CHAPTER - 1

INTRODUCTION

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 INTRODUCTIO

In 1970s, the WHO defined stroke as a “neurological deficit of cerebrovascular cause that
lasts after 24 hours or is interrupted by death within 24 hours”. Clinically, a wide range of
focal deficits are possible, including changes in the level of consciousness and impairments
neurological function involves sensory, motor, cognitive, perceptual and language functions
long term disabilities death .1

Stroke (cerebrovascualr accident) is the sudden loss of neurological function or other

function information of the vessel wall caused by the obtrusion of the blood flow to the brain
and extend of brain tissue damage, Ischemic stroke is very prevalent, affecting about 80% of
the individuals with stroke, and results when a clot blocks or impairs blood flow, depriving
the brain of essential oxygen and nutrients. Hemorrhagic stroke occurs when blood vessels
breaks, causing leakage of blood in or around the brain. 2

Include that Middle Cerebral Artery Syndrome The middle cerebral artery is the second of
the two main branches of the internal carotid artery and supplies the entire lateral aspect of
the cerebral hemisphere (frontal, temporal, and parietal lobes) and subcortical structures,
involves internal capsule (posterior portion), corona radiata, globus pallidus (outer part),
most of the caudate nucleus, and the putamen. Obstruction of the proximal Middle Cerebral
Artery couse extensive neurological damage with significant cerebral edema. Increased ICP
typically leads to loss of consciousness, brain herniation, and possibly death. presents the
clinical manifestations of Middle Cerebral Artery syndrome. The most common
characteristics of Middle Cerebral Artery syndrome are contralateral spastic hemiparesis
and sensory loss of the face, upper limb, and lower limb, with the face and upper limb more
involved than the lower limb.2

Mostly Loss of upper limb function is a direct develop stroke. Although about 83% of stroke
patients walk again, approximately 65% of them suffer from long-standing limitations in
upper limb function . 3 This unsuccessful use of upper extremity lead to learned nonuse
phenomenon in which patients continuously depend on their unaffected upper extremity to
accomplish their activity of daily living. 4

Main objective of this study is improve hand function the intervention and rehabilitation of
such patients give an emphasis on Task specific exercises and Mirror therapy .

Task Specific Exercises -

An important principle of motor relearning is specificity of practice or enhancing in other words

Task-specific exercises 5. involves integrating tasks that are commonly used in various activities
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of daily living independently (e.g., holding a cup) into the rehabilitation program 6. Movements
performed comprise of motor tasks that focus on an improvement in performance through goal-
oriented treatment task practice and repetition 7 with the aim of properly archived functional
skills. It is well recognized that any movement is the result concluded show that of interaction
between the subject, the task, and the environment, where the Task takes place. Various terms are
used to describe this treatment approach. For example, Task Specific exercises is used
interchangeably with task-oriented training 2, task-related training, or repetitive task training 8.

This study designing a Task specific exercises program, it is recommended and giving that the
tasks are challenging, progress from easy to hard, are based on patient capacity, are practiced
within different contexts and environments, aim toward learning the whole task, include different
types of feedback, and involve active participation of the individual 9. Patient response to Task
specific exercises might be variable and may depend on whether the patient has right or left side
hemisphere lesion. Task specific exercises displays great changes in response and recovery in
patients with stroke 10.

It is expected that continuous training compels brain reorganization and increases upper limb
hand functional and lower limb performance . There is evidence that TST affects neural plasticity
in stroke patients. 11

MIRROR THERAPY

Mirror therapy is technique work on is rehabilitation purpose new therapeuticin tervention called
mirror therapy, which focuses onthe movement of contralateral limbs. Mirror therapy involves
performing movements of the unaffected limb while watching its reflection in a mirror located
such that the image of contralateral limb is superimposed over the affected limb, consequently
creating a visual illusion of enhanced movement capability of the impaired limb.12 Using cheap
and simple instruments, mirror therapy enables patients to control their movements by
themselves and is known to beeffective in improving upper-limb motor recovery and motor
function after stroke. 13

The Mirror therapy program was first introduced by Ramachandran in 1996 to treat phantom
limb pain after amputation.14

Mirror neurons seem to be involved in the mechanism underlying Mirror therapy. They are
nervous cells with visual-motor properties discovered in the F5 brain area of the macaque. This
particular type of neurons, also present in human brain, are active both when an action is in
progression and develment when the action is observed being performed by others, mainly if
conspecifics. 15

