Impact of Mirror Therapy Combined With Conventional Training on Gait and Lower Limb Motor Function Among Post-Stroke Patients

NCT07797712 | Recruiting

• 1 other identifier: IIUI/RERC/ADT/2026/05/260
• Study Type: interventional
• Target: 52
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial aims to evaluate the effects of mirror therapy combined with conventional training on gait and lower limb motor function among post-stroke patients. Stroke remains a worldwide health crisis, persistently ranking as a leading cause of long-term severe disability. The study will evaluate the gait and lower limb motor function.

Conditions

Stroke

Keywords

Gait; Stroke; Mirror Movement Therapy

Outcome Measures

Primary Outcomes (4)

• 10-Meter Walk Test (10MWT)

  This test measures gait speed (m/s) over a short distance and is a highly sensitive measure of functional walking ability. It has excellent test-retest reliability (ICC = 0.95 to 0.99) in individuals with chronic stroke and is considered a valid core outcome measure for gait recovery.

  Baseline, Weeks 3 and 6.

• Timed Up and Go Test (TUG)

  This test assesses functional mobility and dynamic balance by measuring the time (in seconds) it takes an individual to stand up from a chair, walk 3 meters, turn, walk back, and sit down. It demonstrates excellent reliability (ICC = 0.95) in the stroke population and is highly responsive to changes in mobility.

  Baseline, Weeks 3 and 6.

• Fugl-Meyer Assessment for Lower Extremity (FMA-LE)

  This is a stroke-specific performance-based impairment index used to quantitatively measure motor function, sensation, and coordination in the lower limb. It is widely regarded as the gold standard for assessing motor recovery after stroke, with high inter-rater reliability (ICC = 0.97).

  Baseline, Weeks 3 and 6.

• Wisconsin Gait Scale (WGS)

  This is a valid and reliable observational gait analysis tool specifically designed for the qualitative assessment of hemiplegic gait. It assesses 14 observable parameters across different phases of gait (e.g., stance, swing) and has high inter-rater (r = 0.91) and test-retest (r = 0.92) reliability in stroke patients (Rodriquez et al., 1996). The WGS was selected to capture the nuanced spatiotemporal improvements in gait pattern (e.g., step length, symmetry) that are clinically meaningful but may not be fully reflected in speed or timed tests alone.

  Baseline, Weeks 3 and 6.

Study Arms (2)

Group A

EXPERIMENTAL

Participants in this group will receive mirror therapy-based functional training with conventional lower limb training. This training program will focus on gait and lower limb motor function.

Other: Mirror Therapy Based Functional Training; Other: Conventional Lower Limb Training

Group B

ACTIVE COMPARATOR

Participants in this group will receive conventional lower limb training. This training program will focus on gait and lower limb motor function.

Other: Conventional Lower Limb Training

Interventions

Mirror Therapy Based Functional Training OTHER

(Basic) - Sitting position: * Ankle dorsiflexion/plantarflexion (simulating pressing a gas pedal) * Knee extension/flexion (simulating kicking a ball) * Hip flexion/extension (simulating marching) * Ankle circling in both directions (Intermediate)-Sitting to standing transition: * Performing "stepping" movements while seated * Simulated sit-to-stand movements focusing on weight transfer observed in the reflection * Sliding the foot forward and backward along the floor (simulating the swing phase of gait) * Heel slides (Advanced) - Standing position: * Heel raises and toe raises in standing * Weight shifting between limbs observing symmetry in the mirror * Mini squats and half squats with mirror feedback * Stepping forward, backward, and laterally * Tracing shapes or following a moving target with the foot * Practicing coordinated ankle movements essential for navigating uneven terrain.

Group A

Conventional Lower Limb Training OTHER

Passive and active-assisted range of motion exercises for hip, knee, and ankle joints of the affected limb * Bridging exercises * Ankle dorsiflexion/plantarflexion against manual resistance or TheraBand * Seated knee extension * Mini squats * Heel raises * Straight leg raises * Weight shifting in standing (side-to-side and front-toback) * Sit-to-stand transfers * Tandem standing * Single-leg stance (with support as needed) * Standing on foam surface (if available) * Practice walking on level surfaces with emphasis on weight-bearing on affected limb * Focus on heel strike and push-off phases * Verbal cues for step length and symmetry * Gait speed variations (slow to moderate pace) * Gentle stretching of hamstrings, quadriceps, gastrocnemius, and soleus muscles

Group A; Group B

Eligibility Criteria

• Age: 40 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Diagnosed with the first-ever unilateral stroke.
• Duration of stroke between 3 months and 6 months (subacute to chronic stage).
• Both male and female patients aged 40 to 70 years.
• Ability to walk at least 10 meters independently.
• Mini Mental State Examination (MMSE) score \>24.
• Brunnstrom stage of recovery for the lower limb is \> 3, indicating some voluntary movement out of synergy.

