Effects of Modified Constraint-Induced Movement Therapy and Mirror Therapy in Hemiplegic Stroke

The purpose of this study is to investigate and compare the effects of Modified Constraint-Induced Movement Therapy (mCIMT) and Mirror Therapy (MT) on upper extremity motor functions, activity participation, and independence in daily living activities among hemiplegic stroke patients. Participants diagnosed with stroke will be randomly assigned to intervention groups. The study aims to determine which therapeutic modality provides a higher contribution to the functional recovery of the paretic upper limb and overall quality of life.

Inclusion Criteria: * \* Diagnosis: Confirmed first ischemic or hemorrhagic stroke with clinical and neurological evaluation. * Time Since Stroke: 3 to 24 months post-stroke onset. * Hemiplegia: Significant motor deficit in the affected upper extremity. * Motor Function Level: Presence of mild to moderate motor impairment in the affected upper extremity (FMA-UE score appropriate for the application of modified CIMT and mirror therapy). * Cognitive Status: Adequate cognitive capacity to understand and follow the study protocols (Mini-Mental State Examination score of 20 or above). * Visual Perception: Adequate visual perception to perform mirror therapy. * Comorbidities: Absence of severe coexisting medical conditions that prevent participation (e.g., uncontrolled cardiovascular diseases, severe psychiatric disorders). * Prior Treatments: No prior intensive participation in the interventions investigated in this study (modified CIMT or mirror therapy). * Consent: Voluntary agreement to participate and signed informed consent form. Exclusion Criteria: * \* Uncontrolled diabetes or other metabolic disorders. * Progressive non-stroke neurological diseases (e.g., Parkinson's disease, multiple sclerosis). * Terminal illness or short life expectancy. * Severe cognitive impairment preventing comprehension or execution of the study protocols (e.g., advanced dementia). * Severe visual impairment that prevents mirror therapy application (e.g., uncorrected visual acuity loss, neglect). * Severe visuospatial perception disorders making it difficult to perceive or interpret the mirror image. * Absence or minimal level of active movement in the affected upper extremity (limiting the applicability of modified CIMT). * Significant motor deficit in the unaffected upper extremity. * Severe and uncontrolled spasticity in the upper extremity.