Motor Relearning Program Combined With Neck Stabilization Exercises in Subacute Stroke

This is a randomized clinical trial. Target population is patients suffering from subacute stroke with an MMSE score of 24 and above. Data will be collected from The University of Lahore teaching Hospital and Shadman Medical Center. This study will include 96 participants with 10% dropout ratio, according to the selection criteria. The participants will be randomly divided into two groups through a computer-generated random number table.

Group A will recruit 48 patients to fulfil the inclusion criteria. These patients will undergo a 60 minutes session delivered for four weeks with 5 sessions every week, including warm-up, neck stabilization exercises, cranio-cervical flexion, cervical isometrics, 3 sets x 10 repetitions each 10 seconds hold, eye head coordination drills, 3 sets 60 seconds, focusing on target (right, left, up, down) neck control while reaching, 10 successful attempts, all performed in assisted sitting position. Combined with motor relearning program activities assisted supported sitting & standing grasping and releasing cylinder progressing to cloth, reaching targets forward and sideways, picking objects and transferring over shelves 2 meters apart, Coin stacking, assisted grooming and ADLs (combing hair, turning keys, drinking water) 10 successful attempts of each activity. Group B will recruit 48 patients which fulfill the inclusion criteria. These patients will be treated by routine physical therapy, evidence-based exercises including AAROM of shoulder, elbow & wrist joint, Scapular retraction, Shoulder and elbow isometrics, stretching of pectoralis minor and shoulder internal rotators, therapist assisted PNF diagonals for upper limb (Three sets of 10 repetitions each, squeeze hold for 10 seconds, stretch hold for 30 seconds and motor relearning program activities same as Group A, delivered under supervision over a timeframe of 60 minutes per session for four weeks, 5 times per week. The Statistical analysis will be performed through SPSS Software 21

Inclusion criteria

• Patients diagnosed for stroke in subacute phase by a neurologist
• Patients with Mini Mental State Examination score of 24 and above

Exclusion criteria

• Patients with accompanying mental Disorders (unable to cooperate)
• Fracture of upper limb in last 6 months
• Recent surgery of upper periphery effecting mobility and motor functionality
• Non consenting to intervention