Evaluating the Therapeutic Impact of Early Multimodal Rehabilitation in Hemiplegic Stroke Patients

Evaluating the Therapeutic Impact of Early Multimodal Rehabilitation in Hemiplegic Stroke Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Evaluating the Therapeutic Impact of Early Multimodal Rehabilitation in Hemiplegic Stroke Patients Jasmin Behera, Mamata Swain, Jhunilata Pradhan, Sasmita Das This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6697755/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background: Early rehabilitation following stroke has emerged as a pivotal strategy to accelerate recovery and enhance functional outcomes in hemiplegic patients. Despite supporting evidence, the integration of structured rehabilitation protocols in critical care settings remains inconsistent, particularly in resource-limited environments. Purpose: This study aimed to evaluate the effectiveness of early rehabilitation therapy on stroke severity, cognitive function, and motor performance among hemiplegic stroke patients admitted to a critical care unit. Methods: A quasi-experimental design was employed. Fifty-two participants were recruited and evenly assigned to experimental and control groups. The experimental group received a structured multimodal rehabilitation program comprising motor retraining, cognitive stimulation, and task-specific functional practice initiated within 72 hours of stroke onset. The control group received standard post-stroke care. Outcomes were assessed using the NIH Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), and Fugl-Meyer Assessment (FMA). Results: After four weeks, the experimental group demonstrated significantly improved outcomes: 92.3% achieved minor stroke severity, 80.8% attained normal cognitive scores, and 46.2% exhibited only slight dyscoordination in motor tasks. Large effect sizes across all outcome measures confirmed the clinical relevance of early intervention. Conclusions: The findings underscore the importance of timely, interdisciplinary rehabilitation in enhancing neurological recovery after stroke. Critical care nurses play an essential role in promoting early mobilization, integrating cognitive and motor rehabilitation strategies, and adopting standardized protocols to improve functional independence and reduce long-term disability post-stroke. Biological sciences/Neuroscience Health sciences/Health care Early rehabilitation therapy stroke severity Cognitive functions Motor functions Hemiplegia patients Figures Figure 1 Figure 2 Figure 3 Introduction Stroke remains a leading cause of death and long-term disability globally, with hemiplegia a condition characterized by paralysis on one side of the body being one of the most common post-stroke complications ( 1 ). Stroke survivors with hemiplegia face significant challenges across physical, cognitive, and emotional domains, which substantially impact their ability to perform daily tasks and participate in social and occupational roles ( 2 ). The impairments resulting from hemiplegia often lead to reduced quality of life, increased dependency, and long-term healthcare needs. In India, the burden of stroke is substantial, particularly in rural and resource-limited settings where access to rehabilitation services is often limited ( 3 ). According to the Indian Stroke Association, the incidence of stroke has risen significantly in recent years, with hemiplegia accounting for a large portion of post-stroke disabilities ( 4 ). The prolonged care required for hemiplegia patients creates substantial physical, emotional, and financial burdens on patients, caregivers, and healthcare systems ( 5 ). Research indicates that integrated rehabilitation strategies addressing both motor and cognitive impairments may improve the overall functional independence of stroke patients more effectively than conventional therapies focused solely on physical recovery ( 6 , 7 ). This evidence underscores the necessity for comprehensive rehabilitation approaches to mitigate the multifaceted impacts of stroke. Early rehabilitation, particularly interventions targeting both motor and cognitive recovery, has gained attention due to its potential to maximize recovery outcomes during the critical post-stroke neuroplasticity window ( 8 ). Neuroplasticity allows the brain to reorganize and form new connections, facilitating functional recovery following injury ( 9 ). Despite the recognized benefits of early rehabilitation, there remains a lack of consensus on the best timing, intensity, and combination of therapies for optimal recovery, particularly in patients with hemiplegia ( 10 ). While motor function recovery, using interventions such as strength training and balance exercises, has been the primary focus of stroke rehabilitation ( 11 ), cognitive impairments—such as deficits in attention, memory, and executive functioning are often overlooked, despite their significant impact on overall recovery ( 12 , 13 ). Pollock et al. (2020) reported that structured cognitive exercises initiated during early rehabilitation resulted in significant improvements in memory and executive functions, highlighting the need for a comprehensive approach that addresses both cognitive and motor impairments ( 14 ). This study aims to evaluate the effectiveness of early rehabilitation therapy, combining motor and cognitive exercises, in enhancing recovery outcomes in hemiplegia patients. By investigating this holistic approach to rehabilitation, we seek to contribute to the growing body of literature advocating for early intervention as a critical factor in stroke recovery ( 15 ).Thus, this study aims to fill these critical gaps by evaluating the impact of early, structured rehabilitation therapy—targeting both motor and cognitive recovery—on the severity of stroke, mental status, and physical coordination in hemiplegia patients using standardized assessment scales. By focusing on an integrated therapeutic model and its short-term effectiveness, this research will help inform evidence-based, multi-disciplinary rehabilitation protocols tailored for stroke survivors in similar healthcare settings. Methods Ethical Considerations Ethical approval was obtained from the Institutional Review Board of Institute of medical sciences (IMS) and SUM hospital, Bhubaneswar, Odisha (Letter no- Ref.no/IEC/IMS.SH/SOA/2024/882). The study protocol adhered to ethical standards for human research, with emphasis on participant safety, autonomy, and confidentiality. Written informed consent was obtained from all participants in accordance with the Declaration of Helsinki. No financial or coercive incentives were offered. Data were anonymized and securely stored. Both control and experimental groups received appropriate clinical oversight to ensure safety and dignity throughout the study. Study Design and Approach This study employed a quasi-experimental research design with a pre-test and post-test control group approach to evaluate the effect of early rehabilitation therapy on cognitive and motor function among hemiplegia patients. The study was conducted over four weeks at a tertiary care hospital in Bhubaneswar, Odisha, India. Setting, Sample, and Sampling Technique The study was carried out in the neurology and stroke rehabilitation units of the selected tertiary care facility. A total of 52 hemiplegic stroke patients who met the inclusion criteria were recruited using purposive sampling followed by random allocation. Inclusion criteria consisted of adult patients (aged 25–72 years) with first-ever stroke-induced hemiplegia, medically stable, and within 2 weeks of stroke onset. Patients with severe cognitive impairment, recurrent stroke, or other neurological conditions were excluded. Eligible participants were recruited through purposive sampling and randomly assigned to experimental and control groups using a simple randomization method by a blinded third party. To ensure unbiased allocation, a simple randomization technique was implemented. Each participant was assigned a number, placed in identical slips, and randomly drawn by a blinded third party to allocate them to either the experimental group (n = 26) or the control group (n = 26). A priori power analysis was performed using G*Power 3.1 to determine the minimum sample size required to detect a medium effect size with 80% power at a 0.05 significance level. Data Collection Procedure and Tools Demographic and clinical baseline data were collected using a self-structured socio-demographic and clinical questionnaire. Three standardized assessment tools were used to measure study outcomes.Stroke severity was assessed using the NIHSS [16], cognitive function by MMSE [17], and motor function by the Fugl-Meyer Assessment (motor domain) [18], all of which have established reliability and validity. The National Institutes of Health Stroke Scale (NIHSS) is a standardized neurological examination tool designed to assess the severity of neurological deficits in stroke patients. It is widely used in both clinical practice and research to provide a quantitative measure of stroke-related impairment. The scale consists of 15 items, each evaluating specific neurological functions such as level of consciousness, gaze, visual fields, motor function, and language, with each item scored from 0 to 4 based on the degree of impairment. The total score ranges from 0 to 42, with interpretation as follows: 0 indicates no stroke symptoms, 1–4 signifies a minor stroke, 5–15 a moderate stroke, 16–20 a moderate to severe stroke, and 21–42 a severe stroke. The NIHSS has demonstrated strong psychometric properties, with high inter-rater reliability (r = 0.98) and robust test-retest reliability. The Content Validity Index (CVI) of the tool is 0.92, confirming its appropriateness for assessing stroke severity in diverse clinical settings. The Mini-Mental State Examination (MMSE) is a widely used 30-point questionnaire designed to assess cognitive function, focusing on key domains such as orientation, memory, attention, language, and visuospatial skills. It serves as an effective screening tool for cognitive impairment and is also employed to monitor cognitive changes over time. The total score ranges from 0 to 30, with scores interpreted as follows: 24–30 indicates normal cognition, 19–23 suggests mild cognitive impairment, 10–18 reflects moderate impairment, and scores below 10 represent severe impairment. The MMSE demonstrates high test-retest reliability, with correlation coefficients ranging from 0.89 to 0.97, and has shown strong construct validity in comparison with comprehensive neuropsychological evaluations. Its Content Validity Index (CVI) is reported at 0.95, confirming the tool's reliability and suitability for use in both clinical and research settings. The Fugl-Meyer Assessment (FMA) for motor function is a standardized, performance-based scale designed to evaluate motor recovery in patients following a stroke. Recognized as the gold standard for assessing sensorimotor function, the FMA comprehensively measures recovery across five domains: motor function, sensory function, balance, joint range of motion, and joint pain. In the present study, only the motor function subscale was utilized. This subscale has a scoring range of 0 to 100, with interpretations as follows: scores below 50 indicate severe hemiplegia, 50–84 suggest marked hemiplegia, 85–94 denote moderate hemiplegia, 95–99 reflect slight motor dyscoordination, and a score of 100 represents normal motor function. The FMA exhibits excellent reliability, with inter-rater and intra-rater correlation coefficients ranging from 0.96 to 0.99. It also demonstrates strong content validity, with a Content Validity Index (CVI) of 0.97, confirming its robustness for both clinical evaluation and research use in stroke rehabilitation. Intervention Patients in the experimental group received a structured early rehabilitation program(table-1) for 4 weeks. Each session lasted 45–60 minutes per day, demonstrated according to the patient's tolerance and recovery level. The intervention plan was divided into progressive weekly goals: Week 1: Mobilization and sensory stimulation to initiate cortical activation. Week 2: Passive movements and cognitive tasks involving memory and attention. Week 3: Active movements with executive functioning tasks such as problem-solving and decision-making. Week 4: Advanced mobility and complex cognitive challenges aimed at functional independence. The sessions were administered by licensed physiotherapists with a minimum of three years of clinical experience in stroke rehabilitation. These