Middle cerebral artery (MCA) stroke patients
  • Brunnstrom stage of recovery 1& 2
  • Normal body mass index (18.5 - 24.99 kg/m2)
  • Dominant handedness

Exclusion criteria

  • Perceptual, apraxia, major cognitive deficits
  • Recurrent stroke
  • Subjects with cerebellar lesions, painful or subluxated shoulder, any contracture or deformity of the upper extremity

Treatment and study plan

Standard physical therapy program

Other
  • Soft tissue technique (stretch) will be applied for the anterior pectoral region, elbow flexors, pronators, wrist flexors, and finger flexors(for both research groups.
  • Passive Range of motion exercises will be applied for the glenohumeral joint, scapulothoracic articulation, elbow joint, radioulnar joint, and wrist joint(for both research groups).
  • Muscular electrical stimulation will be applied for supraspinatus, anterior and posterior deltoid, biceps and triceps, pronators and supinators, wrist and finger extensors, and finally the lumbricals (Each muscle group 20 min) (for both research groups).

In mental practice, the patient adheres to a set of imagined task performances ( picking up a cup) or movements (reaching out with the arm).

isolated muscle facilitation

Other

Muscle facilitation exercises will be applied for the anterior deltoid, middle deltoid, posterior deltoid, biceps, triceps, radioulnar pronators and supinators, wrist and finger extensors, wrist and finger flexors, and lumbricals using EMG biofeedback.

During EMG biofeedback training, the electrodes will be placed on (pectoralis major, triceps, and finger flexor muscles, and (trapezius, biceps, and wrist flexors) to ensure the isolated firing of each muscle group (100 reps each muscle group). Before training, patients should be instructed how to perform muscle contraction exercises according to the displayed EMG signal through multimedia publicity, to improve their coordination. During training, patients can take a sitting or lying down position. Then, the electrode piece will be attached to the abdominal part of the patients' deltoid muscle, triceps brachii, a forearm muscle group, thus collecting the EMG signal generated by the relaxation of the patients' upper limb muscles

synergetic muscle facilitation program

Other

Muscle facilitation exercises will be applied for the anterior deltoid, middle deltoid, posterior deltoid, biceps, triceps, radioulnar pronators and supinators, wrist and finger extensors, wrist and finger flexors, and lumbricals During the synergetic muscle facilitation, we will permit the muscles that are linked together through flexion or extension synergy to fire together (100 reps each muscle group) using EMG biofeedback training.

Primary outcomes

  1. Evaluation of upper limb functional performance (dexterity- coordination) using the Action Reach Arm Test (ARAT)

    Time frame: before enrollment and the end of treatment at 6 weeks

    • Action Reach Arm Test (ARAT): It will be used to assess upper extremity performance (coordination, dexterity, and functioning). It is a 19-item observational measure. Items are categorized into four subscales (grasp, grip, pinch, and gross movement) and arranged in order of decreasing difficulty. Subjects are first asked to perform the most difficult task within a subscale, followed by the least difficult task. while scoring the individual based on their performance of each task

    -Required Equipment: Chair without armrests, Table, Wooden blocks of various sizes, Cricket ball, Sharpening stone, Alloy tubes, Washer and bolt, 2 glasses Sharpening stone, Marbles, Ball bearings, and a Tin lid.

    -scoring: Task performance is rated on a 4-point scale, ranging from 0 (no movement) to 3 (movement performed normally). Scores on the ARAT may range from 0 to 57 points, with a maximum score of 57 indicating better performance.

Secondary outcomes

  1. Analysis of upper limb kinematics (shoulder, elbow, and wrist Positions and acceleration speed of movement) using Kinovea software

    Time frame: Before enrollment and at the end of treatment at 6 weeks

    Kinovea is a valid, precise, and reliable computer program for measuring angles and distances. Kinovia software will be used to analyze the kinematics (Position and acceleration speed)of the shoulder, elbow, and wrist. while patients perform the subscales of the Action Reach Arm Test.

    • Instrumentation: Digital video camera and Computer equipment for the measurement process.
    • procedure: All participants were instructed to wear light clothes for the determination of the selected bony landmarks and to allow easy forward reaching motion. An adhesive marker dot will be placed on preselected anatomical landmarks like the acromion, lateral epicondyle, and wrist (ulnar styloid/mid-forearm) to measure joint angles (shoulder, elbow, wrist) and movement speed. Then, patients will be asked to perform the subscales of the Action Reach Arm Test, such as reaching and grasping. Patients will be captured while performing these tasks using video camera and will be analyzed using Kinovia program.

Study contacts

Contact information is provided by the study sponsor or research team.

Mohamed A Mousa, assistant lecturer

CONTACT

[email protected]

+20 10 92841554

Sponsors and collaborators

Lead sponsor

Cairo University

Other

Registry information

Official study title

Effect of Isolated Versus Synergetic Muscle Facilitation on Upper Limb Functional Performance in Patients With Acute Stroke

Important dates

Study start
2025
Primary completion
2026
Study completion
2026
First posted
Dec 9, 2025
Registry last updated
Dec 9, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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