COMPARATIVE EFFECTS OF ACTIVITY-BASED MIRROR TRAINING WITH OR WITHOUT RHYTHMIC AUDITORY STIMULATION TO IMPROVE LOWER EXTREMITY FUNCTIONS IN SUBACUTE STROKE PATIENTS: A RANDOMIZED CONTROLLED TRIAL

Background: Stroke is a leading cause of long-term disability worldwide, with lower limb impairments often resulting in reduced mobility, impaired balance, and loss of independence. Rehabilitation strategies targeting the restoration of motor function and gait are therefore essential to improve quality of life and reintegration into daily activities. Mirror therapy has been recognized as an effective approach to enhance motor recovery, while rhythmic auditory stimulation provides external cues that may further facilitate gait symmetry and walking performance. Objective: The purpose of this study was to compare the effects of activity-based mirror training (ABMT) with and without rhythmic auditory stimulation (RAS) on lower extremity function in subacute stroke patients. Methods: This randomized controlled trial was conducted at THQ Hospital Muridke, Sheikhupura, and Muhammad Ali Physiotherapy Clinic and Rehabilitation Centre, Lahore, between June and December 2023. A total of 40 participants were recruited using non-probability convenience sampling, of which 36 completed the study. Participants aged 45–65 years with unilateral hemiplegia in the subacute phase were randomized into two groups using a flip coin method. Group A received ABMT with RAS, while Group B received ABMT without RAS. Interventions were delivered in 30 sessions over six weeks. Outcomes were assessed at baseline and post-intervention using the Fugl-Meyer Assessment for the Lower Extremity (FMA-LE), the Rivermead Visual Gait Assessment (RVGA), and the 10-Meter Walk Test (10-MWT). Data were analyzed using SPSS version 26. Results: The mean age of participants was 55.66 ± 6.92 years. In the FMA-LE, scores improved from 14.16 ± 1.94 to 23.38 ± 1.78 in the ABMT with RAS group compared to 15.16 ± 2.00 to 22.00 ± 1.13 in the ABMT group (p = 0.015). The 10-MWT improved from 0.704 ± 0.224 m/s to 1.21 ± 0.178 m/s in the ABMT with RAS group versus 0.653 ± 0.230 m/s to 1.032 ± 0.144 m/s in the ABMT group (p = 0.001). RVGA scores decreased from 19.94 ± 4.56 to 12.61 ± 1.61 in the ABMT with RAS group, while the ABMT group improved from 21.77 ± 5.73 to 16.55 ± 4.39 (p = 0.003). Conclusion: Both interventions significantly improved motor recovery and gait function in subacute stroke patients. However, ABMT combined with RAS produced superior improvements in lower limb motor control, gait velocity, and gait quality, supporting its role as an effective adjunct to stroke rehabilitation programs.