Comparison of the Acute Effects of Mirror Therapy and Virtual Reality Therapy on Upper Extremity Function and Performance in Hemiplegic Patients

This study aims to comprehensively investigate and directly compare the immediate neurophysiological and functional effects of two innovative neurorehabilitation techniques-mirror therapy and virtual reality (VR) therapy-on upper extremity motor function among patients with hemiplegia following stroke. A total of 42 participants diagnosed with hemiplegia post-stroke will be randomly assigned to either Group A or Group B. Each participant will receive a single, structured intervention session lasting 30 minutes, designed to promote immediate motor recovery through targeted neuroplasticity-enhancing tasks.

Group A : Mirror Therapy Protocol: Participants will be seated comfortably in a stable and ergonomically supportive chair. A mirror measuring approximately 40 cm by 50 cm will be strategically positioned along the mid-sagittal plane, effectively reflecting the unaffected limb and creating the visual illusion of bilateral symmetrical movements. This visual feedback aims to activate motor-related cortical regions within the affected hemisphere, thus enhancing immediate functional motor improvements. Participants will engage in structured therapeutic exercises, each carefully designed to target various aspects of upper limb motor function:

• Reaching Task: Participants will perform reaching movements towards standardized objects positioned at varying distances and spatial orientations. They will complete 3 sets of 10 repetitions, progressively challenging their spatial accuracy, visual-motor integration, and motor planning skills.
• Joint Range Movements: Participants will execute comprehensive movements involving finger flexion-extension, wrist flexion-extension, elbow flexion-extension, and shoulder flexion-abduction. Each movement will be repeated 10 times, systematically activating multiple joints and muscles to promote functional range of motion and coordination.
• Grasp and Release Exercises: Participants will complete grasping and releasing tasks with objects of different sizes, textures, and weights. This task includes 3 sets of 10 repetitions designed to enhance tactile feedback, grip strength, fine motor coordination, and functional hand dexterity.

Group B: Virtual Reality (VR) Therapy: Participants in the VR group will utilize advanced virtual reality equipment, including high-resolution VR headsets and handheld controllers, immersing themselves in an interactive, three-dimensional virtual environment. This environment is specifically developed to simulate realistic and engaging scenarios, enhancing ecological validity, motivation, and patient engagement through multisensory stimulation. Therapeutic tasks in the VR environment will mirror those in the mirror therapy protocol to facilitate direct comparative analysis:

• Virtual Reaching Tasks: Participants will perform interactive tasks, engaging in accurate reaching movements toward virtual targets displayed at various locations and distances within the virtual environment, emphasizing hand-eye coordination and spatial orientation.
• Virtual Joint Movements: Virtual tasks will guide participants through movements involving finger flexion-extension, wrist flexion-extension, elbow flexion-extension, and shoulder flexion-abduction. Visual and auditory cues in the VR environment will enhance proprioceptive feedback and facilitate precise motor execution.
• Virtual Grasp and Release Tasks: Participants will virtually grasp and manipulate various digital objects, practicing controlled grasp and release movements that mimic real-world functional tasks. Task complexity will vary to address different aspects of motor control, strength, and dexterity.