Stroke a devastating neurological condition, causing severe neurological challenges such as balance issues, motor function and cognitive deficits among survivors and can cause disability and death. The use of Virtual Reality and Motor Imagery in rehabilitation of neurologic disorders is on the rise. In stroke patients, VR and MI combination has not been studied. This study aims to investigate the combined effects of Virtual Reality and Motor Imagery Techniques with Routine Physical Therapy in patients with post stroke patients.

This randomized control trial will be conducted at Safi Hospital Faisalabad in 7 months after the approval of synopsis, involving a sample size of 75 participants selected through convenience sampling based on the inclusion criteria. Participants will be randomly assigned to three groups using lottery method, in which Group A, will receive Virtual Reality and Motor Imagery training in conjunction with routine physical therapy three days a week for 12 weeks. Group B will receive VR and routine physical therapy, supplemented by 10-15 minutes of cycling and walking and Group C will receive routine physical therapy with MI techniques, along with 10-15 minutes of cycling and walking.

Fugal-Meyer Scale will be used to motor function, Berg Balance Scale for balance and Barthel Index will be used to assess activities of daily living. Assessment will be carried out at baseline, 6th week, 8th week and at 12th week and at 16th week after the discontinuation of treatment. The data will be entered and analyzed by using SPSS 26

Inclusion Criteria:

1. Clinical diagnosis of stroke of any etiology
2. Age between 40 to 65 years
3. Both genders
4. At least 6 months post-stroke onset
5. Able to follow and understand visual and verbal commands.
6. Hemiparetic
7. No prior experience with VR-based rehabilitation.
8. Able to walk with the use of walking aids or assistive devices.
9. Mini-Mental State Examination (MMSE) score equal to or greater than 24

Exclusion Criteria:

1. Presence of aphasia, apraxia, and hemineglect
2. Serious cardiovascular disease (heart failure, arrhythmias, angina pectoris or myocardial infarction)
3. Cerebellar lesion
4. Multiple brain accidents
5. Muscular disorder effect upper and lower extremities
6. History of seizures or epilepsy.
7. Patients whose injury occurred fewer than 6 months previously, considering the expected time for spontaneous recovery;
8. Patients with associated disorders such as epilepsy, and sensory and perceptual deficits such as hemineglect and Pusher syndrome;
9. Patients with osteo degenerative disorders that would prevent participation in the games or that could influence the body balance; and individuals who had cognitive and communication disorders, affecting understanding, that could compromise performance in the games
10. Inability to commit to the study schedule or attend the required therapy sessions

The study would be single blinded as assessor of the study would be kept blind of the treatment groups to which patient will be allocated