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

NCT07273201 | Recruiting DMC

• 1 other identifier: P.T.REC/012/005625
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Acute Stroke

Keywords

acute stroke, upper limb functional performance, muscle facilitation

Outcome Measures

Primary Outcomes (1)

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

  \- 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.

  before enrollment and the end of treatment at 6 weeks

Secondary Outcomes (1)

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

  Before enrollment and at the end of treatment at 6 weeks

Study Arms (2)

isolated muscle facilitation training

EXPERIMENTAL

Participants in this group will receive a standard physical therapy program including range of motion exercise, electrical muscle stimulation, and Mental practice with motor imagery and stretching exercise, isolated muscle facilitation using electromyography (EMG) biofeedback for six weeks, followed by task-oriented training ofthe upper limb for six weeks

Other: standard physical therapy program; Other: isolated muscle facilitation

synergistic muscle facilitation training

ACTIVE COMPARATOR

Participants in this group will receive a standard physical therapy program, including a 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

Other: standard physical therapy program; Other: synergetic muscle facilitation program

Interventions

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.

synergistic muscle facilitation training

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 training; synergistic muscle facilitation training

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

isolated muscle facilitation training

Eligibility Criteria

• Age: 50 Years - 60 Years
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• 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

You may not qualify if:

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

Sponsors & Collaborators

• Cairo University: lead

Study Sites (1)

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

Cairo, Egypt

RECRUITING

MeSH Terms

Conditions

Stroke

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Central Study Contacts

Mohamed A Mousa, assistant lecturer

CONTACT

+20 10 92841554; Mohamed.Mousa@pt.cu.edu.eg

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant lecturer of physical therapy for neurology and neurosurgery

Study Record Dates

• First Submitted: November 15, 2025
• First Posted: December 9, 2025
• Study Start: October 1, 2025
• Primary Completion: April 1, 2026
• Study Completion (Estimated): July 1, 2026
• Last Updated: December 9, 2025

Record last verified: 2025-12

Locations

EG (1)