Mirror vs Virtual Reality Therapy for Upper Extremity Function in Hemiplegic Patients

Fugl-Meyer Assessment for Upper Extremity (FMA-UE)

The Fugl-Meyer Assessment is a standardized and widely used tool designed to evaluate motor function, balance, sensation, and joint functioning in individuals with post-stroke hemiplegia. In this study, only the upper extremity motor domain will be used, which includes evaluation of movement, coordination, and reflex action of the shoulder, elbow, forearm, wrist, and hand. The assessment is scored on a 3-point ordinal scale: 0 (cannot perform), 1 (performs partially), and 2 (performs fully), with a maximum score of 66 indicating better motor recovery. Participants are seated or lying in a comfortable position during the test, and each movement is explained and demonstrated. The researcher scores the quality and completion of each movement. The FMA-UE is a valid and reliable measure of motor function and is widely used in stroke rehabilitation research

Box and Block Test (BBT)

The Box and Block Test (BBT) is a standardized assessment of unilateral gross manual dexterity. Participants are instructed to transfer as many wooden blocks as possible from one compartment of a box to the other within 60 seconds using one hand. The number of successfully transferred blocks is recorded as the score. The test is widely recognized for its simplicity, reliability, and sensitivity in detecting changes in motor function, especially in post-stroke patients. In this study, the BBT will be used to evaluate changes in upper extremity motor performance and coordination immediately before and after the intervention session.

Modified Ashworth Scale (MAS)

The Modified Ashworth Scale (MAS) is used to assess muscle spasticity by measuring resistance during passive soft-tissue stretching. It is a reliable clinical tool commonly used in neurological rehabilitation settings, especially in stroke patients. During the assessment, the target limb is passively moved through its range of motion, and the resistance to movement is rated on a 6-point scale ranging from 0 (no increase in muscle tone) to 4 (affected part rigid in flexion or extension). Participants are placed in a neutral and relaxed position during testing to ensure consistency. The evaluation will be conducted on the upper extremity muscles involved in voluntary function, and changes in MAS scores will be recorded to determine immediate effects of the intervention on spasticity levels.

joint Position Sense Test (Proprioception Assessment)

The Joint Position Sense Test assesses proprioceptive accuracy by evaluating a participant's ability to replicate specific joint angles with the opposite limb while blindfolded or with eyes closed. For this study, the test involves passive positioning of the affected upper limb at predetermined target angles (e.g., 60° and 100° of shoulder flexion), which participants will then attempt to match with the contralateral limb. The difference in angle reproduction is used as a measure of proprioceptive acuity. This method provides insight into sensorimotor integration deficits common in hemiplegic patients and will be used to assess changes before and after the intervention

Simple Reaction Time (SRT) with BlazePod

Simple Reaction Time (SRT) is a measure of how quickly an individual responds to a single stimulus. In this study, SRT will be evaluated using BlazePod light pods, which emit visual cues in a random sequence. Participants, seated comfortably with their hands resting near the pods, will be instructed to tap the lit pod as quickly as possible upon activation. The device records the reaction time in milliseconds. This test provides valuable information about the efficiency of sensorimotor integration and central processing speed. It is particularly relevant in stroke rehabilitation, where improvements in reaction time often correlate with better functional recovery.

Global Rating of Change (GRC) scale

The Global Rating of Change (GRC) scale is a subjective measure used to evaluate a patient's perceived improvement or deterioration in their health status over time. It is particularly useful in musculoskeletal and neurorehabilitation studies. In this study, participants will be asked to compare their current condition to their pre-treatment condition immediately after the therapy session. The version used includes a 5-point Likert scale ranging from -2 to +2, where: -2 = much worse, -1 = slightly worse, 0 = no change, +1 = slightly better, and +2 = much better. This simple, patient-centered outcome allows us to capture overall satisfaction and perceived effectiveness of the therapy from the patient's perspective.