Multisensory Stimulation Exercises And Task Oriented Exercises On Upper Limb Function In Post Stroke Patients.
Multisensory Stimulation Exercises And Task Oriented Exercises On Upper Limb Function In Post Stroke Patients.
The objective of the study was to determine the effects of Multisensory stimulation exercises
 and Task-oriented exercises on upper limb function and to determine the effects of
 Multisensory stimulation exercises and Task-oriented exercises on Activities of daily living
 and cognition . Study Design was Randomized control trial. Sampling Technique was purposive
 sampling. Study Setting was Physiotherapy department of Railway General Hospital Rawalpindi
 and NIRM Islamabad. Inclusion criteria were patients with hemiplegia due to stroke, Both male
 & female, Sub-acute and chronic stroke patients, First-ever stroke patient, Age between 40
 -65, Modified Ashworth scale <3.

 Exclusion criteria were Un bearable upper limb pain, Recent surgery, Visual impairment and
 Non cooperative Patients.

 Total sample size calculated, by using epi tool is 12. Assessment tools used were Fugal Meyer
 motor assessment scale, Wolf motor function test, Revised Nottingham sensory, Motor activity
 log and Montreal cognitive assessment.

 Individuals who met the inclusion criteria will be included in this study. All participants
 will go through randomization and divided into two groups Experimental group 1 and
 Experimental group 2. The pre-intervention assessment was made for both groups. Then
 intervention was applied to both groups.All statistical analyses will be performed through
 SPSS 21.
Stroke is defined as a neurological dysfunction due to sudden or acute injury to the central
 nervous system due to vascular causes, which includes cerebral infarction, intracranial
 hemorrhage and subarachnoid hemorrhage.Stroke is categorized as ischemic stroke (85%) and
 hemorrhage stroke (20%). Hemorrhagic stroke is further classified as interacerebral
 hemorrhage (15%) and subarachnoid hemorrhage (5%). Transient Ischemic attack (TIA) is a
 temporary blockage of blood flow to the brain and its symptoms resolves within 24 hours of
 the injury. Stroke is currently the second leading cause of death worldwide and is one of the
 leading causes of long-term disability in the United States. Almost 15 million stroke cases
 occur each year worldwide, resulting in 5 million deaths and leaving about 5 million stroke
 survivors with unchangeable abnormality and dependency.According to world health organization
 (WHO) in 2002 approximately 5.5 million people died due to stroke and 20% of these deaths
 occurred in south Asia .In Pakistan stroke cases reported are estimated to be 3,50,000
 annually.Stroke survivors experience damaged upper limb function which also affects their
 activites of daily living. A large number of them is left with impaired upper extremity
 function, even after completion of conventional rehabilitation programmes.Only 5-20 % of
 patients regain Upper extremity functional status.Along with motor impairments somatosensory
 impairments are also assosoiated with severity of stroke but is overlooked most of the times.
 Sensory impairment decreases the ability to discriminate textures, weights ,shapes and
 sizes.Proprioception and stereognosis were found to be more impaired than tatile sensation
 ,7-53 % had impaired tactile sensations ,31-89% impaied sterognosis and 34-64 % impaired
 proprioception.Mostly, the focus is on motor recovery in paretic limb but the studies showed
 that improvement in sensory functions also leads to motor recovery. By only focusing on motor
 performance without sensory dysfunction assessment, maximum outcomes cannot be achieved.Not
 only Sensory dysfunction but Cognitive issues after stroke such as ,decreased perception and
 attention ,memory deficits ,difficulty in problem solving tend to be disregarded which
 eventually effects patient performance of daily activities.Multisensory stimulation exercises
 also known as neurocognitive therapeutic exercises, cognitive exercise therapy or cognitive
 sensory motor training was proposed by Carlo Perfetti of Italy .The Hallmark of this training
 is that it focuses on sensory retraining along with emphasis on joint position perception. It
 considers recovery as a learning process, the movement as a means to know and the body as a
 surface receptor for information.Laia Salles et.al conducted a randomized controlled pilot
 study to compare the effectiveness of the cognitive exercise therapy with conventional
 treatment protocol on upper limb in sub-acute stroke patients. The result showed favourable
 clinical progression regarding upper extremity functional gain.Sunghee Lee et.al did a study
 on effect of the cognitive exercise therapy on chronic stroke patients upper limb function,
 activities of daily living and quality of life .They compared it with Task oriented exercise
 group. There was significant difference between two groups and application of cognitive
 exercise therapy was found more effective for functional recovery in stroke patients.A study
 compared the effectiveness of cognitive sensory motor training therapy with conventional
 therapy on recovery of arm function in acute stroke patients. There were no significant
 differences found between two groups in acute stroke patients. The studies based on
 Multisensory stimulation exercises of perfetti focused on evaluating motor function of upper
 limb ,activities of daily living and quality of life but cognitive elements such as attention
 and memory also activated in discriminatory tasks and were not evaluated. The past records
 shows that in randomized controlled trials Multi sensory stimulation therapy is used alone
 for the experimental group .Combination of two protocols has not been analyzed yet .So, the
 aim of the study is to observe and determine the combine effect of Task Oriented Exercises
 and Multisensory stimulation exercises on upper limb function , Activities of daily living
 and Cognition .It is expected that the combination of these two approaches will give more
 significant results in improving sub-acute and chronic stroke patients condition.
Inclusion Criteria:

 -  Patients with hemiplegia due to stroke

 -  Sub-acute and chronic stroke patients

 -  First-ever stroke patient

 -  Modified Ashworth scale <3

 Exclusion criteria:

 -  Patient that is not well oriented to understand the command to follow the designed
 motor task

 -  Un bearable upper limb pain

 -  Patient with any type of surgical intervention which may hinder assessment and
 treatment.

 -  Patients with any other neurological disease

 -  Non cooperative Patients