Investigating the Efficacy of Combining Virtual Reality-Based Mirror Therapy (VRMT) and Transcranial Direct Current Stimulation (tDCS) to Improve Upper Limb Recovery in Patients with Stroke

Fugl-Mayer Upper limb assessment (FMA)

FMA is a performance-based impairment measure particular to strokes, designed to assess motor functioning, balance, sensory, and joint functionality. It consists of five domains, which have 155 total items. The full potential scale score is 226. Scale items are scored based on the ability to finish the item using a 3-point ordinal scale. Motor score: from 0 to 100, 66 points for the upper extremity and 34 points for the lower extremities.

Wolf motor function test (WMT)

WMT, consisting of timed and practical tasks, measures the motor function of the upper extremity (UE). The WMFT has 17 items in the most common version. The first six items involved timed functional tasks; items 7 and 14 were strength tests, and the final nine analyzed the participants' movement quality while carrying out various tasks. Items scored on a 6-point scale, with lower scores indicating lower levels of functioning.

box and blocks test (BBT)

BBT assesses manual dexterity of the hand. It requires subjects to lift and release 2.5 cm³ cubes to move them from one compartment to another. BBT comprises 150 blocks. The test should begin with the unaffected upper limb to practice and record baseline values. The score is defined as the number of blocks transferred correctly within 60 seconds.

Nine-Hole Peg Test (NHPT)

NHPT was developed to assess finger dexterity. It is made up of a nine-peg square board. The board has holes on one end for the pegs to fit into, and it also has a shallow circular dish on the other for storing the pegs. The patient is instructed to quickly insert the pegs into the holes on the board after taking each one out of a container as part of the NHPT. Then, one by one, clients must bring the pegs out of the holes and put them back into the container. Scoring is according to how long it took them to finish the test activity, measured in seconds.

Stroke impact scale-16 (SIS-16)

SIS is a self-report health status measure specific to the stroke population. It consists of 16 items from the four physical domains (strength, hand function ADL/IADL, and mobility).

transcranial magnetic stimulation (TMS)

TMS measures cortical excitability, which is non-invasive magnetic stimulation using brief-duration, fast-pulsating, or pulsed magnetic fields to induce electrical currents targeted at spatially separate parts of the cerebral cortex using a computerized, electromechanical medical device.

Functional magnetic resonance imaging (fMRI)

fMRI technique uses MRI technology to evaluate brain activity by looking for variations in blood flow. The coupling between cerebral blood flow and neuronal activation is the basis for this method. The participants will be trained on the task before the experimental session. A block design will be used in the fMRI scan; each fMRI scan lasts for 6 minutes, divided into six blocks with an interval of 30 seconds of task, 15 repeated contractions, each contraction lasting 2 seconds, interspersed with 30 seconds of rest.