You may not qualify if:

• Severe cognitive impairment, perceptual deficits, or inability to follow simple verbal commands (e.g., severe aphasia or low MMSE score).
• Presence of other neurological disorders affecting motor performance such as Parkinson's disease, multiple sclerosis, traumatic brain injury, or cerebellar disorders.
• Severe musculoskeletal disorders of the lower limb, including fracture, contracture, severe osteoarthritis, or pain limiting participation in exercise.
• Uncontrolled medical conditions such as unstable hypertension, uncontrolled diabetes mellitus, a recent cardiac event, or other conditions making exercise unsafe.
• Severe visual impairment, vestibular dysfunction, or hearing loss that may interfere with treatment instructions or mirror-based feedback.
• Severe unilateral neglect (hemispatial neglect) or apraxia interfering with task performance.
• Current participation in another physiotherapy, rehabilitation, or interventional research study during the data collection period.

Sponsors & Collaborators

• Ibadat International University, Islamabad: lead

Study Sites (1)

Department of Physical Therapy at suleman medical complex hospital, Quetta.

Quetta, Balochistan, Pakistan

RECRUITING

Related Publications (1)

• GBD 2021 Stroke Collaborators. (2023). Global, regional, and national burden of stroke and its risk factors, 1990-2021: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet Neurology, 22(10), 915-939. 2. Khan, M., Ahmed, S., & Anwar, S. (2022). Burden of stroke in Pakistan: A growing concern. Journal of Pakistan Medical Association, 72(2), 242-246. 3. Li, S., Francisco, G. E., & Zhou, P. (2018). Post-stroke hemiplegic gait: New perspective and insights. Physical Medicine and Rehabilitation Clinics of North America, 29(4), 719-735. 4. Hatem, S. M., Saussez, G., Della Faille, M., Prist, V., Zhang, X., Dispa, D., et al. (2016). Rehabilitation of motor function after stroke: A multiple systematic review focused on techniques to stimulate upper extremity recovery. Frontiers in Human Neuroscience, 10, 442. 5. Garrison, K. A., Winstein, C. J., & Aziz-Zadeh, L. (2010). The mirror neuron system: A neural substrate for methods in stroke rehabilitation. Neurorehabilitation and Neural Repair, 24(5), 404-412. 6. Thieme, H., Morkisch, N., Mehrholz, J., Pohl, M., Behrens, J., & Dohle, C. (2018). Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews, 7, CD008449. 7. Broderick, P., Horgan, F., Blake, C., & O'Keeffe, M. (2022). Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis. Clinical Rehabilitation, 36(4), 437-453. 8. Veerbeek, J. M., van Wegen, E., van Peppen, R., van der Wees, P. J., Hendriks, E., Rietberg, M., et al. (2014). What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS ONE, 9(2), e87987. 9. Hornby, T. G., Reisman, D. S., Ward, I. G., Scheets, P. L., Miller, A., Haddad, D., et al. (2020). Clinical practice guideline to improve locomotor function following chronic stroke, incomplete spinal cord injury, and brain injury. Journal of Neurologic Physical Therapy, 44(1), 49-100.

  BACKGROUND

MeSH Terms

Conditions

Stroke

Condition Hierarchy (Ancestors)

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

Central Study Contacts

Muhammad Ammar Muhammad Ammar, DPT, MS-PT NPT

CONTACT

+923138092081; ammarkhanazxc36@gmail.com

Dr Nazish Rafique, DPT, MS-PT NMPT

CONTACT

+923002132436; nazish.rafique@uipt.iiui.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Two-arm parallel group randomized controlled trial
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: Parallel Assignment

Study Record Dates

• First Submitted: July 6, 2026
• First Posted: September 1, 2026
• Study Start: April 15, 2026
• Primary Completion: September 20, 2026
• Study Completion: September 25, 2026
• Last Updated: September 1, 2026

Record last verified: 2026-05

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)