Combined Effects of Virtual Reality and Motor Imagery Techniques With Routine Physical Therapy in Post Stroke Patients

Not Applicable

Completed

Interventions: Other: Virtual Reality technique + Motor Imagery technique + Routine Physical Therapy
Other: Virtual Reality + Routine Physical Therapy
Other: Motor Imagery +Routine Physical Therapy

Brief Summary: Stroke a devastating neurological condition, causing severe neurological challenges such as balance issues, motor function and cognitive deficits among survivors and can cause disability and death. The use of Virtual Reality and Motor Imagery in rehabilitation of neurologic disorders is on the rise. In stroke patients, VR and MI combination has not been studied. This study aims to investigate the combined effects of Virtual Reality and Motor Imagery Techniques with Routine Physical Therapy in patients with post stroke patients.

Detailed Description: This randomized control trial will be conducted at Safi Hospital Faisalabad in 7 months after the approval of synopsis, involving a sample size of 75 participants selected through convenience sampling based on the inclusion criteria. Participants will be randomly assigned to three groups using lottery method, in which Group A, will receive Virtual Reality and Motor Imagery training in conjunction with routine physical therapy three days a week for 12 weeks. Group B will receive VR and routine physical therapy, supplemented by 10-15 minutes of cycling and walking and Group C will receive routine physical therapy with MI techniques, along with 10-15 minutes of cycling and walking.

Fugal-Meyer Scale will be used to motor function, Berg Balance Scale for balance and Barthel Index will be used to assess activities of daily living. Assessment will be carried out at baseline, 6th week, 8th week and at 12th week and at 16th week after the discontinuation of treatment. The data will be entered and analyzed by using SPSS 26

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Presence of aphasia, apraxia, and hemineglect
Serious cardiovascular disease (heart failure, arrhythmias, angina pectoris or myocardial infarction)
Cerebellar lesion
Multiple brain accidents
Muscular disorder effect upper and lower extremities
History of seizures or epilepsy.
Patients whose injury occurred fewer than 6 months previously, considering the expected time for spontaneous recovery;
Patients with associated disorders such as epilepsy, and sensory and perceptual deficits such as hemineglect and Pusher syndrome;
Patients with osteo degenerative disorders that would prevent participation in the games or that could influence the body balance; and individuals who had cognitive and communication disorders, affecting understanding, that could compromise performance in the games
Inability to commit to the study schedule or attend the required therapy sessions

Arm && Interventions

Group	Intervention	Description
Group A: (Virtual Reality technique + Motor Imagery technique + Routine Physical Therapy)	Virtual Reality technique + Motor Imagery technique + Routine Physical Therapy	Participants in this group will receive Virtual Reality (VR) for and Motor Imagery (MI) training with routine physical therapy for every alternate day (3 days per week) for 12 weeks. Total 45 minutes of session. Routine physical therapy protocol will be given for 30 minutes. VR techniques for 10-15 minutes MI techniques for 05-10 minutes
Group B: (Virtual Reality + Routine Physical Therapy )	Virtual Reality + Routine Physical Therapy	The VR system consisted of a wall-mounted display, a Nintendo Wii box, a Wii remote, and a Wii Fit board. The participants will be instructed to stand on Wii Fit board while interacting with the VR system and playing the selected games. Routine physical therapy protocol will be given for 30 minutes along with cycling and walking for 10-15 minutes. VR techniques for 10-15 minutes.
Group C: (Motor Imagery +Routine Physical Therapy)	Motor Imagery +Routine Physical Therapy	During the presentation of a video clip, patients will watch the video and afterwards try to do movement as same as shown in video. Routine physical therapy protocol will be given for 30 minutes along with Cycling and walking for 10-15 minutes MI techniques for 10-15 minutes

Primary Outcome Measures

Name	Time	Method
Barthel Index	16 weeks	Activities of Daily Living will be measured with Barthel Index. The Barthel Index for Activities of Daily Living is an ordinal scale which measures a person's ability to complete activities of daily living (ADL). A score of 95 or 100 (the Barthel Index was measured in 5-point increments between 0 and 100) was considered a favorable outcome.
Berg Balance Scale	16 weeks	The Berg Balance Scale (BBS) is used to objectively determine a patient's ability (or inability) to safely balance during a series of predetermined tasks. It is a 14 item list with each item consisting of a five-point ordinal scale ranging from 0 to 4, with 0 indicating the lowest level of function and 4 the highest level of function and takes approximately 20 minutes to complete.
Fugal-Meyer Scale	16 weeks	Motor Function will be measured with Fugal-Meyer Scale. Motor score: ranges from 0 (hemiplegia) to 100 points (normal motor performance). Divided into 66 points for upper extremity and 34 points for the lower extremity.

Secondary Outcome Measures

Name	Time	Method