Comparison of the Effectiveness of Mirror Therapy and Mirror Mode of Hand Robot in Stroke

Comparison of The Effectiveness Of Mirror Therapy And Mirror Mode of a Hand Robot in Upper Extremity Motor Recovery After Stroke

The goal of this clinical trial is to compare the effectiveness of conventional mirror therapy and robotic mirror mode training in promoting upper extremity motor recovery in adult patients with ischemic stroke during the early subacute phase. The main questions it aims to answer are:

Does mirror mode of a robotic hand device result in greater motor function recovery compared to conventional mirror therapy?

Are there differences between the groups in somatosensory improvement and gross motor skill outcomes?

Do both intervention modalities result in clinically significant improvements in motor and functional outcomes?

Researchers will compare a conventional mirror therapy group and a robotic-assisted mirror mode group to determine which provides more significant gains in motor function, somatosensory input, and functional use of the paretic arm.

Participants will:

Receive standard physiotherapy sessions for 6 weeks

Be randomly assigned to either mirror therapy or robotic mirror mode intervention

Be evaluated using Fugl-Meyer Assessment, ARAT, Box and Block Test, Wolf Motor Function Test and Tactile/proprioceptive sensory test using Fugl-Meyer Assessment Sensory subsection.

Upper extremity motor impairment is one of the leading causes of functional disability following stroke. Although conventional therapies promote some degree of recovery, restoring hand function remains a major challenge, particularly in patients with severe paresis. Mirror therapy has been widely used due to its affordability and portability. However, proprioceptive feedback limitations and the potential mismatch between visual and somatosensory input reduce its effectiveness.

This study investigates an innovative approach that combines visual illusion and proprioceptive input using a robotic hand device in mirror mode. The robotic intervention is designed to synchronize joint motion with visual feedback, potentially enhancing the mirror neuron system's activation and promoting neuroplastic changes more efficiently than conventional mirror therapy.

The study will be conducted over a 6-week period with stroke patients in the early subacute phase. Both groups will receive equivalent durations of upper limb training in addition to conventional physiotherapy.

This trial aims not only to compare motor outcomes but also to evaluate whether motor improvements translate into functional hand use and to explore differences in somatosensory gains between interventions. By addressing both visual and proprioceptive components of motor learning, this research may guide future clinical strategies for individualized stroke rehabilitation.

Inclusion Criteria:

• Having a ischemic/hemorrhagic stroke diagnosis through MRI and/or CT
• Volunteering to enter the study
• First ever stroke or no sequeale (mRS 0)
• Being in subacute/chronic phase of stroke (between 1st week to 1 year)
• Having a adequate sitting balance or able to maintain upright sitting position for 30 minutes
• Having a motor deficit in the hand (Brunnstrom hand motor recovery stages 1-4 )
• Having a full range of motion in hand

Exclusion Criteria:

• Severe Pain (VAS ≥ 8)
• Having a neurological or orthopedic problem in hand
• Severe spatial hemineglect (NIHSS 11th subscale> 1)
• Spasticity (mAS ≥ 2)
• Apraxia
• Visual/auditory loss that affects treatment
• Unstable Vital Signs