Patients will have conventional physical therapy program as follow :

Range of motion (ROM) and stretching begin with passive ROM to all joints of the upper limb (10 repetitions × 2 sets), followed by active-assisted ROM using a stick or the unaffected limb. Stretching is performed for 30-60 seconds, 3-5 repetitions.Strengthening exercises focus on isometric contractions of scapular stabilizers, deltoid, and biceps/triceps, holding 5-10 seconds × 10 repetitions, along with isotonic exercises using therabands or light weights (0.5-1 kg) for 8-12 repetitions × 2-3 sets. Activities of daily living (ADL) training involve self-care practices including grooming, eating, and buttoning, as well as task-specific training such as reaching, grasping, and releasing real objects. Each ADL task is practiced for 15-20 minutes, with 1-2 tasks per session.Scapular stability exercises include graded practice with large to small objects, bimanual training will be applied to both groups

This group will be treated by conventional physical therapy program in addition to virtual reality using Nintendo Wii Group II (study group) will receive the same treatment as group I in addition to exergaming technology using Nintendo Wii. The Wii program will be of game based VR movement therapy using the Wii for one hour each session. Three games will be selected from the Wii sports and Wii Fit packages for upper limb. Participants who could not grip the controller, a bandage will be used to fix the controller on to the affected hand. Games like; Tennis, Baseball, Golf club and Boxing. The patient will select three games from Wii sports (Tennis- Golf- Boxing-Baseball) then patients will be given a trial of playing each game to be familiar with it after that they will be given one hour practice 20 minutes for each game for six weeks and three times per week (18 sessions)

Twenty patients with subacute stroke will receive conventional physical therapy program and virtual reality through Nintendo Wii The patient will hold the Wii remote in his hand to move the Avatar on the screen and practice the exercise Figure.6. If the patient cannot hold the Wii remote in his hand it will be strapped to his hand. A full instruction according to every game will be explained to the patients explaining every game rules and how to perform and what is the goal of each game. The patient will have one trial in every game to perform before setting the time. Screen /projector will be positioned at eye level of each patient and a Chair for sitting or standing according to the patient, The patient will select three games from Wii sports (Tennis- Golf- Boxing-Baseball) then patients will be given a trial of playing each game to be familiar with it after that they will be given one hour practice 20 minutes for each game for six weeks and three times per week (18 sessions)

Upper Extremity Functional Recovery will be assessed by Chedoke Arm and Hand Activity Inventory-7 item version (CAHAI-7). CAHAI-7 assesses the affected arm and hand during bilateral tasks by asking the person to complete seven specific activities. Each item of the CAHAI is scored on a 7-point quantitative scale ranging from 7 to 49, with higher scores reflecting greater functional recovery

Cortical Reorganization will be assessed by Quantitative Electroencephalography (QEEG) QEEG indices can give meaningful prognostic information of motor and functional recovery in patients with stroke. Delta Alpha Ratio (DAR) and Delta Theta to Alpha Beta Ratio (DTABR) are quantitative EEG (QEEG) indices used to measure brain electrical activity. Lower values of DAR and DTABR are associated with better recovery in patients with brain injury.

Gross manual dexterity will be assessed by Box and Block test (BBT). BBT contains a wooden box that is divided into two sections and the patient is asked to move the blocks from one side of to the other side. The BBT score represents the number of blocks successfully moved from one side of the box to the other within 60 seconds. A higher score indicates greater manual dexterity