Roods vs PNF for Upper Limb Function in Acute MCA Stroke (RVP-MCA)

May 23, 2026 updated by: Dr. Marium Zafar, University of Faisalabad

Comparison Between Roods Facilitatory Techniques and Sequential PNF Pattern on Upper Limb Function in Acute Phase of Middle Cerebral Artery Stroke Patients

Middle cerebral artery (MCA) stroke often causes weakness or stiffness in the arm and hand, making daily activities difficult. This study compares two physical therapy approaches - Rood's facilitatory techniques (using touch, quick stretch, and ice to activate muscles) and PNF sequential patterns (using diagonal movement patterns) - to improve arm function in acute stroke patients. Both groups will also receive neuromuscular electrical stimulation (NMES). A total of 28 patients will be randomly assigned to one of two groups and receive treatment three times per week for eight weeks. Arm function will be measured using the Fugl-Meyer Assessment, and muscle stiffness will be measured using the Modified Ashworth Scale before and after treatment.

Study Overview

Status

Enrolling by invitation

Conditions

Intervention / Treatment

Detailed Description

This is a single-blind, parallel-group randomized controlled trial. The study will be conducted at three settings in Faisalabad, Pakistan: Allied Hospital, Madinah Teaching Hospital, and Shahid Heera's Health Clinic. Adult patients (≥18 years) with CT or MRI-confirmed MCA stroke (ischemic or hemorrhagic), mild to moderate upper limb motor dysfunction (MRC ≥2), and cognitive competence (MoCA ≥19) will be included. Exclusion criteria include severe comorbidities, fixed contractures, severe cognitive impairment, skin contraindications to sensory stimulation, and inability to provide consent. A sample size of 28 participants (14 per group) was calculated using Rao soft app based on previous literature. Participants will be randomly assigned using a computer-generated sequence. The single-blind design keeps participants unaware of group allocation. Group A receives NMES followed by Rood's facilitatory techniques: quick stretch before or during movement to activate muscle spindles, tactile stimulation (light stroking) over the muscle belly for 10-20 seconds, and icing for 5-7 seconds on the tendon or muscle surface immediately preceding activation. Group B receives NMES followed by PNF sequential training using conventional upper limb diagonal functional patterns (D1 and D2). PNF techniques include rhythmic initiation, dynamic reversals, repetitive contractions, and combination of isotonic contractions with moderate resistance, performing 8-12 repetitions per pattern over 20-30 minutes per session. NMES parameters: biphasic waveform at 30-40Hz frequency with pulse duration of 200-300μs, producing comfortable visible contraction, administered for 30 minutes per session. Both groups receive interventions three times per week for eight weeks. Outcome measures: Fugl-Meyer Assessment for Upper Extremity (FMA-UE, score range 0-66) measures motor function; Modified Ashworth Scale (MAS, score range 0-4) measures muscle tone. Assessments are conducted at baseline and post-intervention by a qualified physiotherapist. Data will be analyzed using SPSS version 22.

Study Type

Interventional

Enrollment (Estimated)

28

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab Province
      • Faisalābad, Punjab Province, Pakistan, 3800
        • The University of Faisalabad

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Adults (40-60 years) with confirmed MCA stroke (ischemic or hemorrhagic) on neuroimaging (CT or MRI)
  • Mild to moderate upper limb motor dysfunction with MRC ≥2 for proximal limb motor strength
  • Cognitive competence to understand instructions (MoCA ≥19 or equivalent)
  • First stroke, acute or subacute phase
  • Willingness to provide written informed consent
  • Both male and female genders

Exclusion Criteria:

  • Severe coexisting medical disorders (heart, liver, kidney failure; malignant tumors)
  • Fixed musculoskeletal abnormalities or contracture in affected upper limb
  • Severe cognitive impairment or aphasia preventing adherence or consent (MMSE below threshold)
  • Skin sores, ulcers, or hypersensitivity (e.g., to cold) contraindicated for sensory stimulation
  • Refusal or inability to give informed consent

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Rood's Facilitatory Techniques Group
Participants receive neuromuscular electrical stimulation (NMES) followed by Rood's facilitatory techniques including quick stretch, tactile stimulation for 10-20 seconds over muscle belly, and icing for 5-7 seconds on tendon or muscle surface. Interventions delivered three times per week for eight weeks.
Device: Neuromuscular Electrical Stimulation
Biphasic waveform NMES at 30-40Hz frequency with pulse duration of 200-300μs, producing comfortable but visible muscle contraction. Applied to affected upper limb for 30 minutes per session, three times per week for eight weeks.
Procedure: Rood's Facilitatory Techniques
Quick stretch applied before or during movement to activate muscle spindles; tactile stimulation (light stroking) over muscle belly for 10-20 seconds; icing for 5-7 seconds on tendon or muscle surface immediately preceding activation. Applied three times per week for eight weeks following NMES.
Active Comparator: PNF Sequential Pattern Group
Participants receive neuromuscular electrical stimulation (NMES) followed by PNF sequential training with upper limb diagonal functional patterns (D1 and D2), including rhythmic initiation, dynamic reversals, repetitive contractions, and isotonic contractions with moderate resistance (8-12 repetitions per pattern over 20-30 minutes). Interventions delivered three times per week for eight weeks.
Device: Neuromuscular Electrical Stimulation
Biphasic waveform NMES at 30-40Hz frequency with pulse duration of 200-300μs, producing comfortable but visible muscle contraction. Applied to affected upper limb for 30 minutes per session, three times per week for eight weeks.
Procedure: Proprioceptive Neuromuscular Facilitation
PNF sequential training with upper limb diagonal functional patterns (D1 and D2). Techniques include rhythmic initiation, dynamic reversals, repetitive contractions, and combination of isotonic contractions with moderate resistance according to patient's capabilities. Each session includes 8-12 repetitions per pattern over 20-30 minutes, three times per week for eight weeks.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Upper Limb Motor Function
Time Frame: Baseline and 8 weeks (post-intervention)
Fugl-Meyer Assessment for Upper Extremity (FMA-UE). A standardized 66-point scale assessing motor recovery after stroke based on Brunnstrom stages. Evaluates shoulder, elbow, wrist, hand, and coordination functions. Higher scores indicate better motor function.
Baseline and 8 weeks (post-intervention)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Muscle Tone
Time Frame: Baseline and 8 weeks (post-intervention)
Modified Ashworth Scale (MAS). A 5-point scale (0-4) measuring resistance during passive stretching of the affected upper limb muscles. 0 = normal tone; 4 = rigidity. Assesses spasticity reduction.
Baseline and 8 weeks (post-intervention)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Faisalabad

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 1, 2026

Primary Completion (Estimated)

June 15, 2026

Study Completion (Estimated)

July 15, 2026

Study Registration Dates

First Submitted

May 23, 2026

First Submitted That Met QC Criteria

May 23, 2026

First Posted (Actual)

June 1, 2026

Study Record Updates

Last Update Posted (Actual)

June 1, 2026

Last Update Submitted That Met QC Criteria

May 23, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • TUF/EIRB/ 220 /26

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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