Effects of combined mirror therapy and functional electrical stimulation on upper limb motor recovery in subacute stroke: A pilot controlled clinical study

Upper limb motor impairment remains one of the most disabling consequences following stroke, significantly limiting functional independence and quality of life. Despite advances in neurorehabilitation, recovery of the paretic upper limb is often incomplete. Mirror therapy (MT) and functional electrical stimulation (FES) have each demonstrated beneficial effects on motor recovery through different neurophysiological mechanisms. MT primarily facilitates cortical reorganization via visual feedback and activation of the mirror neuron system, while FES provides peripheral sensory input and assisted muscle activation. Recent research suggests that combining central and peripheral therapeutic approaches may enhance neuroplasticity; however, clinical evidence regarding the simultaneous application of MT and FES in subacute stroke remains limited. To explore whether the combination of mirror therapy and functional electrical stimulation may influence upper limb motor recovery in patients with subacute ischemic stroke compared with conventional therapy associated with mirror therapy alone. A controlled pilot clinical study included 30 patients with subacute ischemic stroke allocated into two parallel groups: mirror therapy plus functional electrical stimulation (MT+FES, n=15) and conventional therapy plus mirror therapy (CT+MT, n=15). Both groups received rehabilitation interventions for six weeks, five sessions per week. Outcome measures included Brunnstrom Motor Recovery Stages, Fugl - Meyer Assessment for the upper limb, Modified Ashworth Scale for spasticity, and the Bhakta hand function test. Assessments were performed at baseline and post -intervention. Results: Improvements in upper limb motor function were observed in both groups. The MT+FES group showed a greater magnitude of change in motor recovery and distal upper limb function, with more pronounced reductions in spasticity at the wrist and hand level. The findings suggest that simultaneous application of mirror therapy and functional electrical stimulation may contribute to improved upper limb motor recovery in patients with subacute stroke. These results should be interpreted as preliminary and warrant confirmation in adequately powered randomized controlled trials.