A Preliminary Study on Effectiveness of Varying Dose of Paretic Upper Limb Training with Visual Deprivation in Poststroke Patients: A Randomised Clinical Trial

Abstract

Introduction: Poststroke Upper Limb (UL) rehabilitation with visual deprivation has shown potential in enhancing motor recovery through neural plasticity. However, the optimal dosage remains unclear. Aim: To evaluate the effectiveness of varying doses of paretic UL training with visual deprivation in stroke patients. Materials and Methods: This single-centre, parallel-group, single-blinded, randomised clinical trial involved 36 stroke patients who were randomly distributed into three groups varying in treatment frequency: Group A (n=12) received two sessions per week, Group B (n=12) received three sessions per week, and Group C (n=12) received five sessions per week for four weeks. Each session lasted 40 minutes of visual deprivation training for the paretic UL. A trained physiotherapist, who was blinded to group allocation, conducted pre- and postevaluations. The Wolf Motor Function Test was the principal outcome measure. This study utilised Analysis of Variance (ANOVA) for between group comparisons and independent sample t-tests for within group pre-post comparisons, with a significance level of 5%. Results: Out of the 36 study participants, three dropouts were recorded by the completion of the study: one from Group A and two from Group B. The average age of participants was 54.75±8.06 years, and the duration of stroke was 10.08±4.35 months, with 69.4% experiencing left-sided involvement. All groups showed significant improvement. Group C exhibited the highest improvement in the Wolf Motor Function Test score, with an F value of 42.86 (p-value=0.001). Post-hoc analysis revealed a significant difference in motor score improvement in Group C, (p-value=0.001). Additionally, Group C demonstrated greater improvements in the Wolf Motor Functional Ability Score (WMFAS), with a mean improvement of 15.00±0.82 (F=158.00, p-value=0.001). Conclusion: Visual deprivation training with higher intensity (five sessions per week) was effective in improving UL motor function in poststroke patients, proving superior to lower intensity (two or three sessions per week). These results highlight the importance of frequent training. Future research with larger and more diverse stroke patient populations, as well as long-term follow-up studies, is needed to validate these findings.

Keywords

• hemiplegia
• motor function
• neuroplasticity
• rehabilitation