Clinical Research Directory

Inclusion Criteria: * The patients were diagnosed clinically and referred from a neurologist * The study included cases who were 45 years old or more * Ischemic stroke at least six months following the stroke, were receiving treatment at the outpatient clinic, and demonstrated satisfactory cognitive function (Montreal Cognitive Assessment score of more than 26), spasticity of the limbs ranging from grade 1+ (2) on a modified Ashworth scale, and a confirmed diagnosis of CRPS by clinical assessment by a neurologist using the Budapest criteria for diagnosis of CRPS. * Unilateral upper-limb or shoulder pain persisting for at least four weeks and up to six months following the onset of stroke. Pain intensity rated ≥ 4/10 on the Visual Analogue Scale (VAS) at rest or with active/passive shoulder movement. Exclusion Criteria: * Patients with current history of hand troubles and shoulder dysfunction before developing a stroke. * Patients with overactive sympathetic system from other causes e.g. congestive heart failure, impaired kidney functions. * Patients with significant musculoskeletal disorders which include rheumatoid arthritis or metabolic disorders comprising diabetes, Patients with cognitive impairments, Visual, auditory and speech problems and Patients with psychiatric disorders or seizures.