The aim of the study is to investigate the comparison of the effects of mirror therapy, Repetitive Transcranial Magnetic Stimulation and robot-assisted hand therapy added to conventional neurological rehabilitation on upper extremity function, quality of life and pain in stroke.
Patients who applied to Afyonkarahisar Health Sciences University Hospital Physical Medicine and Rehabilitation Polyclinic with the diagnosis of hemiplegia after a cerebrovascular accident in the inpatient ward or as an outpatient for neurological rehabilitation after taking the anamnesis and physical examination, who met the inclusion criteria and eliminated the
Female and male patients between the ages of 40-80
stroke at least 3 months ago
voluntarily agreed to participate in the study regularly, whose health status is suitable for rehabilitation and who are medically stable
mini mental test score of 15 and above
Parallel
Procedure: Mirror therapy
Other interventionThe first group of participants will receive a total of 20 sessions of upper extremity mirror therapy program, 5 sessions per week for 4 weeks.
Device: Low Frequency rTMS Protocol
DeviceRepetitive Transcranial Magnetic Stimulation (rTMS) will be applied at an intensity of 100-110% of the resting motor threshold and low frequency (1 Hz) to the contralateral M1 upper extremity motor cortex region for a total of 20 sessions, 5 sessions per week for 4 weeks. rTMS application is planned to provide magnetic stimulation with the stimulator of the Magventure MagPro R30 device.
Robotic-assisted hand therapy
DeviceIn the Robot Assisted Therapy group, a total of 20 sessions will be applied 5 days a week for 4 weeks using continuous passive range of motion, active assistive exercise and play therapy programs for hemiplegic upper extremities with AMADEO (Tyromotion Austria).
Fugl Meyer Upper Extremity Assessment Questionnaire
The Fugl Meyer Upper Extremity Motor Assessment Scale was developed to quantitatively assess sensorimotor recovery after stroke. It was prepared based on Brunnstrom's stages of motor recovery. The FMUE Scale consists of 33 items, each scored from 0 to 2, where 0 = cannot perform, 1 = partially performs, and 2 = fully performs. The total score is 66. A range of data is available for the minimum clinically important differences for the FMUE Scale. A change of 4 to 7 points in chronic stroke, 12 points in subacute stroke, and 9 to 10 points is considered clinically significant.Higher scores indicate better upper limb functional recovery.
Brunnstrom Staging
It is a test that evaluates the motor development of hemiplegic participants. In this test, the neurophysiological recovery process of the hemiplegic participant is defined as 6 stages. According to this staging, the lowest stage is stage 1 (flaccid, stage without voluntary movement), and the highest stage is stage 6 (stage with isolated joint movement). In Brunnstrom staging, the hand and upper extremity are evaluated separately.
Mini Mental Test
It is a widely used cognitive screening test. The total score is 30 points. It has been stated that scores below 15 indicate low cognitive function, scores between 15-26 indicate medium, and scores above 26 indicate high cognitive level.
Modified Ashworth Scale
The modified Ashworth scale is a muscle tone assessment scale used to assess the resistance experienced during passive range of motion, which does not require any instrumentation and is quick to perform.This scale grades the muscle tone from 0 (normal) to 4 (severe spasticity). Higher scores indicating sever spasticity.
Box Block Test
It is used to evaluate rough manual dexterity based on performance (time). 150 small wooden cubes are filled from the box with the participant's hand to be tested into the adjacent box. The participant is asked to throw one cube at a time into the semi-empty box. How many cubes are thrown in 60 seconds is counted. The result gives the score. How many cubes are thrown in 60 seconds is counted. The result gives the score. The higher the score, the higher the success rate.
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