Telerehabilitation Based Motor Relearning Program and Telerehabilitation Based Conventional Physical Therapy in Stroke

Several recent studies have demonstrated the effectiveness of telerehabilitation in stroke rehabilitation. An umbrella review published in 2024 evaluated systematic reviews and meta-analyses conducted between 2010 and 2023 and concluded that telerehabilitation is effective in enhancing mobility, upper limb function, and balance in post-stroke patients. The review also emphasized the technology's role in increasing access to rehabilitation services and reducing treatment delays, especially in rural or underserved areas. The findings support the integration of telerehabilitation into standard stroke care practices.

A randomized controlled trial conducted in 2023 on 60 post-stroke patients compared home-based telerehabilitation with traditional outpatient therapy over an 8-week period. Participants in both groups demonstrated significant improvements in the Berg Balance Scale (BBS) and Fugl-Meyer Assessment (FMA) scores. However, the telerehabilitation group reported slightly higher patient satisfaction and adherence, indicating that home-based telerehabilitation is a feasible and effective alternative for improving motor function and balance in stroke survivors.

A longitudinal observational study published in 2022 involving 120 individuals in the subacute and chronic phases of stroke recovery explored balance recovery mechanisms. The findings showed that balance impairments are most responsive to intervention within the first six months after stroke, corresponding with a heightened period of neuroplasticity. The study highlighted the importance of early, structured, and task-specific rehabilitation during this critical phase, supporting the potential application of the Motor Relearning Program (MRP).

A pilot study published in 2021 evaluated the feasibility of delivering task-specific therapy through telerehabilitation using video conferencing. The intervention included functional training exercises for 25 stroke patients aged 45-70 years over six weeks. Significant improvements were observed in trunk control, sit-to-stand transfers, and walking ability, with positive participant feedback and no reported adverse events. The findings suggest that telerehabilitation can effectively deliver neurophysiological principles such as motor learning.

A clinical trial conducted in 2020 involving 40 subacute stroke patients assessed the effectiveness of task-specific training based on the Motor Relearning Program (MRP). Participants performed repetitive, goal-oriented functional tasks, including transfers and walking. After four weeks, the intervention group demonstrated significant improvements in trunk control and balance compared with the group receiving standard physiotherapy, indicating that MRP is highly effective in improving motor control and coordination when delivered in person.

A systematic review published in 2020 examined 22 randomized trials investigating telerehabilitation interventions for stroke recovery. The findings indicated that telerehabilitation was non-inferior to conventional in-clinic therapy in improving gait, balance, and upper limb function. The review further emphasized that structured and patient-specific telerehabilitation is particularly beneficial during the subacute stage when recovery potential is highest.

A controlled trial published in 2017 assessed the effectiveness of telerehabilitation in improving motor function after stroke. Fifty stroke patients aged 40-70 years were randomly assigned to either a telerehabilitation group or a conventional therapy group. After eight weeks, both groups showed significant improvements in motor function, while the telerehabilitation group achieved superior balance outcomes, demonstrating the effectiveness of remotely delivered motor-focused interventions.

A foundational publication in 2015 described the theoretical framework of the Motor Relearning Program (MRP). The program emphasizes active participation, task analysis, and repetitive practice to retrain functional movements. Based on principles of motor control and neuroplasticity, MRP is considered particularly effective for post-stroke patients during the recovery period of 3-12 months. Although widely accepted for face-to-face rehabilitation, its application through digital platforms remains underexplored.

Another meta-analysis published in 2015 evaluated telerehabilitation programs for stroke patients and concluded that while telerehabilitation improves overall function, many interventions lacked specificity and did not incorporate evidence-based motor learning principles. The findings highlighted the need to strengthen telerehabilitation frameworks through structured approaches such as the Motor Relearning Program.

Despite the increasing adoption of telerehabilitation in post-stroke care, notable gaps remain in the current body of research. No study to date has directly compared conventional telerehabilitation programs, which are typically based on general physiotherapy principles, with telerehabilitation approaches specifically structured around the Motor Relearning Program. While existing evidence supports the use of general telerehabilitation in improving motor function, balance, and participation among stroke survivors, these programs often lack the task-specific, neuroplasticity-driven framework that defines the Motor Relearning Program. Separately, MRP-based interventions delivered in clinical settings have demonstrated superior outcomes in balance, functional mobility, and motor recovery compared to routine therapy. However, a head-to-head comparison between conventional telerehabilitation and MRP-based telerehabilitation has not yet been explored in published literature. Furthermore, most existing studies are limited by small, homogenous sample sizes, non-standardized outcome measures, and the absence of long-term follow-up. The integration of advanced technologies such as wearable sensors and real-time feedback into telerehabilitation protocols also remains underdeveloped. These gaps highlight the urgent need for rigorous, comparative, and technology-integrated research to evaluate the effectiveness of structured, MRP-based telerehabilitation in diverse stroke populations.

Inclusion criteria

* Adults aged 40-70 years.

• Male or female participants.
• Diagnosed with ischemic or hemorrhagic stroke 3-12 months prior to enrollment.
• Medically stable and cleared to participate in physical rehabilitation.
• Mini-Mental State Examination (MMSE) score ≥24.
• Able to understand and follow verbal instructions.
• Have access to a smartphone, tablet, or computer with a stable internet connection for telerehabilitation sessions.
• Willing and able to provide written informed consent.

Exclusion criteria

* MMSE score <24 or severe cognitive impairment.

• Presence of other neurological disorders (e.g., Parkinson's disease or multiple sclerosis).
• Uncontrolled hypertension or recent cardiac event.
• Severe visual, auditory, or communication impairments that prevent participation.
• Currently enrolled in another structured rehabilitation program.
• Any musculoskeletal or medical condition that would interfere with safe participation in the intervention.