Mirror vs Virtual Reality Therapy for Upper Extremity Function in Hemiplegic Patients

NCT07018336 | Recruiting

• 1 other identifier: 07032025535
• Study Type: interventional
• Target: 42
• Locations: 1 country
• Sites: 1

Brief Summary

Upper extremity impairment in hemiplegic patients significantly impacts daily activities and reduces quality of life. Although traditional rehabilitation methods can help, some patients experience limited progress. Recently, modern techniques such as mirror therapy and virtual reality (VR) have emerged, demonstrating promising results in motor skill improvement. This study aims to directly compare the acute effects of mirror therapy and VR therapy on upper limb motor function in hemiplegic patients. Forty-two participants aged 18-75 with hemiplegia due to stroke (6-12 months post-stroke) will be randomly assigned to either mirror therapy or VR therapy. The evaluation includes motor function (Fugl-Meyer Assessment), spasticity (Modified Ashworth Scale), activities of daily living (Barthel Index), fine motor skills (Box and Block Test), proprioception, and reaction time. The goal is to identify the effectiveness of the mirror therapy and VR therapy on motor function, spasticity control, proprioception, daily activity performance, and reaction times, contributing valuable insights to clinical rehabilitation practices.

Conditions

Hemiplegia; Stroke; Upper Extremity Dysfunction

Keywords

Stroke; Spasticity; Proprioception; Reaction Time

Outcome Measures

Primary Outcomes (2)

• Fugl-Meyer Assessment for Upper Extremity (FMA-UE)

  The Fugl-Meyer Assessment is a standardized and widely used tool designed to evaluate motor function, balance, sensation, and joint functioning in individuals with post-stroke hemiplegia. In this study, only the upper extremity motor domain will be used, which includes evaluation of movement, coordination, and reflex action of the shoulder, elbow, forearm, wrist, and hand. The assessment is scored on a 3-point ordinal scale: 0 (cannot perform), 1 (performs partially), and 2 (performs fully), with a maximum score of 66 indicating better motor recovery. Participants are seated or lying in a comfortable position during the test, and each movement is explained and demonstrated. The researcher scores the quality and completion of each movement. The FMA-UE is a valid and reliable measure of motor function and is widely used in stroke rehabilitation research

  Day 1

• Box and Block Test (BBT)

  The Box and Block Test (BBT) is a standardized assessment of unilateral gross manual dexterity. Participants are instructed to transfer as many wooden blocks as possible from one compartment of a box to the other within 60 seconds using one hand. The number of successfully transferred blocks is recorded as the score. The test is widely recognized for its simplicity, reliability, and sensitivity in detecting changes in motor function, especially in post-stroke patients. In this study, the BBT will be used to evaluate changes in upper extremity motor performance and coordination immediately before and after the intervention session.

  Day 1

Secondary Outcomes (5)

• Modified Ashworth Scale (MAS)

  Day 1

• joint Position Sense Test (Proprioception Assessment)

  Day 1

• Simple Reaction Time (SRT) with BlazePod

  Day 1

• Global Rating of Change (GRC) scale

  Day 1

• Barthel Index (Activities of Daily Living - ADL)

  Day 1

Study Arms (2)

Mirror Therapy

EXPERIMENTAL

Participants will receive a single 30-minute session of mirror therapy applied to the affected upper extremity. The therapy will involve performing functional upper limb movements while viewing the mirror reflection of the unaffected limb to create the visual illusion of symmetrical bilateral movement.

Other: Mirror Therapy

Virtual Reality (VR) Therapy

EXPERIMENTAL

Participants in this group will receive a single 30-minute session of virtual reality-based upper extremity rehabilitation using a Meta Quest 2 head-mounted display. The intervention will consist of task-oriented, interactive exercises targeting shoulder, elbow, wrist, and hand movements. The session will be conducted under supervision to ensure safety and proper task performance.

Device: Virtual Reality (VR) Therapy

Interventions

Mirror Therapy OTHER

Mirror therapy will be applied to the affected upper extremity by placing a mirror in the midsagittal plane to reflect movements of the non-paretic limb, creating the visual illusion of symmetrical bilateral movement. Participants will perform task-specific functional movements of the hand and arm (e.g., grasping, wrist flexion, and extension) while focusing on the mirror image.

Mirror Therapy

Virtual Reality (VR) Therapy DEVICE

Virtual reality therapy will be delivered using the Meta Quest 2 head-mounted display system. Participants will engage in interactive, task-specific upper extremity exercises designed to promote motor activation and functional movement of the affected limb through immersive visual feedback.

Virtual Reality (VR) Therapy

Eligibility Criteria

• Age: 18 Years - 75 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Hemiplegic patients in need of upper extremity rehabilitation.
• Having had a stroke 6 to 12 months prior to the study.
• Being at least Stage 3 for the upper extremity according to the Brunnstrom motor recovery stages.
• Age range: between 18 and 75 years.
• Individuals who volunteer to participate in the study.
• Individuals who are cognitively suitable for mirror therapy and virtual reality applications (a score of at least 24 on the Mini Mental State Examination)

You may not qualify if:

• Patients with severe spasticity (score ≥ 3 on the Modified Ashworth Scale)
• Individuals with secondary neurological conditions (e.g., Parkinson's disease, multiple sclerosis).
• Individuals diagnosed with vestibular dysfunction (as virtual reality equipment may cause issues like nausea or dizziness).
• Individuals with communication issues, such as hearing or vision loss.

Sponsors & Collaborators

• Istinye University: lead

Study Sites (1)

İstinye Üniversite Hastanesi Medical Park Gaziosmanpaşa

Istanbul, Gaziosmanpaşa, 34065, Turkey (Türkiye)

RECRUITING

MeSH Terms

Conditions

Hemiplegia; Stroke; Muscle Spasticity

Interventions

Mirror Movement Therapy; Therapeutics

Condition Hierarchy (Ancestors)

Paralysis; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Muscular Diseases; Musculoskeletal Diseases; Muscle Hypertonia; Neuromuscular Manifestations

Intervention Hierarchy (Ancestors)

Physical Therapy Modalities; Rehabilitation

Study Officials

• Çiçek Günday, Asst. Prof.

  Istinye University, Department of Physiotherapy and Rehabilitation

  PRINCIPAL INVESTIGATOR

• Maysaa Hamdy Othman Ibrahim, Physiotherapist

  Istinye University, Department of Physiotherapy and Rehabilitation

  STUDY DIRECTOR

Central Study Contacts

Çiçek Günday, Asst. Prof.

CONTACT

+90 850 283 60 00; cicek.gunday@istinye.edu.tr

Maysaa Hamdy Othman Ibrahim, Physiotherapist

CONTACT

+90552709409; maysaahamdyothman.ibrahim@stu.istinye.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: INVESTIGATOR
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Asst. Prof.

Study Record Dates

• First Submitted: May 16, 2025
• First Posted: June 12, 2025
• Study Start: May 30, 2025
• Primary Completion (Estimated): July 1, 2026
• Study Completion (Estimated): July 1, 2026
• Last Updated: March 2, 2026

Record last verified: 2026-02

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)