Effects of Mirror Therapy and Motor Imagery on Upper Limb Motor Functions in Middle Cerebral Artery Stroke

This study will compare mirror therapy (MT) with motor imagery (MI), each added to routine Bobath-based physical therapy, to assess upper limb motor function and functional independence in patients with subacute middle cerebral artery (MCA) stroke. Upper limb dysfunction is a common and disabling consequence of MCA stroke, affecting reaching, grasping, manipulation and daily activities. Although MT and MI have each shown benefit, it is unclear which adjunct gives greater and longer-lasting improvement. A total of 36 adults aged 45-60 years will be randomly allocated 1:1 into an MT group or an MI group. Both groups will receive 3 supervised sessions per week for 6 weeks, followed by a 6-week home exercise program. Outcomes (Fugl-Meyer Assessment-Upper Extremity, Action Research Arm Test, Box and Block Test, Modified Barthel Index) will be assessed at baseline, post-intervention (Week 6) and follow-up (Week 12). The study aims to determine which intervention gives superior improvement in upper limb recovery.

Inclusion Criteria: * Patients of both genders aged 45-60 years * First-ever middle cerebral artery (MCA) stroke (ischemic or hemorrhagic) confirmed by CT/MRI * Stroke duration of 1-6 months * Presence of unilateral upper limb motor impairment * Brunnstrom stage II and above * Fugl-Meyer Assessment Upper Extremity (FMA-UE) score \< 47 * Montreal Cognitive Assessment (MoCA) \> 24 * Medically stable * Willing and able to provide written informed consent Exclusion Criteria: * Pre-existing upper limb dysfunction * Visual impairment or unilateral neglect * Severe cognitive impairment or depression * Other neurological disorders * Severe musculoskeletal disorders of the upper limb * Severe spasticity (Modified Ashworth Scale \> 3) * Serious uncontrolled medical conditions * Participation in another clinical trial * Refusal or inability to provide