IMMEDIATE EFFECT OF MOTOR IMAGERY MI ALONG WITH HAND ARM BIMANUAL INTENSIVE TRAINING HABIT ON UPPER EXTREMITY FUNCTION IN SUBJECTS WITH STROKE A RANDOMIZED CLINICAL TRIAL

Stroke is sudden loss of neurological functions caused by impaired perfusion of brain. Absence of ankle control is one of the most prevalent and challenging problem in rehabilitation following stroke . In some patients there is serious loss of strength in affected limb which makes it difficult to carryout exercises in paralytic limb and it also demotivates the patient. Patients with stroke have difficulty in sit to stand activity, standing, walking and weight bearing on affected limb as a result of pain, spasticity, muscle weakness, sensory problems and affected balance. Mirror therapy is a type of intervention in which mirror is placed in midsagittal plane to create a reflection of non affected limb to create an illusion as affected limb is moving normally. It helps to create an illusion as if affected limb is moving and thereby creating a beneficial effects. Studies have been done which explains the beneficial effect in affected limb if resistance training of unaffected limb is done. So the purpose of this study is to find whether the resisted ankle dorsiflexor exercises augment the effect of mirror therapy in motor recovery of stroke patients or not. Also to check whether there is any immediate effect of combination of mirror therapy and resisted ankle exercises on motor outcomes and functional mobility in post stroke patients. There is a need to check whether the participant feels that the movement is happening in affected limb or not during the session. Therefore there is also a need to assess the generation of the sense of agency during the session. To carry the reseach work prior permission of Institutional Ethics Committee will be taken. Subjects will be randomly assigned into two groups using computerized randomisation chart, Group A and Group B. Group A will undergo mirror therapy with resisted ankle dorsiflexor exercises and Group B will undergo mirror therapy alone. Pre intervention assessment of both the groups will be done which includes- Active and passive range of motion using standardized universal goniometer, Modified Tardieu Scale, Timed up and go test, walking velocity using 10 meter walk test. Additionally measurement sense of agency will be evaluated using visual analogue scale of both the group. If the data is normally distributed then parametric tests like paired and unpaired t-tests will  be used and if the data is not normally distributed then non parametric tests like Mann-Whitney U test and Wilcoxon signed-rank test will be used for intra and inter group analysis.