Effects of Modified Constraint-Induced Movement Therapy and Mirror Therapy in Hemiplegic Stroke

Background and Rationale:

Upper extremity impairment is one of the most common and disabling consequences of stroke, severely limiting independence in daily living and restricting social participation. Neuroplasticity-based interventions, such as Modified Constraint-Induced Movement Therapy (mCIMT) and Mirror Therapy (MT), are widely recognized for their potential to facilitate cortical reorganization. However, comparative evidence regarding their specific impacts on multi-dimensional recovery patterns (motor function vs. activity integration) remains limited. This study aims to provide a comprehensive head-to-head comparison of mCIMT and MT in a structured clinical environment.

Methodology & Protocol:

This study is designed as a prospective, randomized, controlled, single-blind clinical trial. Following formal ethical approval (OMU KAEK 2025/640) and obtained informed consent, eligible hemiplegic stroke patients will be screened and randomly allocated into the intervention arms.

All participants will receive standard medical care and baseline conventional physical therapy. The intervention groups will be structured as follows:

Modified Constraint-Induced Movement Therapy (mCIMT) Group: Participants will have their unaffected upper extremity constrained using a specialized mitt or splint for a designated period daily, combined with intensive, repetitive, task-oriented training of the paretic upper limb.

Mirror Therapy (MT) Group: Participants will perform structured, bilateral upper extremity tasks while observing the non-affected limb's movements in a mirror box, creating a visual illusion of normal movement in the paretic limb.

Outcome Measures:

Assessment sessions will be conducted at baseline (pre-treatment) and immediately following the completion of the intervention protocol (post-treatment) by a blinded assessor. Upper extremity motor functions will be evaluated using standardized neurological and functional scales. Secondary outcomes will include clinical assessments of activity participation and the level of independence achieved in activities of daily living.

Inclusion criteria

• * Diagnosis: Confirmed first ischemic or hemorrhagic stroke with clinical and neurological evaluation.

• Time Since Stroke: 3 to 24 months post-stroke onset.
• Hemiplegia: Significant motor deficit in the affected upper extremity.
• Motor Function Level: Presence of mild to moderate motor impairment in the affected upper extremity (FMA-UE score appropriate for the application of modified CIMT and mirror therapy).
• Cognitive Status: Adequate cognitive capacity to understand and follow the study protocols (Mini-Mental State Examination score of 20 or above).
• Visual Perception: Adequate visual perception to perform mirror therapy.
• Comorbidities: Absence of severe coexisting medical conditions that prevent participation (e.g., uncontrolled cardiovascular diseases, severe psychiatric disorders).
• Prior Treatments: No prior intensive participation in the interventions investigated in this study (modified CIMT or mirror therapy).
• Consent: Voluntary agreement to participate and signed informed consent form.

Exclusion criteria

• * Uncontrolled diabetes or other metabolic disorders.

• Progressive non-stroke neurological diseases (e.g., Parkinson's disease, multiple sclerosis).
• Terminal illness or short life expectancy.
• Severe cognitive impairment preventing comprehension or execution of the study protocols (e.g., advanced dementia).
• Severe visual impairment that prevents mirror therapy application (e.g., uncorrected visual acuity loss, neglect).
• Severe visuospatial perception disorders making it difficult to perceive or interpret the mirror image.
• Absence or minimal level of active movement in the affected upper extremity (limiting the applicability of modified CIMT).
• Significant motor deficit in the unaffected upper extremity.
• Severe and uncontrolled spasticity in the upper extremity.