professionals underwent a two-day orientation and hands-on training program conducted by a senior rehabilitation specialist to ensure consistency in delivering the intervention protocol. Intervention fidelity was monitored using a structured checklist that recorded adherence to session components, duration, patient responsiveness, and any deviations. Weekly supervision meetings were held to review session logs and reinforce protocol adherence. Control Group Care The control group consisted of (n=26) hemiplegic stroke patients who received standard care in accordance with institutional stroke management protocols. This routine care emphasized patient comfort, prevention of complications, and maintenance of functional stability. Over the four-week period, patients received physiotherapy sessions twice daily (15–20 minutes each), which included passive range-of-motion exercises, regular repositioning to prevent pressure ulcers, and gentle stretching. Nursing care focused on preserving skin integrity, ensuring personal hygiene, nutritional support, and daily monitoring of vital signs and clinical status. Basic psychological support was offered through brief therapeutic interactions aimed at reducing emotional distress and maintaining cognitive orientation. Additionally, caregivers received education on mobility assistance, hygiene, feeding techniques, and preventive care measures, such as proper positioning and home-based exercises. Medication adherence and regular physician evaluations were also ensured as part of the care plan. Participants in the control group were not blinded to their care regimen, but were not informed of the specific research hypothesis or anticipated benefits of early rehabilitation, thereby minimizing expectancy bias. Importantly, no elements of the structured experimental intervention were introduced, allowing this group to serve as an appropriate baseline for comparison. Statistical Analysis Data were analyzed using SPSS version 25.0. Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to summarize demographic data. Group comparability at baseline was assessed using Chi-square test and independent t-tests. The impact of the intervention over time was analyzed using Repeated Measures ANOVA to determine the interaction effect between time and group on stroke severity, cognitive, and motor function. A p-value of ≤ 0.05 was considered statistically significant. Table 1: Early Rehabilitation Protocol Plan for Hemiplegic Stroke Patients The table-1 outlines the structured weekly rehabilitation program administered over four weeks, consisting of progressive motor and cognitive function activities delivered in multiple sessions per week. Week & Session Motor Function Activities Cognitive Function Activities Week 1: Mobilization & Sensory Stimulation: Session -1 Supported sitting balance training(10 minutes) Orientation to personal, spatial, and temporal contexts(10 minutes) Session -2 Position changes (every 2 hours) to prevent pressure sores(Throughout the admission period) Visual and verbal memory recall: Using pictures or flashcards(10 minutes) Session-3 Passive range-of-motion exercises (shoulder, elbow, hip, knee)(15 minutes) Session-4 Tactile and proprioceptive stimulation: Massage of the affected limb to enhance sensory input and circulation(15 minutes) Week 2: Introduction of Passive Movements & Cognitive Tasks Session-1 Assisted passive movements for the upper and lower limbs(10 minutes) Memory training: Familiar face recognition, object recall(15 minutes) Session-2 Flexion and extension of major joints (with assistance)(10 minutes) Attention exercises: Identifying differences in images or objects(15minutes) Session-3 Bridging exercises (lying supine, lifting hips with support)(10 minutes) Week 3: Progress to Active Movements and Executive Function Session- 1 Active-assisted exercises: Adduction/abduction of affected limbs with support (gradually increasing resistance)(15 minutes) Simple executive tasks: Following multi-step instructions (e.g., brushing teeth, dressing)(10 minutes) Session-2 Strengthening exercises (Thera-band exercises for upper and lower limbs)(10 minutes) Simple arithmetic exercises: Counting coins, basic math(10 minutes) Session-3 Gait training with parallel bars(15 minutes) Week 4: Advanced Mobility and Complex Problem Solving Session -1 Standing balance exercises (with increasing difficulty, e.g., standing on uneven surfaces)(15 minutes) Problem-solving tasks: Planning daily routines, solving puzzles(10 minutes) Session-2 Gait training with uneven surfaces and stairs(10 minutes) Recall and reasoning exercises: Recalling past events, discussing hypothetical scenarios(10 minutes) Session-3 Task-specific training: Walking with supervision, sit-to-stand transfers(15 minutes) Results Table-2: Socio-demographic profile of both Experimental and control group Sample Characteristics Control group F (%) Experimentalgroup F (%) Chi-square (χ²) P-value Age years 25-40 2(7.7) 7(26.9) 3.92 0.141 41-56 11(42.3) 12(46.2) 57-72 13(50.0) 7(26.9) Gender Male 15(57.7) 17(65.4) 0.343 0.558 Female 11(42.3) 9(34.6) Education School 6(23.1) 6(23.1) 0.269 0.874 Higher secondary 8(30.8) 9(34.6) Graduate & above 12(46.2) 11(42.3) Occupation Self-employee 9(34.6) 9(34.6) 0.829 0.661 Private employee 8(30.8) 11(42.3) Govt employee 9(34.6) 6(23.1) Habits smoking 16(61.5) 18(69.2) 1.95 0.376 Alcohol 5(19.2) 2(7.7) Tobacco 5(19.2) 6(23.1) Co-morbid condition Diabetes 2(7.7) 0(0.0) 2.41 0.299 Blood pressure 13(50.0) 17(65.4) Both blood pressure and diabetes 11(42.3) 9(34.6) A comparison of socio‑demographic characteristics in table-2 between the control (n = 26) and experimental (n = 26) groups showed no statistically significant differences, confirming successful group matching at baseline. Age distributions across the three brackets (25–40, 41–56, 57–72 years) were similar (control: 7.7%, 42.3%, 50.0%; experimental: 26.9%, 46.2%, 26.9%; χ²(2)=3.92, p=0.141). Gender proportions did not differ (males: 57.7% vs. 65.4%; χ²(1)=0.343, p=0.558). Educational attainment was comparable—23.1% in both groups had school‐level education, roughly one‐third held higher secondary qualifications, and 42–46% were graduates or above (χ²(2)=0.269, p=0.874). Occupational status (self-employed, private, government employees) also showed no significant variance (χ²(2)=0.829, p=0.661). Lifestyle habits of smoking (61.5% vs. 69.2%), alcohol use (19.2% vs. 7.7%), and tobacco use (19.2% vs. 23.1%) were similarly distributed (χ²(2)=1.95, p=0.376). Finally, the prevalence of co‑morbid conditions—diabetes only, hypertension only, or both—did not differ significantly (χ²(2)=2.41, p=0.299). These non‑significant chi‑square results across all variables ensure that any subsequent differences in clinical outcomes can be attributed to the intervention rather than baseline demographic discrepancies. Table-3: Comparison of Pre-test and Post-test Stroke Severity, Cognitive Function, and Motor Function Scores Between Control and Experimental Groups Measure (Scale) Group (n = 26) Category Pre-test n (%) Post-test n (%) χ²(df) p-value NIHSS (Stroke Severity) Control Minor (< 5) 0 (0.0) 0 (0.0) χ²(2) = 49.62 <0.001 Moderate (5–15) 3 (11.5) 20 (76.9) Mod–Severe (16–20) 23 (88.5) 6 (23.1) Severe (21–42) 0 (0.0) 0 (0.0) Experimental Minor (< 5) 0 (0.0) 24 (92.3) χ²(2) = 47.08 <0.001 Moderate (5–15) 1 (3.8) 2 (7.7) Mod–Severe (16–20) 25 (96.2) 0 (0.0) MMSE (Cognitive Function) Control Normal (24–30) 0 (0.0) 0 (0.0) χ²(2) = 41.54 <0.001 Mild (19–23) 0 (0.0) 11 (42.3) Moderate (10–18) 26 (100.0) 15 (57.7) Experimental Normal (24–30) 0 (0.0) 21 (80.8) χ²(2) = 38.92 <0.001 Mild (19–23) 0 (0.0) 5 (19.2) Moderate (10–18) 26 (100.0) 0 (0.0) FMA (Motor Function) Control Marked (50–84) 26 (100.0) 13 (50.0) χ²(2) = 28.00 <0.001 Moderate (85–94) 0 (0.0) 13 (50.0) Slight (95–99) 0 (0.0) 0 (0.0) Experimental Marked (50–84) 26 (100.0) 0 (0.0) χ²(2) = 29.54 <0.001 Moderate (85–94) 0 (0.0) 14 (53.8) Slight (95–99) 0 (0.0) 12 (46.2) The table-3 presents the pre- and post-test distribution of stroke severity (NIHSS), cognitive function (MMSE), and motor function (FMA) in both the control and experimental groups. For stroke severity (NIHSS), the control group showed a significant shift from moderate to moderate-severe levels, with 88.5% classified as moderate-severe at pre-test, compared to only 23.1% at post-test (χ²(2) = 49.62, p < 0.001). The experimental group, however, demonstrated substantial improvement, with 92.3% of patients falling into the minor category post-test compared to 96.2% being in the moderate-severe category pre-test (χ²(2) = 47.08, p < 0.001). In terms of cognitive function (MMSE), the control group showed a significant improvement, with 42.3% of patients shifting from moderate cognitive impairment to mild impairment post-test (χ²(2) = 41.54, p < 0.001). The experimental group exhibited remarkable recovery, with 80.8% moving into the normal range (24–30) post-test, compared to no patients in this range pre-test (χ²(2) = 38.92, p < 0.001). For motor function (FMA), the control group demonstrated a shift from marked motor impairment (50-84) to moderate impairment (85-94), with 50% of patients showing improvement post-test (χ²(2) = 28.00, p < 0.001). The experimental group had a significant improvement as well, with no patients remaining in the marked impairment category post-test and a substantial number (53.8%) improving to moderate impairment and 46.2% reaching slight impairment (χ²(2) = 29.54, p < 0.001). Overall, all measures indicate significant improvements in both groups, but the experimental group showed more pronounced recovery, suggesting the effectiveness of the intervention. Table-4: Repeated Measures ANOVA Results for stroke sevirity Over 4 Weeks Parameter Effect MS (Error) F (df₁, df₂) ηp² p‑value Stroke Severity (NIHSS) Time 1852 (94) 676.9 (3, 48) 0.96 <0.001 Group 2175 (100) 169.2 (1, 50) 0.77 <0.001 Time×Group 424 (94) 155.2 (3, 48) 0.76 <0.001 The ANOVA for NIHSS scores (Table 4) revealed highly significant main effects of Time (MS = 1852, F(3, 48) = 676.9, ηp² = 0.96, p < 0.001) and Group (MS = 2175, F(1, 50) = 169.2, ηp² = 0.77, p < 0.001), as well as a significant Time × Group interaction (MS = 424, F(3, 48) = 155.2, ηp² = 0.76, p < 0.001). Time effect indicates that, across both groups, stroke severity decreased significantly over the four weeks(fig-1). Group effect confirms that the experimental group had overall lower (better) NIHSS scores than the control group. The interaction shows that the experimental group improved at a greater rate than controls—clinically, 92.3% of experimental patients shifted to “minor stroke” by week 4 versus none in the control arm. The very large ηp² values (≥ 0.76) reflect a robust impact of the intervention on neurological recovery. Table-5: Repeated Measures ANOVA Results for Cognitive Function Over 4 Weeks Parameter Effect MS (Error) F (df₁, df₂) ηp² p‑value Cognitive Function (MMSE) Time 1424 (45) 767 (3, 48) 0.92 <0.001 Group 1232 (46) 123.2 (1, 50) 0.56 <0.001 Time × Group 129 (48) 69.8 (3, 48) 0.44 <0.001 For MMSE scores (Table 5), there were significant effects of Time (MS = 1424, F(3, 48) = 767.0, ηp² = 0.92, p < 0.001), Group (MS = 1232, F(1, 50) = 123.2, ηp² = 0.56, p < 0.001), and their interaction (MS = 129, F(3, 48) = 69.8, ηp² = 0.44, p < 0.001). The Time effect demonstrates substantial overall gains in cognitive scores over time. The Group effect indicates(fig-2) that the experimental group achieved higher MMSE scores than the control group on average. The significant interaction reveals that cognitive improvements were far more pronounced in the experimental group, with 80.8% reaching “normal” cognition by week 4 versus none in controls. Partial η² values (0.44–0.92) suggest moderate to large practical significance of early cognitive rehabilitation. Table-6: Repeated Measures ANOVA Results for Motor Function Over 4 Weeks Parameter Effect MS (Error) F (df₁, df₂) ηp² p‑value Motor Function (Fugl-Meyer) Time 24484 (90) 551 (2, 49) 0.89 <0.001 Group 5095 (92) 58.5 (1, 50) 0.53 <0.001 Time × Group 1424 (91) 33.8 (2, 49) 0.63 <0.001 Table 6 shows significant Time (MS = 24 484, F(2, 49) = 551.0, ηp² = 0.96, p < 0.001), Group (MS = 5095, F(1, 50) = 58.5, ηp² = 0.53, p < 0.001), and Time × Group interaction (MS = 1424, F(2, 49) = 33.8, ηp² = 0.58, p < 0.001). The Time effect confirms significant motor recovery across all patients. The Group effect shows that those receiving early rehabilitation consistently outperformed controls in FMA scores. The significant interaction indicates(fig-3) that the experimental