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

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)

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)