Effect of Virtual Reality on Cortical Reorganization and Upper Extremity Functional Recovery in Patients With Subacute Stroke

NCT07520253 | Not Yet Recruiting DMC

• 1 other identifier: P.T.REC/012/006118
• Study Type: interventional
• Target: 40
• Locations: 1 country
• Sites: 1

Brief Summary

The purposes of the study are:

1. 1.To investigate the effect of virtual reality in patients with subacute stage of Stroke on cortical reorganization.
2. 2.To investigate the effect of virtual reality in patients with subacute stage of Stroke on upper extremity functional recovery.

Conditions

Stroke

Keywords

Stroke

Outcome Measures

Primary Outcomes (3)

• Upper Extremity Functional Recovery

  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

  6 months

• Cortical Reorganization

  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.

  6 months

• Gross manual dexterity

  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

  6 months

Study Arms (2)

Conventional physical therapy group ( Control Group ) ( Group I )

ACTIVE COMPARATOR

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

Other: Conventional physical therapy program

Virtual reality group (Study group) (Group II)

EXPERIMENTAL

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)

Other: Virtual Reality; Other: Conventional physical therapy program

Interventions

Virtual Reality OTHER

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)

Also known as: Exergaming using Nintendo WII

Virtual reality group (Study group) (Group II)

Conventional physical therapy program OTHER

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 (e.g., holding a bowl while stirring)

Conventional physical therapy group ( Control Group ) ( Group I ); Virtual reality group (Study group) (Group II)

Eligibility Criteria

• Age: 50 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Age ranges from 50 to 65 years.
• Both sexes (male and female).
• First stroke ever (ischemic or hemorrhagic) within the last three months.
• Clinical diagnosis of subacute stroke confirmed by neuroimaging (CT / MRI).
• Hemiparetic shoulder power more than three according to Medical Research Council Scale (MRC) (James, 2007).
• Patients who are able to manipulate the Wii remote control.
• Muscle tone grade 1 to 1+ (Mild to Moderate) spasticity for shoulder joint according to Modified Ashworth Scale (Meseguer et al., 2018).
• Participants are in normal cognitive and psychological status according to Montreal Cognitive Assessment screening (Hawkins et al., 2014).

You may not qualify if:

• Patients having severe arm or shoulder pain or symptomatic shoulder sublaxation.
• Contractures or shoulder deformities.
• Patients who have previous experience in using Wii.
• Patients with problems that may interfere with using Wii suchas epilepsy, visual impairments, apraxia and/or spatial neglect

Sponsors & Collaborators

• Cairo University: lead

Study Sites (1)

Faculty of Physical Therapy, Cairo University, Egypt

Cairo, 12613, Egypt

Location

Related Publications (2)

• Sood I, Injety RJ, Farheen A, Kamali S, Jacob A, Mathewson K, Buck BH, Kate MP. Quantitative electroencephalography to assess post-stroke functional disability: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis. 2024 Dec;33(12):108032. doi: 10.1016/j.jstrokecerebrovasdis.2024.108032. Epub 2024 Sep 30.

  PMID: 39357611 BACKGROUND

• Wu J, Zeng A, Chen Z, Wei Y, Huang K, Chen J, Ren Z. Effects of Virtual Reality Training on Upper Limb Function and Balance in Stroke Patients: Systematic Review and Meta-Meta-Analysis. J Med Internet Res. 2021 Oct 12;23(10):e31051. doi: 10.2196/31051.

  PMID: 34636735 BACKGROUND

MeSH Terms

Conditions

Stroke

Condition Hierarchy (Ancestors)

Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases

Study Officials

• ABEER ABO BAKR ABDELKADER ELWISHY ELWISHY, Professor of Physical Therapy

  Cairo University

  STUDY CHAIR

Central Study Contacts

MOHAMMED RAMADAN IBRAHIM MOHAMMED Mohammed, M.S.C

CONTACT

+201004345510; mohammed.ramadan@the.Suezuni.edu.eg

ABEER ABO BAKR ABDELKADER ELWISHY PROF. DR., Professor

CONTACT

+201228088835; abeer.elwishy@pt.cu.edu.eg

Study Design

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

Study Record Dates

• First Submitted: December 31, 2025
• First Posted: April 9, 2026
• Study Start: May 1, 2026
• Primary Completion (Estimated): November 30, 2026
• Study Completion (Estimated): December 30, 2026
• Last Updated: April 9, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share

Locations

EG (1)