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Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Rehabilitation Medicine Center, Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; [2023224020158@stu.scu.edu.cn](2023224020158@stu.scu.edu.cn) (S.L.); [jiayi@stu.scu.edu.cn](jiayi@stu.scu.edu.cn) (J.Z.); [xyprotk@g.ecc.u-tokyo.ac.jp](xyprotk@g.ecc.u-tokyo.ac.jp) (Y.X.)  \n2 Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, China  \n* [Correspondence: nicole@scu.edu.cn](Correspondence: nicole@scu.edu.cn); Tel.: +86-18980602263  \nAbstract  \nObjective: This study investigated the efficacy and neural mechanisms of robot-assisted mirror therapy (RMT) for post-stroke upper limb rehabilitation. RMT integrates the multimodal feedback of mirror therapy with robotic precision and repetition to enhance cortical activation and neuroplasticity. Methods: Seventy-eight stroke patients were randomly assigned to control, mirror therapy (MT), or RMT groups. All received conventional rehabilitation; the MT group additionally underwent mirror therapy, and the RMT group received robot-assisted mirror therapy combined with functional electrical stimulation. The primary outcome was the Fugl–Meyer Assessment for Upper Extremity (FMA-UE), with secondary measures including spasticity, dexterity, daily living, and quality of life. Functional near-infrared spectroscopy (fNIRS) was applied to assess cortical activation and connectivity at baseline, post-intervention, and one-month follow-up. Results: All groups showed significant time effects, though between-group differences were limited. Subgroup analysis revealed that patients at Brunnstrom stages I–II in the MT group achieved greater improvements in upper limb function, dexterity, and daily living ability. fNIRS findings showed enhanced activation in the right sensory association cortex and increased prefrontal–sensory connectivity. Conclusions: While all interventions improved motor outcomes, MT yielded slightly superior recovery associated with neuroplastic changes. RMT demonstrated high safety, compliance, and potential benefit for patients with severe motor deficits.  \nKeywords: stroke; upper limb; motor dysfunction; functional near-infrared spectroscopy (fNIRS); robot-assisted therapy; mirror therapy  \n1. Introduction  \nStroke, caused by an interruption of the blood supply or rupture of cerebral vessel in the brain, resulting in brain tissue damage [1] . Upper limb dysfunction affects 50–80% of patients in the acute phase, and nearly half of these cases become chronic disabilities [2] . Recently, Rehabilitation robotics and mirror therapy have gained significant traction worldwide for managing post-stroke upper limb impairment, with robust evidence increasing confirming their efficacy. MT, introduced in 1996 [3] for phantom limb pain and applied to hemiplegic patients in 1999 [4], has become a widely used intervention for post-stroke  \nupper limb rehabilitation [5] . It relies on visual feedback, creating an illusion of the affected limb’s movement by mirroring the unaffected side. This illusion induces bilateral motor attempts. facilitating neural retraining. MT has been demonstrated to promote a range of functional recoveries, including improvements in muscle tone [6], motor and hand function [7,8], coordination [8], and early rehabilitation outcomes, Furthermore, it also positively impacts psychosocial fa","cbCaidu9r9DGu1XW","https://ap.wps.com/l/cbCaidu9r9DGu1XW","pdf",1603260,21,"English","# Abstract\n# Introduction","[{\"question\":\"What was the objective of the robot-assisted mirror therapy study?\",\"answer\":\"To evaluate the clinical efficacy and neural mechanisms of robot-assisted mirror therapy for post-stroke upper limb rehabilitation.\"},{\"question\":\"How were patients assigned to the study groups?\",\"answer\":\"Seventy-eight stroke patients were randomized to control, mirror therapy (MT), or robot-assisted mirror therapy (RMT) groups, with conventional rehabilitation for all; MT added mirror therapy, and RMT added robot-assisted mirror therapy plus functional electrical stimulation.\"},{\"question\":\"What outcomes and assessments were used to measure recovery?\",\"answer\":\"The primary outcome was Fugl–Meyer Assessment for Upper Extremity (FMA-UE), with secondary measures covering spasticity, dexterity, daily living, and quality of life; cortical activation and connectivity were assessed using fNIRS at baseline, post-intervention, and one-month follow-up.\"}]","Robot-Assisted Mirror Therapy for Upper Limb and Hand Recovery After Stroke - Clinical Efficacy and Insights into Neural Mechanisms | PDF",1790761924,53]