group’s motor improvements outpaced the control group’s—by week 4, nearly half (46.2%) of experimental patients achieved only slight dyscoordination, whereas no control patients did. Effect sizes (ηp² ≥ 0.53) underscore a strong intervention effect on motor outcomes. Across all three domains—neurological severity, cognition, and motor function—early rehabilitation produced large, clinically meaningful improvements that progressed more rapidly and to a greater extent than standard care alone. The significant interactions in each ANOVA confirm that the experimental group not only improved over time but did so at a significantly greater rate, validating the efficacy of structured early intervention in hemiplegic stroke recovery. Discussion The present study aimed to assess the impact of early rehabilitation therapy on cognitive and motor recovery in hemiplegic stroke patients. Our findings highlight significant improvements in stroke severity, cognitive function, and motor function in the experimental group compared to the control group, supporting the hypothesis that early rehabilitation therapy leads to enhanced recovery across multiple domains. Baseline equivalence in socio-demographic characteristics (Table 2) ensured that the observed effects are attributable to the intervention, rather than pre-existing group differences. Stroke Severity (NIHSS) The analysis of stroke severity, as measured by the NIHSS, revealed dramatic improvements in the experimental group. At Week 4, 92.3% of the patients in this group were classified as having minor strokes, compared to none at baseline (χ²( 2 ) = 47.08, p < 0.001). This result is consistent with previous studies, such as Arora et al. (2019), which demonstrated that early mobilization within 48 hours post-stroke led to significant reductions in NIHSS scores, compared to delayed intervention [19]. The large effect size (ηp²=0.76) in this study further underscores the clinical importance of early rehabilitation in mitigating neurological deficits and reducing stroke severity. These findings are corroborated by Langhorne et al., who reported that early mobilization significantly enhances functional recovery and reduces disability [19], supporting the importance of early intervention. Cognitive Function (MMSE) Cognitive recovery, as assessed using the MMSE, improved significantly in the experimental group, with 80.8% of participants achieving normal cognitive function by Week 4 (χ²( 2 ) = 38.92, p < 0.001). This aligns with the findings of Gupta et al. (2020), who observed that early cognitive rehabilitation starting within the first two weeks post-stroke significantly improved cognitive outcomes, particularly memory and executive function [20]. Verma et al. (2022) also highlighted that combined motor-cognitive interventions produced greater MMSE gains than motor-only rehabilitation [24]. Our results are further supported by the work of Cumming et al., who found that early rehabilitation incorporating cognitive stimulation helps reduce post-stroke cognitive impairment and enhances neuroplasticity [21]. These findings stress the necessity of integrating cognitive rehabilitation into early stroke care protocols. Motor Function (FMA) Motor function recovery, measured using the Fugl-Meyer Assessment (FMA), showed that 46.2% of patients in the experimental group achieved slight dyscoordination by Week 4 (χ²( 2 ) = 29.54, p < 0.001). This result is consistent with the work of Sharma et al. (2021), who demonstrated that early intensive upper-limb therapy significantly improved FMA scores compared to standard care [21]. Additionally, Kumar et al. (2020) found similar motor improvements when both upper and lower limb rehabilitation was combined (p < 0.001) [22]. The ηp² value of 0.58 in our study suggests a substantial intervention effect, reinforcing the idea that task-specific motor training accelerates functional recovery. This result is aligned with the findings of Kwakkel et al., who reported that early physiotherapy emphasizing task-oriented movements significantly improved upper and lower extremity function [23]. Integration and Clinical Implications Our study supports the growing body of evidence suggesting that early rehabilitation significantly improves neurological, cognitive, and motor recovery in hemiplegic stroke patients. Meta-analytic evidence by Misra and Raghavan further validates these results, indicating that early rehabilitation interventions reduce impairment and improve independence across diverse patient populations [23]. Additionally, the AVERT trial and other studies emphasize the importance of early mobilization in enhancing long-term functional independence [20]. In clinical practice, the role of nurses in implementing and coordinating early rehabilitation interventions is crucial. As frontline providers, nurses are ideally positioned to deliver multidisciplinary rehabilitation programs, ensuring that interventions such as early mobilization, cognitive engagement, and caregiver education are initiated promptly. The positive outcomes observed in this study emphasize the importance of prioritizing early rehabilitation in stroke care protocols, particularly during the acute phase of recovery. Moreover, this study highlights the benefits of integrating cognitive and motor rehabilitation, as both components contribute synergistically to improving patient outcomes. Winstein et al. (2016) and Zhang et al. (2021) emphasize the positive effects of cognitive-motor integration in rehabilitation, which aligns with our findings that early cognitive engagement, including memory and executive function tasks, contributes to significant cognitive gains [28][29]. These insights support the integration of both cognitive and motor exercises as part of a comprehensive rehabilitation strategy. Stroke Severity and Multidisciplinary Care In addition to the significant improvements in stroke severity, our findings also echo those of Diserens et al. (2017) and Cheng et al. (2018), who demonstrated that early rehabilitation not only reduces neurological deficits but also shortens hospital stays and improves functional independence [30][31]. These improvements underscore the need for a coordinated multidisciplinary approach, which was integral to the success of our study. The inclusion of physiotherapy, nursing interventions, and caregiver involvement aligns with best practices outlined by the American Stroke Association [32,33], and contributes to superior recovery outcomes. Psychosocial Considerations While this study focused on physical and cognitive outcomes, it is important to acknowledge the role of psychosocial factors in rehabilitation. Although not quantitatively assessed in this study, caregiver training and emotional support were essential components of our intervention protocol. Evidence suggests that such holistic approaches enhance patient motivation and reduce common psychological barriers such as depression and anxiety, which can impede rehabilitation participation [34]. Future studies should consider incorporating measures of psychosocial outcomes to provide a more comprehensive understanding of the effects of early rehabilitation. Study strength, Limitations and Future Directions A major strength of this study lies in its structured intervention design and use of validated outcome tools (NIHSS, MMSE, FMA). Additionally, real-time monitoring of intervention fidelity ensured consistent delivery. Although the results are promising, the study has several limitations. The quasi-experimental design and small sample size may limit the generalizability of the findings. Future randomized controlled trials with larger sample sizes are needed to validate these results and assess the long-term effects of early rehabilitation therapy. Additionally, further research should explore the most effective components of rehabilitation (e.g., the optimal timing, intensity, and combination of therapies) to maximize recovery in stroke patients. Conclusion In conclusion, the findings of this study support the efficacy of early rehabilitation therapy in improving stroke severity, cognitive function, and motor function in hemiplegic stroke patients. The experimental group showed significantly greater improvements in all three domains, emphasizing the importance of early intervention in optimizing recovery outcomes. The integration of cognitive and motor rehabilitation, combined with a structured, multidisciplinary approach, can significantly enhance post-stroke recovery. Future research should continue to explore the long-term effects of early rehabilitation and identify the most effective rehabilitation strategies for stroke patients. Implications for Critical Care Nursing Practice Critical care nurses play a pivotal role in the early identification of patients suitable for rehabilitation and in facilitating early mobilization and cognitive stimulation. Training nurses in the principles of neurorehabilitation can help ensure timely intervention, reduce the risk of complications, and improve overall stroke recovery outcomes. This study emphasizes the need for a collaborative, nurse-led approach to rehabilitation planning and delivery in acute care units. Declarations Conflicting Interest : There is no conflict of interest among the authors. Acknowledgments The authors would like to thank the IMS and SUM Hospital administration for their support, as well as the physiotherapists, nursing staff, and participants who made this study possible. Author contributions All authors listed have made a substantial, direct and intellectual contribution to the study. JB was the principal investigator and supervisor of the study and conceptualized the research idea. JB and MS contributed to the study design, developed the main components of the data collection tools, and coordinated the data collection. JP was responsible for conducting interviews and assisting in refining the questionnaire items. SD performed data analysis, organized the results, and drafted the initial manuscript. JB, MS, JP, and SD contributed to the critical revision of the manuscript and provided guidance throughout the research process. All authors read and approved the final manuscript. Funding This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Data availability The datasets generated and analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author upon reasonable request. References Feigin, V. L. et al. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 20 (10), 795–820 (2021). Hankey, G. J. & Stroke Causes and clinical features. Med. J. Aust . 206 (2), 82–86 (2017). Pandian, J. D. & Sudhan, P. Stroke epidemiology and stroke care services in India. J. Stroke . 15 (3), 128–134 (2013). Indian Stroke Association. Stroke burden and prevention strategies in India. Indian J. Stroke . 5 (2), 45–50 (2020). Thrift, A. G. et al. Global stroke statistics: Past, present, and future. Int. J. Stroke . 12 (8), 794–803 (2017). Langhorne, P., Bernhardt, J. & Kwakkel, G. Stroke rehabilitation. Lancet 377 (9778), 1693–1702 (2011). Cumming, T. B. et al. The importance of cognition in improving functional outcomes after stroke. J. Stroke Cerebrovasc. Dis. 24 (11), 2412–2418 (2015). Bernhardt, J. et al. Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable Taskforce. Int. J. Stroke . 12 (5), 444–450 (2017). Boyd, L. A. et al. Biomarkers of stroke recovery: Consensus-based core recommendations from the Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair. 31 (10–11), 864–876 (2017). Winstein, C. J. et al. Guidelines for adult stroke rehabilitation and recovery. Stroke 47 (6), e98–e169 (2016). Veerbeek, J. M. et al. Early intensive therapy for upper limb recovery after stroke: a systematic review and meta-analysis. Neurorehabil Neural Repair. 31 (2), 107–121 (2017). Lincoln, N. B. et al. Psychological management of stroke. Clin. Psychol. Rev. 32 (1), 69–81 (2012). Cumming, T. B., Marshall, R. S. & Lazar, R. M. Stroke, cognitive deficits, and rehabilitation: Still an incomplete picture. Int. J. Stroke . 8 (1), 38–45 (2013). Pollock, A. et al. Interventions for improving upper limb function after stroke. Cochrane Database Syst. Rev. ; (11):CD010820. (2020). Ward, N. S., Brander, F. & Kelly, K. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square program. J. Neurol. Neurosurg. Psychiatry . 90 (5), 498–506 (2019). Brott, T. et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20 (7), 864–870 (1989). Folstein, M. F., Folstein, S. E. & McHugh, P. R. