Digital Mirror Therapy in Stroke Rehabilitation

Summary

Background: While conventional mirror therapy is a Level A recommended rehabilitation for poststroke upper extremity recovery, digital mirror therapy-enabled by augmented reality and computer vision-offers a promising alternative with potential for greater engagement and enriched sensory feedback. However, systematic comparisons of their clinical and physiological benefits, alongside an understanding of patient experiences with digital therapy, are lacking.

Objectives: This randomized controlled trial will compare the efficacy of digital versus conventional mirror therapy for upper extremity rehabilitation in people after chronic stroke. The evaluation will focus on three areas: 1) clinical outcomes in motor function and community integration; 2) musculoskeletal physiological mechanisms, assessed through upper extremity muscle co-activation patterns; and 3) patient-reported barriers and facilitators to adherence with the digital technology. Methods: A parallel-group, assessor-blinded randomized controlled trial will be conducted. Participants with chronic stroke will be randomized to receive either digital or conventional mirror therapy three times per week for a total of 10 sessions over 21 days. The quantitative outcomes will be upper extremity function (using clinical scales), community integration (using a dedicated scale), and muscle activation/co-activation patterns during functional tasks (measured via surface electromyography \[EMG\]). The qualitative outcome will be patient-experienced barriers and facilitators, which will be explored through focus groups. Expected Results: This project aims to determine whether digital mirror therapy yields superior clinical outcomes compared to the conventional protocol. We hypothesize that greater improvement in upper extremity motor function will be associated with increased voluntary activation of task-relevant muscles and a reduction in abnormal co-contraction patterns. Furthermore, the qualitative findings will provide insights into the practical facilitators and barriers to patient adherence to digital technological rehabilitation, which will guide its future development and real-world clinical implementation.

Conditions

• Stroke

Interventions

BEHAVIORAL

digital mirror therapy

In the digital mirror therapy, we will use a self-developed digital visual feedback system to deliver the intervention. We will design 6-8 upper limb functional training tasks for each patient, according to the level of upper extremity functioning. Patients will complete these tasks under the guidance of the investigator during each training session. The digital mirror therapy will be delivered through an augmented reality system with virtual objects and enhanced visual feedback onto the patient's view of their affected upper extremity. Each task will be repeated 20 times per session, with the total duration of each session being approximately 45-60 minutes.

BEHAVIORAL

conventional mirror therapy

The conventional mirror therapy group will receive the identical dose and structure of training but using a physical mirror. The therapy will be performed using a conventional mirror and common physical objects for task-oriented practice. Both groups will participate three times per week in a maximal period of 21 days, for a total of 10 training sessions.

Sponsors & Collaborators

• The Hong Kong Polytechnic University

  lead OTHER

Principal Investigators

• Jack Jiaqi Zhang · The Hong Kong Polytechnic University

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

80 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2026-03-02

Primary Completion

2028-12-31

Completion

2028-12-31

Countries

• Hong Kong

Study Locations