Virtual Reality-Based Mirror Therapy and FES-Cycling in Stroke Rehabilitation

Ankara City Hospital Bilkent60 enrolled

Overview

This randomized controlled, assessor-blinded study aimed to compare the effects of virtual reality-based mirror therapy (VRBMT) and functional electrical stimulation-assisted cycling (FES-cycling) when combined with conventional rehabilitation on upper extremity recovery in patients with stroke. Participants with first-ever stroke, unilateral hemiplegia, and upper extremity impairment within six months after stroke onset were randomly assigned to one of three groups: conventional rehabilitation alone, conventional rehabilitation plus VRBMT, or conventional rehabilitation plus FES-cycling. All participants received a four-week rehabilitation program. Upper extremity motor function, functional independence, use of the affected upper extremity in daily activities, and quality of life were assessed before and after the intervention.

Stroke frequently results in upper extremity motor impairment, leading to limitations in activities of daily living and reduced quality of life. Although conventional rehabilitation is the standard approach for improving motor recovery after stroke, technology-assisted rehabilitation methods have been developed to enhance neuroplasticity and functional outcomes. Virtual reality-based mirror therapy provides visual feedback and aims to stimulate motor relearning mechanisms, whereas functional electrical stimulation-assisted cycling combines repetitive movement with electrically induced muscle activation to support motor recovery. This randomized controlled, assessor-blinded study was designed to compare the additional effects of these two technology-assisted rehabilitation approaches when combined with conventional rehabilitation in patients with post-stroke upper extremity impairment. Participants were randomly assigned to three parallel treatment groups. Clinical assessments were performed before and after completion of the rehabilitation program by an assessor blinded to group allocation.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Interventions

Conventional RehabilitationOTHER

A conventional rehabilitation program including neurophysiological exercises, range of motion exercises, strengthening exercises, stretching exercises, balance and coordination training, and ambulation training.

Virtual Reality-Based Mirror TherapyDEVICE

Virtual reality-based mirror therapy was performed using the Neuroforma system. The intervention provided visual feedback to create an illusion of movement of the paretic upper extremity and aimed to support motor relearning.

Functional Electrical Stimulation-Assisted CyclingDEVICE

Functional electrical stimulation-assisted cycling was performed using the RT-300 system. Electrical stimulation was applied to targeted upper extremity muscles during cycling movements to facilitate repetitive motor activity.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age older than 18 years * First-ever stroke * Unilateral hemiplegia * Time since stroke onset ≤6 months * Upper extremity Brunnstrom recovery stage between 1 and 4 * Modified Ashworth Scale score \<3 in the affected upper extremity * Ability to maintain sufficient sitting balance Exclusion Criteria: * Visual impairment * Contraindication to electrical stimulation, including cardiac pacemaker implantation * Cognitive impairment (Mini-Mental State Examination score \<25) * Severe aphasia preventing completion of clinical assessments * Presence of additional neurological disorders, including Parkinson's disease, Alzheimer's disease, multiple sclerosis, neuromuscular junction disorders, motor neuron disease, or peripheral nerve lesions * Neglect syndrome * Orthopedic conditions affecting upper extremity function, including amputation or joint contracture * Severe cardiac disease * Uncontrolled hypertension * Epilepsy * Psychiatric disorders such as schizophrenia or bipolar disorder * Pregnancy or suspected pregnancy * Acute deep vein thrombosis or thrombophlebitis * Local infection at the treatment site

Outcomes

Primary Outcomes

Change in Upper Extremity Motor Function Assessed by the Fugl-Meyer Assessment

Upper extremity motor function was evaluated using the upper extremity section of the Fugl-Meyer Assessment (FMA-UE). The FMA-UE assesses motor impairment of the affected upper extremity, with total scores ranging from 0 to 66. Higher scores indicate better upper extremity motor function. Change from baseline to the post-treatment assessment was calculated as the post-treatment score minus the baseline score.