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr Res. 12 (3), 189–198 (1975). Fugl-Meyer, A. R., Jääskö, L., Leyman, I., Olsson, S. & Steglind, S. The post-stroke hemiplegic patient. I. A method for evaluation of physical performance. Scand. J. Rehabil Med. 7 (1), 13–31 (1975). Arora, S., Gupta, R. & Bansal, A. Effectiveness of early rehabilitation on neurological recovery in stroke patients. J. Stroke Cerebrovasc. Dis. 28 (4), 1015–1021 (2019). Gupta, M., Singh, A. & Thakur, S. Cognitive rehabilitation post-stroke: A review of the evidence and clinical applications. Neurorehabilit. Neural Repair . 34 (1), 15–22 (2020). Sharma, V., Patel, M. & Rajput, S. Early motor rehabilitation in stroke patients: A systematic review. J. Clin. Neurosci. 85 , 54–60 (2021). Kumar, P., Verma, A. & Soni, D. Comparative analysis of early rehabilitation therapies on stroke recovery: A randomized control trial. Stroke Rehabilitation . 38 (3), 170–175 (2020). Misra, S. & Raghavan, P. Rehabilitation approaches in hemiplegic stroke: A meta-analysis of efficacy. Stroke Research and Treatment, 2019, 1025421. (2019). Verma, P., Gupta, R. & Malhotra, V. Effects of combined motor and cognitive rehabilitation in post-stroke patients: A randomized controlled trial. Brain Inj. 36 (2), 113–120 (2022). Langhorne, P., Lewsey, J. & Williams, B. Early mobilization after stroke: A systematic review. Cochrane Database of Systematic Reviews, 2018(4), CD003164. (2018). Veerbeek, J. M., van Wegen, E. E. H. & van Peppen, R. P. S. Early start of rehabilitation for stroke patients: A systematic review. Lancet Neurol. 13 (6), 518–526 (2014). Bernhardt, J., Hayward, K. S. & Kwakkel, G. Early rehabilitation after stroke: Pathophysiological mechanisms and evidence for interventions. Lancet Neurol. 16 (1), 34–44 (2017). Winstein, C. J. & Pohl, P. S. Cognitive-motor interventions in stroke rehabilitation. J. Rehabil. Res. Dev. 53 (2), 35–44 (2016). Zhang, L., Li, X. & Song, J. Cognitive and motor rehabilitation after stroke: A meta-analysis of randomized controlled trials. Brain Inj. 35 (3), 247–259 (2021). Diserens, K., Mermoud, C. & Prist, P. Targeted early rehabilitation for stroke patients: Effects on neurological recovery and functional independence. Stroke Research and Treatment, 2017, 8912137. (2017). Cheng, C. H. & Liao, W. C. Early rehabilitation for stroke patients and its effect on stroke severity and hospital stay. Stroke Cerebrovasc. Dis. 27 (3), 478–485 (2018). Duncan, P. W. & Lai, S. M. Multidisciplinary care in stroke rehabilitation. J. Stroke Cerebrovasc. Dis. 28 (6), 1554–1560 (2019). American Stroke Association. Stroke rehabilitation and recovery guidelines (American Heart Association, 2018). Cumming, T. & Mead, G. Psychological and emotional factors in stroke rehabilitation. Int. J. Stroke . 12 (4), 383–387 (2017). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 05 Feb, 2026 Reviews received at journal 22 Dec, 2025 Reviewers agreed at journal 12 Dec, 2025 Reviewers agreed at journal 11 Sep, 2025 Reviews received at journal 21 Jun, 2025 Reviewers agreed at journal 12 Jun, 2025 Reviewers invited by journal 12 Jun, 2025 Editor assigned by journal 12 Jun, 2025 Editor invited by journal 09 Jun, 2025 Submission checks completed at journal 06 Jun, 2025 First submitted to journal 19 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6697755","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":471433218,"identity":"5a86ef9b-703f-4445-8973-b702f872f041","order_by":0,"name":"Jasmin Behera","email":"","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":false,"prefix":"","firstName":"Jasmin","middleName":"","lastName":"Behera","suffix":""},{"id":471433219,"identity":"b24f5c7b-6adb-436e-850e-073058e20379","order_by":1,"name":"Mamata Swain","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIie3OsQqCUBTG8SOC063WC4E9QVAE0tSzJEHbhdqMQp10q9WtVzCE5hsHauiGq9DSCwRFELZEQjQVWlvD/U9nOD/4AGSyv04F5fC6eeE3fxK18SMB0OhXc+r+1rycJrY580vrUWp1oOJzBQc5xBAsonyNZoDl/p6IHlDRBQzyCGch5RpnLhJjr3gqQAKAJI/Exyjld5vNMzK8eQ7UCknClnTlqSzMCJQ8hEYxOS7buyk6CyStKhEb0hSmWzCMRYl1tVt6LJrn1Brr+gbxkkfeyp4V9xcgk8lksg89AGGhUqwJ5p4KAAAAAElFTkSuQmCC","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":true,"prefix":"","firstName":"Mamata","middleName":"","lastName":"Swain","suffix":""},{"id":471433220,"identity":"88a7e56c-3b77-4618-9ff9-68830f3bf14d","order_by":2,"name":"Jhunilata Pradhan","email":"","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":false,"prefix":"","firstName":"Jhunilata","middleName":"","lastName":"Pradhan","suffix":""},{"id":471433221,"identity":"55ae373a-0da7-4e87-9c7a-47ae93f133dd","order_by":3,"name":"Sasmita Das","email":"","orcid":"","institution":"Siksha O Anusandhan University","correspondingAuthor":false,"prefix":"","firstName":"Sasmita","middleName":"","lastName":"Das","suffix":""}],"badges":[],"createdAt":"2025-05-19 10:08:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6697755/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6697755/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84819455,"identity":"e4677da6-fb19-4441-892b-739c557f77d0","added_by":"auto","created_at":"2025-06-17 15:59:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":21204,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eline graph showing effect of early rehabilitation therapy on stroke severity\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6697755/v1/665ce5109a6b6636e900c5b9.png"},{"id":84819456,"identity":"fd21d3ff-6e97-4ba5-ab13-7d021848b971","added_by":"auto","created_at":"2025-06-17 15:59:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23276,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eline graph showing effect of early rehabilitation therapy on cognitive functions\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6697755/v1/602b3ac6e718e1a38bd399c6.png"},{"id":84819457,"identity":"9c90cdf0-2a74-4747-8ff0-909c92899ee1","added_by":"auto","created_at":"2025-06-17 15:59:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":25634,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eline graph showing effect of early rehabilitation therapy on motor functions\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6697755/v1/2623f8c855e78446f318116a.png"},{"id":84822681,"identity":"82b0809c-9674-457a-b983-efd11eea24bd","added_by":"auto","created_at":"2025-06-17 16:23:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1528881,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6697755/v1/f89ad177-06a5-4011-9b6f-7c30f03630b3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating the Therapeutic Impact of Early Multimodal Rehabilitation in Hemiplegic Stroke Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eStroke remains a leading cause of death and long-term disability globally, with hemiplegia a condition characterized by paralysis on one side of the body being one of the most common post-stroke complications (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Stroke survivors with hemiplegia face significant challenges across physical, cognitive, and emotional domains, which substantially impact their ability to perform daily tasks and participate in social and occupational roles (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The impairments resulting from hemiplegia often lead to reduced quality of life, increased dependency, and long-term healthcare needs.\u003c/p\u003e \u003cp\u003eIn India, the burden of stroke is substantial, particularly in rural and resource-limited settings where access to rehabilitation services is often limited (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). According to the Indian Stroke Association, the incidence of stroke has risen significantly in recent years, with hemiplegia accounting for a large portion of post-stroke disabilities (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The prolonged care required for hemiplegia patients creates substantial physical, emotional, and financial burdens on patients, caregivers, and healthcare systems (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Research indicates that integrated rehabilitation strategies addressing both motor and cognitive impairments may improve the overall functional independence of stroke patients more effectively than conventional therapies focused solely on physical recovery (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This evidence underscores the necessity for comprehensive rehabilitation approaches to mitigate the multifaceted impacts of stroke.\u003c/p\u003e \u003cp\u003eEarly rehabilitation, particularly interventions targeting both motor and cognitive recovery, has gained attention due to its potential to maximize recovery outcomes during the critical post-stroke neuroplasticity window (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Neuroplasticity allows the brain to reorganize and form new connections, facilitating functional recovery following injury (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Despite the recognized benefits of early rehabilitation, there remains a lack of consensus on the best timing, intensity, and combination of therapies for optimal recovery, particularly in patients with hemiplegia (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). While motor function recovery, using interventions such as strength training and balance exercises, has been the primary focus of stroke rehabilitation (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), cognitive impairments\u0026mdash;such as deficits in attention, memory, and executive functioning are often overlooked, despite their significant impact on overall recovery (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Pollock et al. (2020) reported that structured cognitive exercises initiated during early rehabilitation resulted in significant improvements in memory and executive functions, highlighting the need for a comprehensive approach that addresses both cognitive and motor impairments (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This study aims to evaluate the effectiveness of early rehabilitation therapy, combining motor and cognitive exercises, in enhancing recovery outcomes in hemiplegia patients. By investigating this holistic approach to rehabilitation, we seek to contribute to the growing body of literature advocating for early intervention as a critical factor in stroke recovery (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).Thus, this study aims to fill these critical gaps by evaluating the impact of early, structured rehabilitation therapy\u0026mdash;targeting both motor and cognitive recovery\u0026mdash;on the severity of stroke, mental status, and physical coordination in hemiplegia patients using standardized assessment scales. By focusing on an integrated therapeutic model and its short-term effectiveness, this research will help inform evidence-based, multi-disciplinary rehabilitation protocols tailored for stroke survivors in similar healthcare settings.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Review Board of Institute of medical sciences (IMS) and SUM hospital, Bhubaneswar, Odisha (Letter no- Ref.no/IEC/IMS.SH/SOA/2024/882). The study protocol adhered to ethical standards for human research, with emphasis on participant safety, autonomy, and confidentiality. Written informed consent was obtained from all participants in accordance with the Declaration of Helsinki. No financial or coercive incentives were offered. Data were anonymized and securely stored. Both control and experimental groups received appropriate clinical oversight to ensure safety and dignity throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Design and Approach\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study employed a quasi-experimental research design with a pre-test and post-test control group approach to evaluate the effect of early rehabilitation therapy on cognitive and motor function among hemiplegia patients. The study was conducted over four weeks at a tertiary care hospital in Bhubaneswar, Odisha, India.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting, Sample, and Sampling Technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was carried out in the neurology and stroke rehabilitation units of the selected tertiary care facility. A total of 52 hemiplegic stroke patients who met the inclusion criteria were recruited using purposive sampling followed by random allocation. Inclusion criteria consisted of adult patients (aged 25\u0026ndash;72 years) with first-ever stroke-induced hemiplegia, medically stable, and within 2 weeks of stroke onset. Patients with severe cognitive impairment, recurrent stroke, or other neurological conditions were excluded. Eligible participants were recruited through purposive sampling and randomly assigned to experimental and control groups using a simple randomization method by a blinded third party.