Mirror Neurons account for about 20% of all the neurons present in the human brain. These
mirror neurons are responsible for laterality reconstruction i.e., the ability to differentiate
between the left and the right side. 16

This study became the foundation for future studies on the neuroplasticity of the peripheral and
central nerve system. 17 Since then, mirror therapy has been applied to the treatment of stroke,

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peripheral nerve system injury, and coordination disorder other neurological disorders. 13

Aim this study effects of Mirror therapy on the upper limb and lower limb have show
improvements in range of motion, improvements in speed and perfection of movement, increased
squeeze strength, and improvements in motor function and motor recovery in chronic stroke
patients. 18

Mirror therapy has also been inclusion reported to enhance upper limb motor recovery and self-
care ability in patients with subacute stroke. 18

Previously study show that In addition, it is reported that mirror therapy enhanced the motor
function of distal part of the upper limbs in acute stroke patients. 19 Stevens and Stoykov also
reported that stroke patients who trained with mirror therapy for 3 to 4 weeks had increased Fugl-
Meyer Assessment scores, active range of motion, movement speed, and hand dexterity 20
Similarly, Sathian et al found that 2weeks of intense Mirror therapy in chronic stroke patients
resulted show that study a significant recovery of grip strength and hand movement of the
paretic arm. 21

 Need of study - Task specific exercises and Mirror therapy

had shown their effectiveness in improving upper extremity
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 hand functions of stroke patients individually, but shorter study
or not so much us studies are done to show the combined and
comparative effect of therapies in post stroke treatment.
Therefore, the need of the study is to find the comparative effects
of Task specific exercises and Mirror therapy in upper limb hand
functional integrity of post stroke hemiplegic patients.

AIMS AND OBJECTIVES OF STUDY

 AIMS AND OBJECTIVES

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 AIMS AND OBJECTIVES

Aim - To examine the effect of Task specific exercises and Mirror

Therapy in improving the upper extremity function in post stroke
hemiplegic patients.

Objective –

1. To find out the effectiveness of Task specific exercises Therapy

on arm functions in post stroke hemiplegic patients.
2. To find out the effectiveness of Mirror therapy Therapy on arm
functions in post stroke hemiplegics.
3. To compare the effects and find out the outcome measures
between Task specific exercises and Mirror therapy.

HYPOTHESIS

Null Hypothesis [Ho] – There will be no significant difference

between the effect of Task specific exercises and Merrior therapy
improving motor functions of hemiparetic upper extremity hand .

Alternative Hypothesis

[H1] - There will be significant effehemip Task specific

exercises in improving motor functions of hemiparetic upper
extremity hand .

[H2] - There will be significant effect of Mirror therapy improving

motor functions of hemiparetic upper extremity hand .

[H3] - Both Task specific exercises and Mirror therapy will be

equally effective in improving motor functions of hemiparetic upper
extremity hand .

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 [H4] - There will be significant difference between the effect Task

specific exercises and merrior therapy in improving motor

functions of hemiparetic upper extremity hand .

MATERIAL AND METHODS

STUDY DESIGN

Comparative exprimental study

STUDY DURATION

The duration of the study was 6 months and treatment duration 4 week.

STUDY SETUP

Department of Physiotherapy, 0PD, Maharaja Yeshwantrao

(M.Y.) Hospital and M.G..M. Medical College, Indore.

SAMPLING
Simple Random Purposive Sampling method was used to divide
the patients in two groups.

SAMPLE SIZE

Total Sample - 30
Group A -15 ( Task specific exercises)

Group B- 15 ( Mirror therapy )

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 SELECTION CRITERIA

Inclusion criteria -

1. Both male and female patients include

2. Age of subject should be between 45 to 75 years.

3. Patients with first ever stroke

4. Patients with having stroke from 2 months upto 1 year post-stroke.

5. Patients with Voluntary Control Grading from 2 to 4 for affected upper limb patient
should be able to understand the instructions and follow commands.

Exclusion criteria –

Patients were excluded if they had.

Poor cognitive function as assessed with Mini Mental State Examination score <
24 .

uncontrolled systemic hypertension or With perceptual or apraxic deficits.

Visual deficit such as homonymous hemianopia With reflex sympathetic dystrophy

or With severe shoulder subluxation or Contracture in the affected upper limb.

