Cawthorne-Cooksey Exercises and Frenkel Exercises on Balance and Coordination in Stroke

NCT07724860 | Completed

• 1 other identifier: REC/RCR & AHS/25/0224
• Study Type: interventional
• Target: 22
• Locations: 1 country
• Sites: 1

Brief Summary

Stroke, often caused by cerebral circulation disruption can lead to transient or permanent brain function deficit it is a leading cause of disability and death globally, with a particularly high burden in low- and middle-income countries like Pakistan. Balance and coordination impairments are common post-stroke, severely impacting patients' mobility and quality of life. While Cawthorne-Cooksey and Frenkel exercises are low-cost rehabilitation techniques known to aid balance and coordination, there is limited evidence comparing their effectiveness in stroke patients. This study aims to evaluate and compare the effects of Cawthorne-Cooksey and Frenkel exercises on improving balance and coordination in post-stroke patients. Specific goals include determining which protocol leads to faster and more sustained improvements and providing evidence-based recommendations for stroke rehabilitation.

Conditions

Stroke; Stroke (CVA) or TIA; Balance; Coordination Impairment

Keywords

Balance; Stroke; Frenkel Exercises; Coordination

Outcome Measures

Primary Outcomes (2)

• Berg balance Scale

  The Berg Balance Scale (BBS) is designed to evaluate static and dynamic balance through 14 functional tasks, each scored from 0 to 4 points, with a total possible score of 56. A higher score indicates better balance performance, while a lower score reflects greater fall risk and impaired balance

  6 weeks

• Lower Extremity Motor Coordination Test

  The Lower Extremity Motor Coordination Test (LEMOCOT) is a performance-based measure used to assess motor coordination deficits after stroke. The scoring system for LEMOCOT is based on the ability to move the big toe as fast and accurately as possible between targets marked on an electronic mat equipped with force sensors. The scoring involves calculating the contact surface area, endpoint location, center of pressure (COP), and distance between them. The absolute and variable errors of the endpoint are also calculated to assess the performance of the lower extremities.

  6 weeks

Study Arms (2)

Cawthorne-Cooksey Exercise group

EXPERIMENTAL

Other: Cawthorne-Cooksey Exercises

Frenkel Exercises

EXPERIMENTAL

Other: Frenkel Exercises

Interventions

Frenkel Exercises OTHER

Warm-up, such as ankle pumping and circles, will be performed before starting the session for 5-10 minutes. Cool-down exercises like deep breathing will be performed for 5-10 minutes after the intervention. A. Lying (Supine) Exercises: Typically performed with the head raised, limbs fully supported: * Hip and knee flexion/extension: slide heel to therapist's hand or along a marked path. * Hip abduction/adduction: leg moves sideways along the plinth surface. Targeted placement practice: placing the heel on the therapist's hand or on a mark. B. Sitting Exercises Patient sits (may use support) and: * Heel-to-mark sliding: extend and lift heel or toe to visual guide Alternate heel/toe lifts: enhancing proprioceptive control * Stride sitting: stand, then sit, shifting trunk forward, possibly using wall bars for support. * Upper limb tasks: reaching loops, placing objects, hand-mouth coordination. 16 C. Standing Exercises Focus on balance and coordination: • Stride standing: weight transfer

Frenkel Exercises

Cawthorne-Cooksey Exercises OTHER

Warm up like ankle pumping and circles will be performed before starting the session for 5- 10 minutes. Cool down exercises like deep breathing will be performed for 5-10 minutes after intervention. A. In Supine Lying 1. Eye movements: at first slow, then quick. * Up and down. * From side to side. * Focus on finger moving from 3ft to 1ft away from face. 15 2. Head movements: at first slow, then quick. Later with eyes closed. * Bend backwards and forwards. * Turn from side to side. B. Sitting * 1 and 2 - as above * Shoulder shrugging and circling * Bend forward and pick up objects from the ground C. Standing As A1, A2 and B3 * Change from sitting to standing with eyes open, then eyes closed. * Throw a small ball from hand to hand (above eye level). * Throw a ball from hand to hand under the knee. * Change from sitting to standing and turn round in between. * Weight shifting on alternate legs

Cawthorne-Cooksey Exercise group

Eligibility Criteria

• Age: 40 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Adults aged 40-75 years
• First-time ischemic or hemorrhagic stroke, diagnosed within the past 3-6 months (subacute phase)
• Berg Balance Scale (BBS) score between 21-40 (indicating moderate balance impairment)
• Ability to follow instructions (Mini-Mental State Exam score ≥ 24)
• No previous participation in a rehabilitation program

You may not qualify if:

• History of multiple strokes or recurrent strokes
• Individuals with a history of neurological deficits other than stroke, such as Parkinson's disease or multiple sclerosis
• Severe musculoskeletal disorders, visual or auditory impairments
• Any contraindications to start rehabilitation (i.e. severe uncontrolled hypertension, uncontrolled diabetes or unstable angina)
• Use of assistive devices

Sponsors & Collaborators

• Riphah International University: lead

Study Sites (1)

Sehat Medical Complex

Lahore, Punjab Province, 54000, Pakistan

Location

Related Publications (4)

• Sherin A, Ul-Haq Z, Fazid S, Shah BH, Khattak MI, Nabi F. Prevalence of stroke in Pakistan: Findings from Khyber Pakhtunkhwa integrated population health survey (KP-IPHS) 2016-17. Pak J Med Sci. 2020 Nov-Dec;36(7):1435-1440. doi: 10.12669/pjms.36.7.2824.

  PMID: 33235553 BACKGROUND

• Arif A, Arshad K, Tariq S, Sundas S, Tariq N, Kabir A, et al. COMPARATIVE EFFECTS OF VIRTUAL REALITY AND FRENKEL'S EXERCISES ON BALANCE, GAIT AND QUALITY OF LIFE IN PATIENTS WITH STROKE. Insights-Journal of Health and Rehabilitation. 2024;2(2 (Health & Rehab)):459-67.

  BACKGROUND

• Saini V, Guada L, Yavagal DR. Global Epidemiology of Stroke and Access to Acute Ischemic Stroke Interventions. Neurology. 2021 Nov 16;97(20 Suppl 2):S6-S16. doi: 10.1212/WNL.0000000000012781.

  PMID: 34785599 BACKGROUND

• Shoeb M, Mishra A, Yadav KK, Kumar S, Yadav S. Effect of BAPS Board Versus Frenkel Exercise on Balance in Stroke Patient's-A Pilot Study.

  BACKGROUND

MeSH Terms

Conditions

Stroke; Ataxia

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Dyskinesias; Neurologic Manifestations; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Zain ul abbas, MS

  Children's Hospital Lahore

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 21, 2026
• First Posted: July 24, 2026
• Study Start: July 1, 2025
• Primary Completion: February 1, 2026
• Study Completion: June 1, 2026
• Last Updated: July 24, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)