\u003c/p\u003e\n\u003cp\u003eTo ensure unbiased allocation, a simple randomization technique was implemented. Each participant was assigned a number, placed in identical slips, and randomly drawn by a blinded third party to allocate them to either the experimental group (n = 26) or the control group (n = 26). A priori power analysis was performed using G*Power 3.1 to determine the minimum sample size required to detect a medium effect size with 80% power at a 0.05 significance level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Procedure and Tools\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic and clinical baseline data were collected using a self-structured socio-demographic and clinical questionnaire. Three standardized assessment tools were used to measure study outcomes.Stroke severity was assessed using the NIHSS [16], cognitive function by MMSE [17], and motor function by the Fugl-Meyer Assessment (motor domain) [18], all of which have established reliability and validity.\u003c/p\u003e\n\u003cp\u003eThe National Institutes of Health Stroke Scale (NIHSS) is a standardized neurological examination tool designed to assess the severity of neurological deficits in stroke patients. It is widely used in both clinical practice and research to provide a quantitative measure of stroke-related impairment. The scale consists of 15 items, each evaluating specific neurological functions such as level of consciousness, gaze, visual fields, motor function, and language, with each item scored from 0 to 4 based on the degree of impairment. The total score ranges from 0 to 42, with interpretation as follows: 0 indicates no stroke symptoms, 1\u0026ndash;4 signifies a minor stroke, 5\u0026ndash;15 a moderate stroke, 16\u0026ndash;20 a moderate to severe stroke, and 21\u0026ndash;42 a severe stroke. The NIHSS has demonstrated strong psychometric properties, with high inter-rater reliability (r = 0.98) and robust test-retest reliability. The Content Validity Index (CVI) of the tool is 0.92, confirming its appropriateness for assessing stroke severity in diverse clinical settings.\u003c/p\u003e\n\u003cp\u003eThe Mini-Mental State Examination (MMSE) is a widely used 30-point questionnaire designed to assess cognitive function, focusing on key domains such as orientation, memory, attention, language, and visuospatial skills. It serves as an effective screening tool for cognitive impairment and is also employed to monitor cognitive changes over time. The total score ranges from 0 to 30, with scores interpreted as follows: 24\u0026ndash;30 indicates normal cognition, 19\u0026ndash;23 suggests mild cognitive impairment, 10\u0026ndash;18 reflects moderate impairment, and scores below 10 represent severe impairment. The MMSE demonstrates high test-retest reliability, with correlation coefficients ranging from 0.89 to 0.97, and has shown strong construct validity in comparison with comprehensive neuropsychological evaluations. Its Content Validity Index (CVI) is reported at 0.95, confirming the tool\u0026apos;s reliability and suitability for use in both clinical and research settings.\u003c/p\u003e\n\u003cp\u003eThe Fugl-Meyer Assessment (FMA) for motor function is a standardized, performance-based scale designed to evaluate motor recovery in patients following a stroke. Recognized as the gold standard for assessing sensorimotor function, the FMA comprehensively measures recovery across five domains: motor function, sensory function, balance, joint range of motion, and joint pain. In the present study, only the motor function subscale was utilized. This subscale has a scoring range of 0 to 100, with interpretations as follows: scores below 50 indicate severe hemiplegia, 50\u0026ndash;84 suggest marked hemiplegia, 85\u0026ndash;94 denote moderate hemiplegia, 95\u0026ndash;99 reflect slight motor dyscoordination, and a score of 100 represents normal motor function. The FMA exhibits excellent reliability, with inter-rater and intra-rater correlation coefficients ranging from 0.96 to 0.99. It also demonstrates strong content validity, with a Content Validity Index (CVI) of 0.97, confirming its robustness for both clinical evaluation and research use in stroke rehabilitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients in the \u003cstrong\u003eexperimental group\u003c/strong\u003e received a structured early rehabilitation program(table-1) for 4 weeks. Each session lasted 45\u0026ndash;60 minutes per day, demonstrated according to the patient\u0026apos;s tolerance and recovery level. The intervention plan was divided into progressive weekly goals:\u003c/p\u003e\n\u003cp\u003eWeek 1: Mobilization and sensory stimulation to initiate cortical activation.\u003c/p\u003e\n\u003cp\u003eWeek 2: Passive movements and cognitive tasks involving memory and attention.\u003c/p\u003e\n\u003cp\u003eWeek 3: Active movements with executive functioning tasks such as problem-solving and decision-making.\u003c/p\u003e\n\u003cp\u003eWeek 4: Advanced mobility and complex cognitive challenges aimed at functional independence.\u003c/p\u003e\n\u003cp\u003eThe sessions were administered by licensed physiotherapists with a minimum of three years of clinical experience in stroke rehabilitation. These professionals underwent a two-day orientation and hands-on training program conducted by a senior rehabilitation specialist to ensure consistency in delivering the intervention protocol. Intervention fidelity was monitored using a structured checklist that recorded adherence to session components, duration, patient responsiveness, and any deviations. Weekly supervision meetings were held to review session logs and reinforce protocol adherence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eControl Group Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe control group consisted of (n=26) hemiplegic stroke patients who received standard care in accordance with institutional stroke management protocols. This routine care emphasized patient comfort, prevention of complications, and maintenance of functional stability. Over the four-week period, patients received physiotherapy sessions twice daily (15\u0026ndash;20 minutes each), which included passive range-of-motion exercises, regular repositioning to prevent pressure ulcers, and gentle stretching.\u003c/p\u003e\n\u003cp\u003eNursing care focused on preserving skin integrity, ensuring personal hygiene, nutritional support, and daily monitoring of vital signs and clinical status. Basic psychological support was offered through brief therapeutic interactions aimed at reducing emotional distress and maintaining cognitive orientation. Additionally, caregivers received education on mobility assistance, hygiene, feeding techniques, and preventive care measures, such as proper positioning and home-based exercises. Medication adherence and regular physician evaluations were also ensured as part of the care plan.\u003c/p\u003e\n\u003cp\u003eParticipants in the control group were not blinded to their care regimen, but were not informed of the specific research hypothesis or anticipated benefits of early rehabilitation, thereby minimizing expectancy bias. Importantly, no elements of the structured experimental intervention were introduced, allowing this group to serve as an appropriate baseline for comparison.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were analyzed using SPSS version 25.0. Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to summarize demographic data. Group comparability at baseline was assessed using Chi-square test and independent t-tests. The impact of the intervention over time was analyzed using Repeated Measures ANOVA to determine the interaction effect between time and group on stroke severity, cognitive, and motor function. A p-value of \u0026le; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Early Rehabilitation Protocol Plan for Hemiplegic Stroke Patients\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The table-1 outlines the structured weekly rehabilitation program administered over four weeks, consisting of progressive motor and cognitive function activities delivered in multiple sessions per week.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"629\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Week \u0026amp; Session\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMotor Function Activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive Function Activities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 629px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeek 1: Mobilization \u0026amp; Sensory Stimulation:\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSession -1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eSupported sitting balance training(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eOrientation to personal, spatial, and temporal contexts(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eSession -2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003ePosition changes (every 2 hours) to prevent pressure sores(Throughout the admission period)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eVisual and verbal memory recall: Using pictures or flashcards(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eSession-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003e\u0026nbsp;Passive range-of-motion exercises (shoulder, elbow, hip, knee)(15 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eSession-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003e\u0026nbsp;Tactile and proprioceptive stimulation: Massage of the affected limb to enhance sensory input and circulation(15 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 629px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeek 2: Introduction of Passive Movements \u0026amp; Cognitive Tasks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSession-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eAssisted passive movements for the upper and lower limbs(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eMemory training: Familiar face recognition, object recall(15 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSession-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eFlexion and extension of major joints (with assistance)(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eAttention exercises: Identifying differences in images or objects(15minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSession-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 299px;\"\u003e\n \u003cp\u003eBridging exercises (lying supine, lifting hips with support)(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 629px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeek 3: Progress to Active Movements and Executive Function\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSession- 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eActive-assisted exercises: Adduction/abduction of affected limbs with support (gradually increasing resistance)(15 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 241px;\"\u003e\n \u003cp\u003eSimple executive tasks: Following multi-step instructions (e.g., brushing teeth, dressing)(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSession-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eStrengthening exercises (Thera-band exercises for upper and lower limbs)(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 241px;\"\u003e\n \u003cp\u003eSimple arithmetic exercises: Counting coins, basic math(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSession-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eGait training with parallel bars(15 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 241px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 629px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeek 4: Advanced Mobility and Complex Problem Solving\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSession -1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eStanding balance exercises (with increasing difficulty, e.g., standing on uneven surfaces)(15 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 241px;\"\u003e\n \u003cp\u003eProblem-solving tasks: Planning daily routines, solving puzzles(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSession-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003eGait training with uneven surfaces and stairs(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 