Clinical comparison of the contribution of functional electrical stimulation cycle ergometer and virtual reality based mirror therapy to functionality in stroke patients undergoing conventional upper extremity rehabilitation

Aim: With this single-blind prospective randomized study, we aimed to examine the effects of virtual reality based mirror therapy (VR-MT) and functional electrical stimulation cycle ergometer (FES-cycle) applied in addition to conventional rehabilitation (CR) in stroke patients in the acute and subacute stages to improve plegic upper extremity motor and sensory functions, spasticity, range of motion, activities of daily living and quality of life. Materials and Method: Our study was carried out in Ankara Bilkent City Hospital between May 2021 and February 2023. 60 patients who met the inclusion criteria were divided into 3 groups with 20 patients in each group by simple randomization method. CR including neurophysiological approach, range of motion (ROM), stretching, strengthening exercises and occupational therapy was applied to all patients who participated in the study for 40 minutes daily, 5 days a week, for 4 weeks. VR-MT and FES-cycle treatments were administered by the physician who conducted the study in a total of 20 sessions. VR-MT was applied for 15 minutes, and FES-cycle was applied starting with 13 minutes and gradually increasing to 25 minutes starting from the 13th session. Before treatment and at the end of the 4 week treatment, Brunnstrom recovery stages (BRS), Fugl Meyer motor assessment (FM), superficial sensation-light touch and deep/cortical sensation examination, functional independence measure (FIM), modified Ashworth scale (MAS), motor activity log-28 (MAL-28), short form-36 survey (SF-36) and pain-free passive ROM scales were evaluated by a blinded evaluator. Results: In our study, BRS, FM, FIM, MAL-28 and SF-36 scores improved statistically in all 3 groups. Elbow flexion spasticity in CR group and elbow, wrist and finger flexion spasticity in FES-cycle group increased statistically. Shoulder ROM in the CR group and shoulder, elbow and wrist ROM in the VR-MT group increased statistically. No statistically significant difference was observed in any parameter except SF-36 in the comparison of post-treatment evaluations and differences in change between groups, but the improvement in BRS, FM and FIM parameters was greater in the FES-cycle group compared to CR. In the comparison of the SF-36 subscales between the groups after treatment, statistical significance was found in favor of the FBE group compared to the CR and SGTAT groups. Conclusion: Best of our knowledge, this is the first study to compare VR-MT and FES-cycle treatments applied to the upper extremities of stroke patients with CR and each other. No statistically significant superiority of SGTAT or FBE treatment was found compared to CR in improving upper extremity motor and sensory functions, spasticity, upper extremity range of motion and activities of daily living in stroke patients. However, the best improvement in upper extremity motor function, functionality and activities of daily living was observed in the FES-cycle group. Although both methods were found to be statistically superior to CR in improving quality of life, FES-cycle treatment was found to be more effective. Keywords: Cycle ergometer, Functional electrical stimulation, Hemiplegia, Mirror therapy, Stroke rehabilitation, Upper extremity rehabilitation, Virtual reality