This study aims to comprehensively investigate and directly compare the immediate
neurophysiological and functional effects of two innovative neurorehabilitation
techniques-mirror therapy and virtual reality (VR) therapy-on upper extremity motor
function among patients with hemiplegia following stroke. A total of 42 participants
diagnosed with hemiplegia post-stroke will be randomly assigned to either Group A or
Group B. Each participant will receive a single, structured intervention session lasting
30 minutes, designed to promote immediate motor recovery through targeted
neuroplasticity-enhancing tasks.
Group A : Mirror Therapy Protocol: Participants will be seated comfortably in a stable
and ergonomically supportive chair. A mirror measuring approximately 40 cm by 50 cm will
be strategically positioned along the mid-sagittal plane, effectively reflecting the
unaffected limb and creating the visual illusion of bilateral symmetrical movements. This
visual feedback aims to activate motor-related cortical regions within the affected
hemisphere, thus enhancing immediate functional motor improvements. Participants will
engage in structured therapeutic exercises, each carefully designed to target various
aspects of upper limb motor function:
Reaching Task: Participants will perform reaching movements towards standardized
objects positioned at varying distances and spatial orientations. They will complete
3 sets of 10 repetitions, progressively challenging their spatial accuracy,
visual-motor integration, and motor planning skills.
Joint Range Movements: Participants will execute comprehensive movements involving
finger flexion-extension, wrist flexion-extension, elbow flexion-extension, and
shoulder flexion-abduction. Each movement will be repeated 10 times, systematically
activating multiple joints and muscles to promote functional range of motion and
coordination.
Grasp and Release Exercises: Participants will complete grasping and releasing tasks
with objects of different sizes, textures, and weights. This task includes 3 sets of
10 repetitions designed to enhance tactile feedback, grip strength, fine motor
coordination, and functional hand dexterity.
Group B: Virtual Reality (VR) Therapy: Participants in the VR group will utilize advanced
virtual reality equipment, including high-resolution VR headsets and handheld
controllers, immersing themselves in an interactive, three-dimensional virtual
environment. This environment is specifically developed to simulate realistic and
engaging scenarios, enhancing ecological validity, motivation, and patient engagement
through multisensory stimulation. Therapeutic tasks in the VR environment will mirror
those in the mirror therapy protocol to facilitate direct comparative analysis:
Virtual Reaching Tasks: Participants will perform interactive tasks, engaging in
accurate reaching movements toward virtual targets displayed at various locations
and distances within the virtual environment, emphasizing hand-eye coordination and
spatial orientation.
Virtual Joint Movements: Virtual tasks will guide participants through movements
involving finger flexion-extension, wrist flexion-extension, elbow
flexion-extension, and shoulder flexion-abduction. Visual and auditory cues in the
VR environment will enhance proprioceptive feedback and facilitate precise motor
execution.
Virtual Grasp and Release Tasks: Participants will virtually grasp and manipulate
various digital objects, practicing controlled grasp and release movements that
mimic real-world functional tasks. Task complexity will vary to address different
aspects of motor control, strength, and dexterity.
Assessment Methods: Objective and reliable clinical assessments will be conducted
immediately before and after each therapy session to measure changes in motor function,
muscle tone, sensory-motor integration, and functional independence. The assessments will
include:
Motor Performance: Evaluated by the Fugl-Meyer Motor Assessment (FMA), providing
comprehensive data on upper limb motor function.
Spasticity: Quantified using the Modified Ashworth Scale (MAS), providing reliable
measurements of muscle tone.
Activities of Daily Living (ADL): Assessed with the Barthel Index to objectively
measure functional independence and performance in daily activities.
Fine Motor Skills: Evaluated using the Box and Block Test, offering precise
measurement of hand dexterity and coordination.
Proprioception: Evaluated using standardized joint position matching tasks,
assessing sensory-motor integration and proprioceptive accuracy.
Reaction Time: Assessed via computerized Simple Reaction Time (SRT) testing,
precisely measuring sensorimotor responsiveness and processing speed.
This multidimensional assessment approach ensures a detailed evaluation of the acute
therapeutic impacts of each intervention. By systematically comparing the immediate
effectiveness and therapeutic advantages of mirror therapy and virtual reality therapy,
this study aims to generate evidence-based recommendations, contributing significantly to
clinical decision-making processes and potentially optimizing rehabilitation strategies
for individuals recovering from stroke-related hemiplegia.