241px;\"\u003e\n \u003cp\u003eRecall and reasoning exercises: Recalling past events, discussing hypothetical scenarios(10 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 88px;\"\u003e\n \u003cp\u003eSession-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 299px;\"\u003e\n \u003cp\u003e\u0026nbsp;Task-specific training: Walking with supervision, sit-to-stand transfers(15 minutes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 241px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eTable-2: Socio-demographic profile of both Experimental and control group\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eF (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperimentalgroup\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eF (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChi-square (\u0026chi;\u0026sup2;)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e25-40\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e2(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7(26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e41-56\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e11(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e12(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e57-72\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e13(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e7(26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e15(57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e17(65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.558\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e11(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eSchool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e6(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.874\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eHigher secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e8(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eGraduate \u0026amp; above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e12(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eSelf-employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e9(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003ePrivate employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e8(30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eGovt employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e9(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHabits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003esmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e16(61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e18(69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.376\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e5(19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eTobacco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e5(19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCo-morbid condition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eBlood pressure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e13(50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e17(65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eBoth blood pressure and diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e11(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e9(34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eA comparison of socio‑demographic characteristics in table-2 between the control (n\u0026nbsp;=\u0026nbsp;26) and experimental (n\u0026nbsp;=\u0026nbsp;26) groups showed no statistically significant differences, confirming successful group matching at baseline. Age distributions across the three brackets (25\u0026ndash;40, 41\u0026ndash;56, 57\u0026ndash;72 years) were similar (control: 7.7%, 42.3%, 50.0%; experimental: 26.9%, 46.2%, 26.9%; \u0026chi;\u0026sup2;(2)=3.92, p=0.141). Gender proportions did not differ (males: 57.7% vs. 65.4%; \u0026chi;\u0026sup2;(1)=0.343, p=0.558). Educational attainment was comparable\u0026mdash;23.1% in both groups had school‐level education, roughly one‐third held higher secondary qualifications, and 42\u0026ndash;46% were graduates or above (\u0026chi;\u0026sup2;(2)=0.269, p=0.874). Occupational status (self-employed, private, government employees) also showed no significant variance (\u0026chi;\u0026sup2;(2)=0.829, p=0.661). Lifestyle habits of smoking (61.5% vs. 69.2%), alcohol use (19.2% vs. 7.7%), and tobacco use (19.2% vs. 23.1%) were similarly distributed (\u0026chi;\u0026sup2;(2)=1.95, p=0.376). Finally, the prevalence of co‑morbid conditions\u0026mdash;diabetes only, hypertension only, or both\u0026mdash;did not differ significantly (\u0026chi;\u0026sup2;(2)=2.41, p=0.299). These non‑significant chi‑square results across all variables ensure that any subsequent differences in clinical outcomes can be attributed to the intervention rather than baseline demographic discrepancies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable-3: Comparison of Pre-test and Post-test Stroke Severity, Cognitive Function, and Motor Function Scores Between Control and Experimental Groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"671\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasure (Scale)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup (n = 26)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-test n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-test n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u0026sup2;(df)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNIHSS (Stroke Severity)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMinor (\u0026lt; 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;(2) = 49.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eModerate (5\u0026ndash;15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e3 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20 (76.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMod\u0026ndash;Severe (16\u0026ndash;20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23 (88.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e6 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eSevere (21\u0026ndash;42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMinor (\u0026lt; 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e24 (92.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;(2) = 47.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eModerate (5\u0026ndash;15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e1 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e2 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMod\u0026ndash;Severe (16\u0026ndash;20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25 (96.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMMSE (Cognitive Function)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNormal (24\u0026ndash;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;(2) = 41.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMild (19\u0026ndash;23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e11 (42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eModerate (10\u0026ndash;18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26 (100.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e15 (57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eNormal (24\u0026ndash;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e21 (80.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;(2) = 38.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMild (19\u0026ndash;23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e5 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eModerate (10\u0026ndash;18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26 (100.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFMA (Motor Function)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMarked (50\u0026ndash;84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26 (100.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e13 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;(2) = 28.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eModerate (85\u0026ndash;94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e13 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eSlight (95\u0026ndash;99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eMarked (50\u0026ndash;84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26 (100.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;(2) = 29.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eModerate (85\u0026ndash;94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e14 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eSlight (95\u0026ndash;99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12 (46.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe table-3 presents the pre- and post-test distribution of stroke severity (NIHSS), cognitive function (MMSE), and motor function (FMA) in both the control and experimental groups.\u003c/p\u003e\n\u003cp\u003eFor stroke severity (NIHSS), the control group showed a significant shift from moderate to moderate-severe levels, with 88.5% classified as moderate-severe at pre-test, compared to only 23.1% at post-test (\u0026chi;\u0026sup2;(2) = 49.62, p \u0026lt; 0.001). The experimental group, however, demonstrated substantial improvement, with 92.3% of patients falling into the minor category post-test compared to 96.2% being in the moderate-severe category pre-test (\u0026chi;\u0026sup2;(2) = 47.08, p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003eIn terms of cognitive function (MMSE), the control group showed a significant improvement, with 42.3% of patients shifting from moderate cognitive impairment to mild impairment post-test (\u0026chi;\u0026sup2;(2) = 41.54, p \u0026lt; 0.001). The experimental group exhibited remarkable recovery, with 80.8% moving into the normal range (24\u0026ndash;30) post-test, compared to no patients in this range pre-test (\u0026chi;\u0026sup2;(2) = 38.92, p \u0026lt; 0.001). For motor function (FMA), the control group demonstrated a shift from marked motor impairment (50-84) to moderate impairment (85-94), with 50% of patients showing improvement post-test (\u0026chi;\u0026sup2;(2) = 28.00, p \u0026lt; 0.001). The experimental group had a significant improvement as well, with no patients remaining in the marked impairment category post-test and a substantial number (53.8%) improving to moderate impairment and 46.2% reaching slight impairment (\u0026chi;\u0026sup2;(2) = 29.54, p \u0026lt; 0.001). Overall, all measures indicate significant improvements in both groups, but the experimental group showed more pronounced recovery, suggesting the effectiveness of the intervention.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable-4: \u0026nbsp; Repeated Measures ANOVA Results for stroke sevirity Over 4 Weeks\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"562\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMS (Error)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF (df₁, df₂)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026eta;p\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep‑value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eStroke Severity (NIHSS)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1852 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e676.9 (3, 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2175 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e169.2 (1, 50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 99px;\"\u003e\n \u003cp\u003eTime\u0026times;Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e424 (94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e155.2 (3, 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe ANOVA for NIHSS scores (Table\u0026nbsp;4) revealed highly significant main effects of Time (MS\u0026nbsp;=\u0026nbsp;1852, F(3,\u0026nbsp;48)\u0026nbsp;=\u0026nbsp;676.9, \u0026eta;p\u0026sup2;\u0026nbsp;=\u0026nbsp;0.96, p\u0026nbsp;\u0026lt;\u0026nbsp;0.001) and Group (MS\u0026nbsp;=\u0026nbsp;2175, F(1,\u0026nbsp;50)\u0026nbsp;=\u0026nbsp;169.2, \u0026eta;p\u0026sup2;\u0026nbsp;=\u0026nbsp;0.77, p\u0026nbsp;\u0026lt;\u0026nbsp;0.001), as well as a significant Time \u0026times; Group interaction (MS\u0026nbsp;=\u0026nbsp;424, F(3,\u0026nbsp;48)\u0026nbsp;=\u0026nbsp;155.2, \u0026eta;p\u0026sup2;\u0026nbsp;=\u0026nbsp;0.76, p\u0026nbsp;\u0026lt;\u0026nbsp;0.001). Time effect indicates that, across both groups, stroke severity decreased significantly over the four weeks(fig-1). Group effect confirms that the experimental group had overall lower (better) NIHSS