Multimodal Sensory Feedback and Mirror Therapy for Stroke Rehabilitation

Neural Mechanisms and Efficacy of Multimodal Sensory Feedback Augmentation on Mirror Therapy for Stroke Rehabilitation

The goal of this clinical trial is to investigate the clinical and neurophysiological effects of a novel multimodal sensory feedback mirror therapy in stroke survivors with upper extremity hemiparesis , aged between 20 and 85 years.

The main questions it aims to answer are:

1. Does Multimodal Augmented Mirror Therapy (MAF-MT) lead to significantly greater improvements in functional recovery compared to unimodal digital mirror visual feedback mirror therapy (MVF-MT) or traditional mirror therapy (TMT) ?
2. What are the underlying neurophysiological changes in brain activation (mu rhythm desynchronization) and intermuscular coordination patterns associated with this hybridized feedback approach?

Researchers will compare the MAF-MT group (receiving digital mirror visual feedback with multimodal sensory feedback) to the MVF-MT group (digital mirror feedback only) and the TMT group (traditional mirror therapy using the standard mirror box) to see if the integration of multimodal feedback leads to superior functional and brain acitivity outcomes.

Participants will undergo eligibility screening including assessments of motor impairment and cognitive status. They will participate in 20 sessions of intervention, consisting of approximately 75 minutes of assigned therapies. They will receive specific sensory intervention depending on group assignment and complete evaluation (described in Outcome Measures) before the intervention, immediately after, and at a one-month follow-up

Inclusion Criteria:

• At least 3 months post-onset of a unilateral stroke
• Age between 20 and 85 years
• An initial Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score between 18 and 56
• Ability to follow study instructions, as determined by a Montreal Cognitive Assessment (MoCA) score ≥ 18
• No concurrent participation in other neurorehabilitation studies or drug clinical trials

Exclusion Criteria:

• Severe neglect, as measured by the line bisection test
• Uncontrolled major medical conditions, such as uncontrolled hypertension or heart failure, or concomitant neurological conditions, for example, dementia, Parkinson's disease, brain tumors, or other brain conditions
• Severe pain, swelling, spasticity or contractures in affected arms that prevent movement practice and assessments.