Virtual Reality-Based Mirror Therapy and FES-Cycling in Stroke Rehabilitation

Comparison of Virtual Reality-Based Mirror Therapy and Functional Electrical Stimulation-Assisted Cycling for Upper Extremity Rehabilitation After Stroke: A Randomized Controlled Trial

This randomized controlled, assessor-blinded study aimed to compare the effects of virtual reality-based mirror therapy (VRBMT) and functional electrical stimulation-assisted cycling (FES-cycling) when combined with conventional rehabilitation on upper extremity recovery in patients with stroke.

Participants with first-ever stroke, unilateral hemiplegia, and upper extremity impairment within six months after stroke onset were randomly assigned to one of three groups: conventional rehabilitation alone, conventional rehabilitation plus VRBMT, or conventional rehabilitation plus FES-cycling.

All participants received a four-week rehabilitation program. Upper extremity motor function, functional independence, use of the affected upper extremity in daily activities, and quality of life were assessed before and after the intervention.

Stroke frequently results in upper extremity motor impairment, leading to limitations in activities of daily living and reduced quality of life. Although conventional rehabilitation is the standard approach for improving motor recovery after stroke, technology-assisted rehabilitation methods have been developed to enhance neuroplasticity and functional outcomes.

Virtual reality-based mirror therapy provides visual feedback and aims to stimulate motor relearning mechanisms, whereas functional electrical stimulation-assisted cycling combines repetitive movement with electrically induced muscle activation to support motor recovery.

This randomized controlled, assessor-blinded study was designed to compare the additional effects of these two technology-assisted rehabilitation approaches when combined with conventional rehabilitation in patients with post-stroke upper extremity impairment.

Participants were randomly assigned to three parallel treatment groups. Clinical assessments were performed before and after completion of the rehabilitation program by an assessor blinded to group allocation.

Inclusion Criteria:

• Age older than 18 years
• First-ever stroke
• Unilateral hemiplegia
• Time since stroke onset ≤6 months
• Upper extremity Brunnstrom recovery stage between 1 and 4
• Modified Ashworth Scale score <3 in the affected upper extremity
• Ability to maintain sufficient sitting balance

Exclusion Criteria:

• Visual impairment
• Contraindication to electrical stimulation, including cardiac pacemaker implantation
• Cognitive impairment (Mini-Mental State Examination score <25)
• Severe aphasia preventing completion of clinical assessments
• Presence of additional neurological disorders, including Parkinson's disease, Alzheimer's disease, multiple sclerosis, neuromuscular junction disorders, motor neuron disease, or peripheral nerve lesions
• Neglect syndrome
• Orthopedic conditions affecting upper extremity function, including amputation or joint contracture
• Severe cardiac disease
• Uncontrolled hypertension
• Epilepsy
• Psychiatric disorders such as schizophrenia or bipolar disorder
• Pregnancy or suspected pregnancy
• Acute deep vein thrombosis or thrombophlebitis
• Local infection at the treatment site