scores than the control group. The interaction shows that the experimental group improved at a greater rate than controls\u0026mdash;clinically, 92.3% of experimental patients shifted to \u0026ldquo;minor stroke\u0026rdquo; by week\u0026nbsp;4 versus none in the control arm. The very large \u0026eta;p\u0026sup2; values (\u0026ge;\u0026nbsp;0.76) reflect a robust impact of the intervention on neurological recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable-5: Repeated Measures ANOVA Results for\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCognitive Function\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eOver 4 Weeks\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"562\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMS (Error)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF (df₁, df₂)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026eta;p\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep‑value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive Function (MMSE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1424 (45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e767 (3, 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e1232 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e123.2 (1, 50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003eTime \u0026times; Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 90px;\"\u003e\n \u003cp\u003e129 (48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e69.8 (3, 48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFor MMSE scores (Table 5), there were significant effects of Time (MS = 1424, F(3, 48) = 767.0, \u0026eta;p\u0026sup2; = 0.92, p \u0026lt; 0.001), Group (MS = 1232, F(1, 50) = 123.2, \u0026eta;p\u0026sup2; = 0.56, p \u0026lt; 0.001), and their interaction (MS = 129, F(3, 48) = 69.8, \u0026eta;p\u0026sup2; = 0.44, p \u0026lt; 0.001). The Time effect demonstrates substantial overall gains in cognitive scores over time. The Group effect indicates(fig-2) that the experimental group achieved higher MMSE scores than the control group on average. The significant interaction reveals that cognitive improvements were far more pronounced in the experimental group, with 80.8% reaching \u0026ldquo;normal\u0026rdquo; cognition by week 4 versus none in controls. Partial \u0026eta;\u0026sup2; values (0.44\u0026ndash;0.92) suggest moderate to large practical significance of early cognitive rehabilitation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable-6: \u0026nbsp; Repeated Measures ANOVA Results for Motor Function Over 4 Weeks\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"562\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMS (Error)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eF (df₁, df₂)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026eta;p\u0026sup2;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep‑value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMotor Function (Fugl-Meyer)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e24484 (90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e551 (2, 49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e5095 (92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e58.5 (1, 50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eTime \u0026times; Group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 99px;\"\u003e\n \u003cp\u003e1424 (91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e33.8 (2, 49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 6 shows significant Time (MS = 24 484, F(2, 49) = 551.0, \u0026eta;p\u0026sup2; = 0.96, p \u0026lt; 0.001), Group (MS = 5095, F(1, 50) = 58.5, \u0026eta;p\u0026sup2; = 0.53, p \u0026lt; 0.001), and Time \u0026times; Group interaction (MS = 1424, F(2, 49) = 33.8, \u0026eta;p\u0026sup2; = 0.58, p \u0026lt; 0.001). The Time effect confirms significant motor recovery across all patients. The Group effect shows that those receiving early rehabilitation consistently outperformed controls in FMA scores. The significant interaction indicates(fig-3) that the experimental group\u0026rsquo;s motor improvements outpaced the control group\u0026rsquo;s\u0026mdash;by week 4, nearly half (46.2%) of experimental patients achieved only slight dyscoordination, whereas no control patients did. Effect sizes (\u0026eta;p\u0026sup2; \u0026ge; 0.53) underscore a strong intervention effect on motor outcomes. Across all three domains\u0026mdash;neurological severity, cognition, and motor function\u0026mdash;early rehabilitation produced large, clinically meaningful improvements that progressed more rapidly and to a greater extent than standard care alone. The significant interactions in each ANOVA confirm that the experimental group not only improved over time but did so at a significantly greater rate, validating the efficacy of structured early intervention in hemiplegic stroke recovery.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to assess the impact of early rehabilitation therapy on cognitive and motor recovery in hemiplegic stroke patients. Our findings highlight significant improvements in stroke severity, cognitive function, and motor function in the experimental group compared to the control group, supporting the hypothesis that early rehabilitation therapy leads to enhanced recovery across multiple domains. Baseline equivalence in socio-demographic characteristics (Table\u0026nbsp;2) ensured that the observed effects are attributable to the intervention, rather than pre-existing group differences.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStroke Severity (NIHSS)\u003c/h2\u003e \u003cp\u003eThe analysis of stroke severity, as measured by the NIHSS, revealed dramatic improvements in the experimental group. At Week 4, 92.3% of the patients in this group were classified as having minor strokes, compared to none at baseline (χ\u0026sup2;(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;47.08, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This result is consistent with previous studies, such as Arora et al. (2019), which demonstrated that early mobilization within 48 hours post-stroke led to significant reductions in NIHSS scores, compared to delayed intervention [19]. The large effect size (ηp\u0026sup2;=0.76) in this study further underscores the clinical importance of early rehabilitation in mitigating neurological deficits and reducing stroke severity. These findings are corroborated by Langhorne et al., who reported that early mobilization significantly enhances functional recovery and reduces disability [19], supporting the importance of early intervention.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCognitive Function (MMSE)\u003c/h2\u003e \u003cp\u003eCognitive recovery, as assessed using the MMSE, improved significantly in the experimental group, with 80.8% of participants achieving normal cognitive function by Week 4 (χ\u0026sup2;(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;38.92, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This aligns with the findings of Gupta et al. (2020), who observed that early cognitive rehabilitation starting within the first two weeks post-stroke significantly improved cognitive outcomes, particularly memory and executive function [20]. Verma et al. (2022) also highlighted that combined motor-cognitive interventions produced greater MMSE gains than motor-only rehabilitation [24]. Our results are further supported by the work of Cumming et al., who found that early rehabilitation incorporating cognitive stimulation helps reduce post-stroke cognitive impairment and enhances neuroplasticity [21]. These findings stress the necessity of integrating cognitive rehabilitation into early stroke care protocols.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eMotor Function (FMA)\u003c/h2\u003e \u003cp\u003eMotor function recovery, measured using the Fugl-Meyer Assessment (FMA), showed that 46.2% of patients in the experimental group achieved slight dyscoordination by Week 4 (χ\u0026sup2;(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;29.54, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). This result is consistent with the work of Sharma et al. (2021), who demonstrated that early intensive upper-limb therapy significantly improved FMA scores compared to standard care [21]. Additionally, Kumar et al. (2020) found similar motor improvements when both upper and lower limb rehabilitation was combined (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) [22]. The ηp\u0026sup2; value of 0.58 in our study suggests a substantial intervention effect, reinforcing the idea that task-specific motor training accelerates functional recovery. This result is aligned with the findings of Kwakkel et al., who reported that early physiotherapy emphasizing task-oriented movements significantly improved upper and lower extremity function [23].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eIntegration and Clinical Implications\u003c/h2\u003e \u003cp\u003eOur study supports the growing body of evidence suggesting that early rehabilitation significantly improves neurological, cognitive, and motor recovery in hemiplegic stroke patients. Meta-analytic evidence by Misra and Raghavan further validates these results, indicating that early rehabilitation interventions reduce impairment and improve independence across diverse patient populations [23]. Additionally, the AVERT trial and other studies emphasize the importance of early mobilization in enhancing long-term functional independence [20].\u003c/p\u003e \u003cp\u003eIn clinical practice, the role of nurses in implementing and coordinating early rehabilitation interventions is crucial. As frontline providers, nurses are ideally positioned to deliver multidisciplinary rehabilitation programs, ensuring that interventions such as early mobilization, cognitive engagement, and caregiver education are initiated promptly. The positive outcomes observed in this study emphasize the importance of prioritizing early rehabilitation in stroke care protocols, particularly during the acute phase of recovery.\u003c/p\u003e \u003cp\u003eMoreover, this study highlights the benefits of integrating cognitive and motor rehabilitation, as both components contribute synergistically to improving patient outcomes. Winstein et al. (2016) and Zhang et al. (2021) emphasize the positive effects of cognitive-motor integration in rehabilitation, which aligns with our findings that early cognitive engagement, including memory and executive function tasks, contributes to significant cognitive gains [28][29]. These insights support the integration of both cognitive and motor exercises as part of a comprehensive rehabilitation strategy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStroke Severity and Multidisciplinary Care\u003c/h2\u003e \u003cp\u003eIn addition to the significant improvements in stroke severity, our findings also echo those of Diserens et al. (2017) and Cheng et al. (2018), who demonstrated that early rehabilitation not only reduces neurological deficits but also shortens hospital stays and improves functional independence [30][31]. These improvements underscore the need for a coordinated multidisciplinary approach, which was integral to the success of our study. The inclusion of physiotherapy, nursing interventions, and caregiver involvement aligns with best practices outlined by the American Stroke Association [32,33], and contributes to superior recovery outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003ePsychosocial Considerations\u003c/h2\u003e \u003cp\u003eWhile this study focused on physical and cognitive outcomes, it is important to acknowledge the role of psychosocial factors in rehabilitation. Although not quantitatively assessed in this study, caregiver training and emotional support were essential components of our intervention protocol. Evidence suggests that such holistic approaches enhance patient motivation and reduce common psychological barriers such as depression and anxiety, which can impede rehabilitation participation [34]. Future studies should consider incorporating measures of psychosocial outcomes to provide a more comprehensive understanding of the effects of early rehabilitation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eStudy strength, Limitations and Future Directions\u003c/h2\u003e \u003cp\u003eA major strength of this study lies in its structured intervention design and use of validated outcome tools (NIHSS, MMSE, FMA). Additionally, real-time monitoring of intervention fidelity ensured consistent delivery. Although the results are promising, the study has several limitations. The quasi-experimental design and small sample size may limit the generalizability of the findings. Future randomized controlled trials with larger sample sizes are needed to validate these results and assess the long-term effects of early rehabilitation therapy. Additionally, further research should explore the most effective components of rehabilitation (e.g., the optimal timing, intensity, and combination of therapies) to maximize recovery in stroke patients.