Effect of Virtual Reality on Cortical Reorganization and Upper Extremity Functional Recovery in Patients With Subacute Stroke

April 7, 2026 updated by: Mohammed Ramadan Ibrahim Mohammed, Cairo University

Effect Of Virtual Reality On Cortical Reorganization And Upper Extremity Functional Recovery In Patients With Subacute Stroke

The purposes of the study are:

  1. To investigate the effect of virtual reality in patients with subacute stage of Stroke on cortical reorganization.
  2. To investigate the effect of virtual reality in patients with subacute stage of Stroke on upper extremity functional recovery.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

40

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Egypt
      • Cairo, Egypt, 12613
        • Faculty of Physical Therapy, Cairo University, Egypt

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • • Age ranges from 50 to 65 years.

    • Both sexes (male and female).
    • First stroke ever (ischemic or hemorrhagic) within the last three months.
    • Clinical diagnosis of subacute stroke confirmed by neuroimaging (CT / MRI).
    • Hemiparetic shoulder power more than three according to Medical Research Council Scale (MRC) (James, 2007).
    • Patients who are able to manipulate the Wii remote control.
    • Muscle tone grade 1 to 1+ (Mild to Moderate) spasticity for shoulder joint according to Modified Ashworth Scale (Meseguer et al., 2018).
    • Participants are in normal cognitive and psychological status according to Montreal Cognitive Assessment screening (Hawkins et al., 2014).

Exclusion Criteria:

  • • Patients having severe arm or shoulder pain or symptomatic shoulder sublaxation.

    • Contractures or shoulder deformities.
    • Patients who have previous experience in using Wii.
    • Patients with problems that may interfere with using Wii suchas epilepsy, visual impairments, apraxia and/or spatial neglect

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Conventional physical therapy group ( Control Group ) ( Group I )

Patients will have conventional physical therapy program as follow :

Range of motion (ROM) and stretching begin with passive ROM to all joints of the upper limb (10 repetitions × 2 sets), followed by active-assisted ROM using a stick or the unaffected limb. Stretching is performed for 30-60 seconds, 3-5 repetitions.Strengthening exercises focus on isometric contractions of scapular stabilizers, deltoid, and biceps/triceps, holding 5-10 seconds × 10 repetitions, along with isotonic exercises using therabands or light weights (0.5-1 kg) for 8-12 repetitions × 2-3 sets. Activities of daily living (ADL) training involve self-care practices including grooming, eating, and buttoning, as well as task-specific training such as reaching, grasping, and releasing real objects. Each ADL task is practiced for 15-20 minutes, with 1-2 tasks per session.Scapular stability exercises include graded practice with large to small objects, bimanual training will be applied to both groups
Other: Conventional physical therapy program

Patients will have conventional physical therapy program as follow :

Range of motion (ROM) and stretching begin with passive ROM to all joints of the upper limb (10 repetitions × 2 sets), followed by active-assisted ROM using a stick or the unaffected limb. Stretching is performed for 30-60 seconds, 3-5 repetitions.Strengthening exercises focus on isometric contractions of scapular stabilizers, deltoid, and biceps/triceps, holding 5-10 seconds × 10 repetitions, along with isotonic exercises using therabands or light weights (0.5-1 kg) for 8-12 repetitions × 2-3 sets. Activities of daily living (ADL) training involve self-care practices including grooming, eating, and buttoning, as well as task-specific training such as reaching, grasping, and releasing real objects. Each ADL task is practiced for 15-20 minutes, with 1-2 tasks per session.Scapular stability exercises include graded practice with large to small objects, bimanual training (e.g., holding a bowl while stirring)
Experimental: Virtual reality group (Study group) (Group II)
This group will be treated by conventional physical therapy program in addition to virtual reality using Nintendo Wii Group II (study group) will receive the same treatment as group I in addition to exergaming technology using Nintendo Wii. The Wii program will be of game based VR movement therapy using the Wii for one hour each session. Three games will be selected from the Wii sports and Wii Fit packages for upper limb. Participants who could not grip the controller, a bandage will be used to fix the controller on to the affected hand. Games like; Tennis, Baseball, Golf club and Boxing. The patient will select three games from Wii sports (Tennis- Golf- Boxing-Baseball) then patients will be given a trial of playing each game to be familiar with it after that they will be given one hour practice 20 minutes for each game for six weeks and three times per week (18 sessions)
Other: Conventional physical therapy program

