A New Approach to Rehabilitating Movement in Stroke: Evidence-based Approaches

A New Approach to Rehabilitating Movement in Stroke: Evidence-based Approaches

A New Approach to Rehabilitating Movement in Stroke: Evidence-based Approaches

May 5, 2023

Advancements in technology have led to the development of new approaches to rehabilitation aimed at reducing paralysis, restoring movement, and improving outcomes in stroke patients. Studies have proved the effectiveness of these approaches. Among the novel approaches are mirror therapy, biofeedback therapy, robot-assisted therapy, restrictive-forced motion therapy, virtual reality, telerehabilitation, and transcranial magnetic stimulation treatments.

Mirror Therapy

This approach uses visual feedback on motor performance to enhance the effectiveness of therapy. In mirror therapy, visual inputs to the premotor area of the brain – primarily responsible for learning – are reorganized, thereby increasing sensory signals and motor performance. Preventing learned disuse is an effective way to accelerate neuroplasticity.

Mirror therapy is effective on mirror neurons, which are activated when a specific action is actively performed or when a similar activity is passively observed by someone else. During mirror therapy, a mirror is placed between the hemiplegic and healthy limbs, with the hemiplegic limb behind the mirror. The patient is asked to move the healthy limb, which then activates the affected hemisphere by observing the movement of the healthy limb. The intact hemisphere then transmits a stimulus to the affected hemisphere, creating a perception of movement in the hemiplegic limb. By providing a feeling of painless movement in the hemiplegic limb, the patient is encouraged to perform the same movement with the hemiplegic limb. However, a study conducted by Demirbas et al. on 53 stroke patients determined that adding mirror therapy to the study group for 30 minutes five days a week for four weeks did not contribute to motor recovery.

Biofeedback Therapy

This approach transforms the contractions and movements of the muscles into visual and auditory signals with the help of electronic devices, providing information about the muscles’ normal or abnormal physiological events. This phenomenon enables the individual to be aware of their body functions and to change them voluntarily using the information provided. Myoelectric signals are converted into visual and auditory signals and transmitted to the patient, making the stroke patient aware of the immobility in their extremities. The patient can regain functional mobility in the affected extremity by activating the paretic muscle. 

Robot-Assisted Therapy

Robots used in robot-assisted therapy are devices that make predetermined movements, have many functions, can be programmed, have various shapes and sizes, and are different from each other in terms of systems developed for rehabilitation purposes. In robot-assisted therapy, the robot helps the patient who cannot perform the specified movement by making them move, directing their movement, ensuring the repetition of the movement, and increasing the patient’s motivation. The person applying the treatment can also observe the patient. Robots developed for the rehabilitation of the lower extremities after a stroke have been designed to restore and increase the mobility of the affected extremity by increasing muscle strength. Robots developed to provide a balanced gait for the patient after a stroke can be examined in two ways: manual-assisted walking on the treadmill and robot-assisted gait rehabilitation. Manual-assisted walking on the treadmill takes place with the help of a physiotherapist, and the body’s center of gravity is supported so that the individual can walk in a balanced way without sliding forward or backward. The deteriorated foot is corrected manually by the physiotherapist each time. In the robot-assisted walking rehabilitation approach, robotic devices are used, and the device automatically measures and records the patient’s condition. During the procedure, the patient is observed by the physiotherapist. 

Virtual Reality Approach

Virtual reality is used to rehabilitate physical and cognitive problems by allowing individuals to interact with computer-generated three-dimensional objects and animations, creating a realistic environment. Various physical and mental problems may occur after a stroke. Virtual reality therapy can be used to facilitate movement after a stroke.

In virtual reality treatment, a computer-based program system is used to create a lifelike environment. A virtual environment is created using a device attached to the user’s head and a projection system. The user can interact with the virtual environment created with these devices and engage in interactions such as visual, sensory, movement, balance, and even smell. The user can be fully or semi-active in this environment.


Telerehabilitation uses information and communication technology to transmit medical rehabilitation services over long distances. This method aims to reduce treatment and care expenses after discharge, save patients time and financial expenditure on travel, reduce hospital length of stay, and enable those living in rural areas to access clinical services.

The telerehabilitation approach is increasingly gaining interest as an alternative and cost-effective option for rehabilitation compared to traditional face-to-face treatment methods in-home care services. This rehabilitation method includes various services such as monitoring, intervention, supervision, training, counseling, and consultation.

Transcranial Magnetic Stimulation Therapy

Transcranial Magnetic Stimulation (TMS) is a therapeutic application that aims to regulate interactions between brain hemispheres. This is achieved by increasing the excitability of the affected cortex after a stroke or reducing the excitability of the unaffected cortex through inhibition. By doing so, TMS aims to correct abnormal inhibitory communication between the two hemispheres. The TMS approach is a potential treatment modality to increase motor function and cortical plasticity. This technique uses a stimulating coil to create a strong magnetic field and delivers a small and temporary electric current to the cerebral cortex. In this technique, a low-frequency magnetic field is applied to the unaffected hemisphere motor cortex, or a high-frequency magnetic field is applied to the affected hemisphere, changing regional activities in the cortex. This change is achieved by increasing blood flow to the region and revealing the metabolic changes occurring in that region. By stimulating the motor cortex beyond the motor threshold, muscle contraction and stimulation of the affected extremities can be achieved.

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