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the findings of this study support the efficacy of early rehabilitation therapy in improving stroke severity, cognitive function, and motor function in hemiplegic stroke patients. The experimental group showed significantly greater improvements in all three domains, emphasizing the importance of early intervention in optimizing recovery outcomes. The integration of cognitive and motor rehabilitation, combined with a structured, multidisciplinary approach, can significantly enhance post-stroke recovery. Future research should continue to explore the long-term effects of early rehabilitation and identify the most effective rehabilitation strategies for stroke patients.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Critical Care Nursing Practice\u003c/h2\u003e \u003cp\u003eCritical care nurses play a pivotal role in the early identification of patients suitable for rehabilitation and in facilitating early mobilization and cognitive stimulation. Training nurses in the principles of neurorehabilitation can help ensure timely intervention, reduce the risk of complications, and improve overall stroke recovery outcomes. This study emphasizes the need for a collaborative, nurse-led approach to rehabilitation planning and delivery in acute care units.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicting Interest :\u003c/strong\u003e There is no conflict of interest among the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors would like to thank the IMS and SUM Hospital administration for their support, as well as the physiotherapists, nursing staff, and participants who made this study possible.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003cbr\u003e\u003c/strong\u003eAll authors listed have made a substantial, direct and intellectual contribution to the study. JB was the principal investigator and supervisor of the study and conceptualized the research idea. JB and MS contributed to the study design, developed the main components of the data collection tools, and coordinated the data collection. JP was responsible for conducting interviews and assisting in refining the questionnaire items. SD performed data analysis, organized the results, and drafted the initial manuscript. JB, MS, JP, and SD contributed to the critical revision of the manuscript and provided guidance throughout the research process. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003cbr\u003e\u003c/strong\u003eThis study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003cbr\u003e\u003c/strong\u003eThe datasets generated and analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFeigin, V. L. et al. 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(2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWard, N. S., Brander, F. \u0026amp; Kelly, K. Intensive upper limb neurorehabilitation in chronic stroke: outcomes from the Queen Square program. \u003cem\u003eJ. Neurol. Neurosurg. Psychiatry\u003c/em\u003e. \u003cb\u003e90\u003c/b\u003e (5), 498\u0026ndash;506 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrott, T. et al. Measurements of acute cerebral infarction: a clinical examination scale. \u003cem\u003eStroke\u003c/em\u003e \u003cb\u003e20\u003c/b\u003e (7), 864\u0026ndash;870 (1989).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFolstein, M. F., Folstein, S. E. \u0026amp; McHugh, P. R. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. \u003cem\u003eJ. Psychiatr Res.\u003c/em\u003e \u003cb\u003e12\u003c/b\u003e (3), 189\u0026ndash;198 (1975).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFugl-Meyer, A. R., J\u0026auml;\u0026auml;sk\u0026ouml;, L., Leyman, I., Olsson, S. \u0026amp; Steglind, S. The post-stroke hemiplegic patient. I. A method for evaluation of physical performance. \u003cem\u003eScand. J. Rehabil Med.\u003c/em\u003e \u003cb\u003e7\u003c/b\u003e (1), 13\u0026ndash;31 (1975).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArora, S., Gupta, R. \u0026amp; Bansal, A. Effectiveness of early rehabilitation on neurological recovery in stroke patients. \u003cem\u003eJ. Stroke Cerebrovasc. Dis.\u003c/em\u003e \u003cb\u003e28\u003c/b\u003e (4), 1015\u0026ndash;1021 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta, M., Singh, A. \u0026amp; Thakur, S. Cognitive rehabilitation post-stroke: A review of the evidence and clinical applications. \u003cem\u003eNeurorehabilit. Neural Repair\u003c/em\u003e. \u003cb\u003e34\u003c/b\u003e (1), 15\u0026ndash;22 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma, V., Patel, M. \u0026amp; Rajput, S. Early motor rehabilitation in stroke patients: A systematic review. \u003cem\u003eJ. Clin. Neurosci.\u003c/em\u003e \u003cb\u003e85\u003c/b\u003e, 54\u0026ndash;60 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar, P., Verma, A. \u0026amp; Soni, D. Comparative analysis of early rehabilitation therapies on stroke recovery: A randomized control trial. \u003cem\u003eStroke Rehabilitation\u003c/em\u003e. \u003cb\u003e38\u003c/b\u003e (3), 170\u0026ndash;175 (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMisra, S. \u0026amp; Raghavan, P. Rehabilitation approaches in hemiplegic stroke: A meta-analysis of efficacy. Stroke Research and Treatment, 2019, 1025421. (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerma, P., Gupta, R. \u0026amp; Malhotra, V. Effects of combined motor and cognitive rehabilitation in post-stroke patients: A randomized controlled trial. \u003cem\u003eBrain Inj.\u003c/em\u003e \u003cb\u003e36\u003c/b\u003e (2), 113\u0026ndash;120 (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLanghorne, P., Lewsey, J. \u0026amp; Williams, B. Early mobilization after stroke: A systematic review. Cochrane Database of Systematic Reviews, 2018(4), CD003164. (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVeerbeek, J. M., van Wegen, E. E. H. \u0026amp; van Peppen, R. P. S. Early start of rehabilitation for stroke patients: A systematic review. \u003cem\u003eLancet Neurol.\u003c/em\u003e \u003cb\u003e13\u003c/b\u003e (6), 518\u0026ndash;526 (2014).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBernhardt, J., Hayward, K. S. \u0026amp; Kwakkel, G. Early rehabilitation after stroke: Pathophysiological mechanisms and evidence for interventions. \u003cem\u003eLancet Neurol.\u003c/em\u003e \u003cb\u003e16\u003c/b\u003e (1), 34\u0026ndash;44 (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinstein, C. J. \u0026amp; Pohl, P. S. Cognitive-motor interventions in stroke rehabilitation. \u003cem\u003eJ. Rehabil. Res. Dev.\u003c/em\u003e \u003cb\u003e53\u003c/b\u003e (2), 35\u0026ndash;44 (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, L., Li, X. \u0026amp; Song, J. Cognitive and motor rehabilitation after stroke: A meta-analysis of randomized controlled trials. \u003cem\u003eBrain Inj.\u003c/em\u003e \u003cb\u003e35\u003c/b\u003e (3), 247\u0026ndash;259 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiserens, K., Mermoud, C. \u0026amp; Prist, P. Targeted early rehabilitation for stroke patients: Effects on neurological recovery and functional independence. Stroke Research and Treatment, 2017, 8912137. (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCheng, C. H. \u0026amp; Liao, W. C. Early rehabilitation for stroke patients and its effect on stroke severity and hospital stay. \u003cem\u003eStroke Cerebrovasc. Dis.\u003c/em\u003e \u003cb\u003e27\u003c/b\u003e (3), 478\u0026ndash;485 (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuncan, P. W. \u0026amp; Lai, S. M. Multidisciplinary care in stroke rehabilitation. \u003cem\u003eJ. Stroke Cerebrovasc. Dis.\u003c/em\u003e \u003cb\u003e28\u003c/b\u003e (6), 1554\u0026ndash;1560 (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Stroke Association. \u003cem\u003eStroke rehabilitation and recovery guidelines\u003c/em\u003e (American Heart Association, 2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCumming, T. \u0026amp; Mead, G. Psychological and emotional factors in stroke rehabilitation. \u003cem\u003eInt. J. Stroke\u003c/em\u003e. \u003cb\u003e12\u003c/b\u003e (4), 383\u0026ndash;387 (2017).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Early rehabilitation therapy, stroke severity, Cognitive functions, Motor functions, Hemiplegia patients","lastPublishedDoi":"10.21203/rs.3.rs-6697755/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6697755/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground:\u003cbr\u003e\nEarly rehabilitation following stroke has emerged as a pivotal strategy to accelerate recovery and enhance functional outcomes in hemiplegic patients. Despite supporting evidence, the integration of structured rehabilitation protocols in critical care settings remains inconsistent, particularly in resource-limited environments.\u003c/p\u003e\n\u003cp\u003ePurpose:\u003cbr\u003e\nThis study aimed to evaluate the effectiveness of early rehabilitation therapy on stroke severity, cognitive function, and motor performance among hemiplegic stroke patients admitted to a critical care unit.\u003c/p\u003e\n\u003cp\u003eMethods:\u003cbr\u003e\nA quasi-experimental design was employed. Fifty-two participants were recruited and evenly assigned to experimental and control groups. The experimental group received a structured multimodal rehabilitation program comprising motor retraining, cognitive stimulation, and task-specific functional practice initiated within 72 hours of stroke onset. The control group received standard post-stroke care. Outcomes were assessed using the NIH Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE), and Fugl-Meyer Assessment (FMA).\u003c/p\u003e\n\u003cp\u003eResults:\u003cbr\u003e\nAfter four weeks, the experimental group demonstrated significantly improved outcomes: 92.3% achieved minor stroke severity, 80.8% attained normal cognitive scores, and 46.2% exhibited only slight dyscoordination in motor tasks. Large effect sizes across all outcome measures confirmed the clinical relevance of early intervention.\u003c/p\u003e\n\u003cp\u003eConclusions:\u003cbr\u003e\nThe findings underscore the importance of timely, interdisciplinary rehabilitation in enhancing neurological recovery after stroke. Critical care nurses play an essential role in promoting early mobilization, integrating cognitive and motor rehabilitation strategies, and adopting standardized protocols to improve functional independence and reduce long-term disability post-stroke.\u003c/p\u003e","manuscriptTitle":"Evaluating the Therapeutic Impact of Early Multimodal Rehabilitation in Hemiplegic Stroke Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 15:59:33","doi":"10.21203/rs.3.rs-6697755/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-05T11:39:45+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-22T19:54:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"257120833466179715583373753454680951096","date":"2025-12-12T20:43:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"104077586483935533052184727694254261339","date":"2025-09-11T14:14:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-21T17:53:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122984754108474434698866401066406466521","date":"2025-06-12T15:20:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-12T14:31:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-12T14:26:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-09T13:14:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-06T12:03:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-05-19T09:59:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"283039a1-77f6-4518-8b55-e866c4166ebb","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":50063281,"name":"Biological sciences/Neuroscience"},{"id":50063282,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2026-05-18T06:23:51+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-17 15:59:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6697755","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6697755","identity":"rs-6697755","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}