This randomized controlled trial aims to evaluate the effects of mirror therapy combined with conventional training on gait and lower limb motor function among post-stroke patients. Stroke remains a worldwide health crisis, persistently ranking as a leading cause of long-term severe disability. The study will evaluate the gait and lower limb motor function.
Diagnosed with the first-ever unilateral stroke.
Duration of stroke between 3 months and 6 months (subacute to chronic stage).
Both male and female patients aged 40 to 70 years.
Ability to walk at least 10 meters independently.
Severe cognitive impairment, perceptual deficits, or inability to follow simple verbal commands (e.g., severe aphasia or low MMSE score).
Presence of other neurological disorders affecting motor performance such as Parkinson's disease, multiple sclerosis, traumatic brain injury, or cerebellar disorders.
Severe musculoskeletal disorders of the lower limb, including fracture, contracture, severe osteoarthritis, or pain limiting participation in exercise.
Uncontrolled medical conditions such as unstable hypertension, uncontrolled diabetes mellitus, a recent cardiac event, or other conditions making exercise unsafe.
Parallel
Mirror Therapy Based Functional Training
Other intervention(Basic) - Sitting position: * Ankle dorsiflexion/plantarflexion (simulating pressing a gas pedal) * Knee extension/flexion (simulating kicking a ball) * Hip flexion/extension (simulating marching) * Ankle circling in both directions (Intermediate)-Sitting to standing transition: * Performing "stepping" movements while seated * Simulated sit-to-stand movements focusing on weight transfer observed in the reflection * Sliding the foot forward and backward along the floor (simulating the swing phase of gait) * Heel slides (Advanced) - Standing position: * Heel raises and toe raises in standing * Weight shifting between limbs observing symmetry in the mirror * Mini squats and half squats with mirror feedback * Stepping forward, backward, and laterally * Tracing shapes or following a moving target with the foot * Practicing coordinated ankle movements essential for navigating uneven terrain.
Conventional Lower Limb Training
Other interventionPassive and active-assisted range of motion exercises for hip, knee, and ankle joints of the affected limb * Bridging exercises * Ankle dorsiflexion/plantarflexion against manual resistance or TheraBand * Seated knee extension * Mini squats * Heel raises * Straight leg raises * Weight shifting in standing (side-to-side and front-toback) * Sit-to-stand transfers * Tandem standing * Single-leg stance (with support as needed) * Standing on foam surface (if available) * Practice walking on level surfaces with emphasis on weight-bearing on affected limb * Focus on heel strike and push-off phases * Verbal cues for step length and symmetry * Gait speed variations (slow to moderate pace) * Gentle stretching of hamstrings, quadriceps, gastrocnemius, and soleus muscles
10-Meter Walk Test (10MWT)
This test measures gait speed (m/s) over a short distance and is a highly sensitive measure of functional walking ability. It has excellent test-retest reliability (ICC = 0.95 to 0.99) in individuals with chronic stroke and is considered a valid core outcome measure for gait recovery.
Timed Up and Go Test (TUG)
This test assesses functional mobility and dynamic balance by measuring the time (in seconds) it takes an individual to stand up from a chair, walk 3 meters, turn, walk back, and sit down. It demonstrates excellent reliability (ICC = 0.95) in the stroke population and is highly responsive to changes in mobility.
Fugl-Meyer Assessment for Lower Extremity (FMA-LE)
This is a stroke-specific performance-based impairment index used to quantitatively measure motor function, sensation, and coordination in the lower limb. It is widely regarded as the gold standard for assessing motor recovery after stroke, with high inter-rater reliability (ICC = 0.97).
Wisconsin Gait Scale (WGS)
This is a valid and reliable observational gait analysis tool specifically designed for the qualitative assessment of hemiplegic gait. It assesses 14 observable parameters across different phases of gait (e.g., stance, swing) and has high inter-rater (r = 0.91) and test-retest (r = 0.92) reliability in stroke patients (Rodriquez et al., 1996). The WGS was selected to capture the nuanced spatiotemporal improvements in gait pattern (e.g., step length, symmetry) that are clinically meaningful but may not be fully reflected in speed or timed tests alone.
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