Effects of Instrument-Assisted Soft Tissue Mobilization (IASTM) Along With Conventional Physical Therapy on Upper Limb Function, Strength, Range of Motion, and Spasticity in Patients With Subacute Stroke.

IASTM + Conventional Physical Therapy

5-10 minutes per session applied to affected upper limb muscles (biceps brachii, brachialis, flexor carpi radialis, flexor carpi ulnaris, thenar and hypothenar muscles) using stainless steel instruments

• Technique: Multidirectional strokes at 30-60 second intervals
• Intensity: Moderate pressure causing mild erythema without bruising
• Frequency: 3 sessions/week for 6 weeks
• Conservative Physical Therapy: 45-minute session including
• Passive stretching of spastic muscles (15 min)
• Active-assisted ROM exercises (10 min)
• Strengthening exercises (10 min) - including isometric holds, concentric/eccentric contractions as tolerated
• Task-oriented Training of upper limb, {Reaching activities, Grasping & releasing objects, Object manipulation tasks (stacking blocks, turning objects), Simulated ADL tasks (feeding, grooming) (10 min)}

Conventional Physical Therapy

45-minute session.

• Passive stretching of spastic muscles (15 min)
• Active-assisted ROM exercises (10 min)
• Strengthening exercises (10 min)-including isometric holds and concentric/eccentric contractions as tolerated
• Task-oriented Training of upper limb, {Reaching activities, Grasping & releasing objects, Object manipulation tasks (stacking blocks, turning objects), Simulated ADL tasks (feeding, grooming)} (10 min)

Moderate-good reliability (κ = 0.65-0.78). The modified Ashworth scale will be used to determine the level of spasticity in the participants. The assessment is done by bringing the patient's limb to the possible maximal extension from flexion and then flexion to extension until the point of resistance is met. Scoring is done from 0-4 (0 being normal while 4 being rigid).

It is a stroke-specific, performance-based outcome measure used to assess upper limb motor recovery following a stroke. The FMA-UE consists of 33 items evaluating reflex activity, voluntary movement within and out of synergy, wrist and hand function, and coordination/speed. Each item is scored on a 3-point ordinal scale (0 = cannot perform, 1 = performs partially, 2 = performs fully), with a maximum score of 66 indicating optimal motor function.

A standardized, performance-based outcome measure assessing muscle strength on a 6-point ordinal scale (0 = no contraction to 5 = normal strength). Evaluates key upper limb muscle groups, including shoulder, elbow, forearm, wrist, and grip bilaterally. Requires no equipment, is clinically feasible, and provides immediate interpretable results. Excellent reliability (ICC = 0.84-0.92) in stroke.

Good-excellent reliability (ICC = 0.90-0.98). A goniometer will be used to assess the range of motion of all joints. A goniometer can assess both active and passive ROM.