Comparison of the effectiveness of mirror therapy and mirror mode of a hand robot in upper extremity motor recovery after stroke

The aim of our study was to compare the effectiveness of mirror therapy and the mirror mode of a hand robot (soft robotic glove) as therapeutic interventions for improving upper extremity motor function after stroke. Thirty subacute stroke patients with severe motor deficits were randomly assigned to two groups: Group I – Hand Robot Group (n=15) and Group II – Mirror Therapy Group (n=15). Both groups received therapy sessions for 6 weeks, 5 days per week, 30 minutes per day, in addition to 60 minutes of conventional physiotherapy each day. Motor function was assessed using the Fugl-Meyer Assessment Upper Extremity Motor Subscale (FMA-UE Motor), while motor skills were assessed using the Box and Block Test (BBT), the Wolf Motor Function Test (WMFT), and the Action Research Arm Test (ARAT). No statistically significant difference was found between the groups at baseline. Group I began treatment at a mean of 12.13 ± 17.98 days post-stroke, while Group II started at 18.29 ± 14.92 days. Both groups demonstrated significant improvements in all outcome measures after the intervention. Between-Group comparisons revealed statistically significant differences in favor of the Hand Robot Group in FMA-UE Motor (p=0.002; r=0.57), ARAT (p=0.001; r=0.61), and WMFT (p=0.019; r=0.42), with medium-to-large effect sizes. However, no significant differences were found between groups in BBT and FMA-UE Sensory subscale scores (p=0.569 and p=0.717, respectively). After dichotomizing the outcome scores based on the Minimal Clinically Important Difference (MCID) thresholds of the scales with established MCID values (FMA-UE Motor, WMFT, and ARAT), a statistically significant motor improvement with a medium effect size was observed only in the Hand Robot Group for the FMA-UE Motor score (p=0.025, Cramer's V=0.47). These findings indicate that integrating combined approaches, such as mirror therapy principles combined with a hand robot, with conventional rehabilitation program is effective in promoting upper extremity motor function recovery after stroke. While the six-week therapy period resulted in clinically significant improvements in motor function in the Hand Robot Group, no significant differences were observed between the groups in terms of motor improvement at the activity level. June 2025, 102 pages. Keywords: Stroke rehabilitation, robotic rehabilitation, mirror therapy, upper extremity motor recovery, soft robotic glove