Patients will have conventional physical therapy program as follow :

Range of motion (ROM) and stretching begin with passive ROM to all joints of the upper limb (10 repetitions × 2 sets), followed by active-assisted ROM using a stick or the unaffected limb. Stretching is performed for 30-60 seconds, 3-5 repetitions.Strengthening exercises focus on isometric contractions of scapular stabilizers, deltoid, and biceps/triceps, holding 5-10 seconds × 10 repetitions, along with isotonic exercises using therabands or light weights (0.5-1 kg) for 8-12 repetitions × 2-3 sets. Activities of daily living (ADL) training involve self-care practices including grooming, eating, and buttoning, as well as task-specific training such as reaching, grasping, and releasing real objects. Each ADL task is practiced for 15-20 minutes, with 1-2 tasks per session.Scapular stability exercises include graded practice with large to small objects, bimanual training (e.g., holding a bowl while stirring)

Other: Virtual Reality
Twenty patients with subacute stroke will receive conventional physical therapy program and virtual reality through Nintendo Wii The patient will hold the Wii remote in his hand to move the Avatar on the screen and practice the exercise Figure.6. If the patient cannot hold the Wii remote in his hand it will be strapped to his hand. A full instruction according to every game will be explained to the patients explaining every game rules and how to perform and what is the goal of each game. The patient will have one trial in every game to perform before setting the time. Screen /projector will be positioned at eye level of each patient and a Chair for sitting or standing according to the patient, The patient will select three games from Wii sports (Tennis- Golf- Boxing-Baseball) then patients will be given a trial of playing each game to be familiar with it after that they will be given one hour practice 20 minutes for each game for six weeks and three times per week (18 sessions)
Other Names:
  • Exergaming using Nintendo WII

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Upper Extremity Functional Recovery
Time Frame: 6 months
Upper Extremity Functional Recovery will be assessed by Chedoke Arm and Hand Activity Inventory-7 item version (CAHAI-7). CAHAI-7 assesses the affected arm and hand during bilateral tasks by asking the person to complete seven specific activities. Each item of the CAHAI is scored on a 7-point quantitative scale ranging from 7 to 49, with higher scores reflecting greater functional recovery
6 months
Cortical Reorganization
Time Frame: 6 months
Cortical Reorganization will be assessed by Quantitative Electroencephalography (QEEG) QEEG indices can give meaningful prognostic information of motor and functional recovery in patients with stroke. Delta Alpha Ratio (DAR) and Delta Theta to Alpha Beta Ratio (DTABR) are quantitative EEG (QEEG) indices used to measure brain electrical activity. Lower values of DAR and DTABR are associated with better recovery in patients with brain injury.
6 months
Gross manual dexterity
Time Frame: 6 months
Gross manual dexterity will be assessed by Box and Block test (BBT). BBT contains a wooden box that is divided into two sections and the patient is asked to move the blocks from one side of to the other side. The BBT score represents the number of blocks successfully moved from one side of the box to the other within 60 seconds. A higher score indicates greater manual dexterity
6 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cairo University

Investigators

  • Study Chair: ABEER ABO BAKR ABDELKADER ELWISHY ELWISHY, Professor of Physical Therapy, Cairo University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

May 1, 2026

Primary Completion (Estimated)

November 30, 2026

Study Completion (Estimated)

December 30, 2026

Study Registration Dates

First Submitted

December 31, 2025

First Submitted That Met QC Criteria

April 7, 2026

First Posted (Actual)

April 9, 2026

Study Record Updates

Last Update Posted (Actual)

April 9, 2026

Last Update Submitted That Met QC Criteria

April 7, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • P.T.REC/012/006118

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Because of patients privacy

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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