the current study is a randomized controlled trial comparing the effectiveness of motor imagery techanique with and without virtual reality on pain intensity , functional disability and quality of life for individual with post stroke shoulder hand syndrome . this trial aims to evaluate pain , functional disability and overall quality of life . the primary outcome is pain reduction . while seconday outcome reduce disability and improve quality of life .the hypothesis is that the combination of motor imagery and virtual reality will result in significant greater clinical improvement compared to motor imagery alone .

Stroke continues to be one of the most common neurological causes of long term disability across the world. It often leads to a wide range of sensory, motor, and cognitive impairments that significantly reduce independence and quality of life. Among the various secondary complications that follow a stroke, Shoulder Hand Syndrome is considered one of the most painful and disabling conditions. It is described as a condition that presents with severe shoulder pain, hand edema, joint stiffness, reduced range of motion, and progressive functional decline. The condition is also known as Complex Regional Pain Syndrome Type One after stroke and it commonly develops within the first few months of the neurological injury. Estimates suggest that the condition affects between twelve to thirty percent of stroke survivors and is associated with marked disability if not treated in a timely and effective manner.Traditional physical therapy approaches such as range of motion exercises, manual therapy, strengthening, and functional task training remain the foundation of treatment. However, these interventions are often limited when patients experience severe pain or fear of movement, which prevents active participation. This has created a need for interventions that can stimulate the brain and support motor recovery without requiring significant physical effort or causing pain. One such approach is motor imagery. Motor imagery is described as the mental rehearsal of movement without any actual execution of the movement. During motor imagery practice, the individual imagines performing a movement as vividly as possible while staying in a relaxed state.hile traditional motor imagery has been widely studied, the use of virtual reality as an adjunct tool has expanded rapidly in recent years. Virtual reality based rehabilitation offers an immersive and engaging environment where the patient experiences visual and sensory feedback that closely resembles real movement. The use of virtual reality enhances motivation, increases concentration, and improves patient satisfaction during therapy sessions. Most importantly, virtual reality supports the activation of mirror neuron pathways and enhances sensory motor integration, which are critical components of recovery after a stroke.The intervention for both groups was delivered over a structured six week period. Each participant attended therapy three days per week, and every session last for a total of thirty minutes. This schedule is designed to provide consistent therapeutic exposure while preventing fatigue and allowing adequate recovery between sessions. By maintaining the same duration and frequency for both groups, the study ensured that any differences in outcomes can be attributed to the type of motor imagery intervention rather than differences in treatment time.

Inclusion Criteria:

• Post-stroke patients diagnosed with Shoulder-Hand Syndrome
• Age 40-70 years
• Both males and females
• Ability to understand motor imagery tasks
• Duration of stroke ≥ 3 months

Exclusion Criteria:

• Cognitive impairment
• Severe visual deficits
• Psychiatric illness
• Pain medication changes during study
• Uncontrolled medical conditions

only ipd used in the results publication will be shared

it will be available after the completion of study

through the corresponding author

the study uses single masking in which the outcome accessor is blinded to group allocation .participants will be assigned to either motor imagery treatment with and without virtual reality by an independent researcher who is not involved in assessment . the assessor responsible for recording baseline and post intervention outcomes will not be informed of the participants intervention group .to maintain blinding participants will be instructed not to disclose their group assignment during assessment