Patients who have received botox injection or acupuncture within past 6 months to
the affect upper limb .

VARIABLES
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 Independent variable - Mirror therapy
Task specific exercises

Dependent variable –Assessment score on Action research arm test

Upper extremity
functional index

STUDY TOOLS

Peg board
Glass
Water jar
Table
pen
coin
key
Magazine/book
Polysterene cup
box
spoon

SUBJECTS

30 subjects that met the inclusion criteria basis of age group

between 45 to 75 years were selected for the study. An informed
and written consent was taken from the patients where the
patient agreed to participate in the study and the data was
collected using the assessment tools.

PROCEDURE

For the 6 months study, subjects fulfilling the inclusion and exclusion criteria basis
for the study work were selected. Study protocol was reviewd. All patients were
assessed and evaluated arranging according to clinical history, neurological
assessment and examination. The patients were divided in two groups, group A and
group B. Each group comprised 15 patients.Subjects of both the groups received
conventional therapy (30 mint ) involves exercises , PNF techniques, Range of
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motion exercise. After conventional treatment, patients were made to relax for some
time, and next both the groups were given further treatment. Group A was given
Task specific exercise and Group B was given Mirror therapy All the activities were
started with simple task and with less repetition, Participants go through
randomized allocation into 2 groups using lottery method. All 2 groups received
conventional physiotherapy .

Group A : had 15 individuals who received 30 minutes of Task specific exercises

Group B : had 15 individuals who received 30 minutes of Mirror therapy

Group A: Task Specific Exercises Group :

Patients in this group received Task Specific Exercises for 30 minutes per day for 5
days in a week for 4 weeks (total = 20 sessions). This intervention focused on
repetitive practice of meaningful and purposeful tasks for patient by using affected
upper limb . It included following functional tasks: reaching, grasping, lifting,
placing objects and counting with fingers . Each of these tasks was performed for 5
repetitions. These tasks were performed with the participant seating and objects
placed over the table of suitable height, provided participants had sufficient
movement in their affected upper limb to attempt the functional tasks. For those
participants who did not have sufficient movement in their affected upper limb to
practice such tasks, therapist assisted the participant by guiding the limb through
the tasks with the help of manual contact and communication . The difficulty level of
practiced task was increased gradually, with the goal being set just above the
patient‟s ability level to perform it .

Upper Limb Exercise

Sitting position: open covered pots of different sizes and transfer flour to a cup with
a spoon, then close the pot.

Sitting position: pick up coins and cards on the table and put the coins in a pot and
gather the cards

Sitting position: write and/or draw pictures on a piece of paper

Sitting position: open a safe box with a key, pick up small objects inside the box, and
transfer them to a pot, then lock the safe box

Sitting position: pick up and transfer jars, bottles, and glasses of ifferent sizes and
weights located on a table. Transfer the liquid contents from jars and bottles to
glasses

Sitting position: throw and catch balls (in pairs).

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Group B: Mirror Therapy Group :

This group B received mirror therapy program for 30 minutes per day for 5
days in a week for 4 weeks (total = 20 sessions). Patients were seated close
to a table on which a mirror (18 x 24 inch) was placed vertically and in mid-
sagital plane . Affected upper limb was kept hidden behind the mirror and
the unaffected upper limb was placed in front of the Mirror. This group
also included following functional tasks: reaching, grasping, lifting, placing
objects and counting with fingers.

Each of the above tasks was performed for 5 repetitions. They were
instructed to watch the image of their unaffected upper UL in the Mirror,
thus seeing the reflection of unaffected UL movements projected over the
affected upper limb .

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 DATA ANALYSIS AND RESULTS

The data was entered into the excel sheet. The data was analysed using SPSS (Statistical Package
for Social Sciences), IBM, 20.0 version. Data was analysed for normality of distribution using
Shapiro-Wilk test, p value = 0.358 indicated that data was normally distributed, thus parametric
test of significance were applied. ARAT score between two groups was compared using
Independent ‘t’ test. Categorical data was compared using chi square test.Total of 30 patients were
included in the study which were equally distributed into 2 groups: group A and group B.

USED FORMULAE:

Mean =

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SD = (If n < 15)

SD = (If n > 15)

Where,

= Sum of all

observations.

N = Number of subjects

included for the study

according

to the inclusion criteria.

= Sum of squares of deviations

from Mean

13
 The standard error of difference between two mean is calculated

by

S.E. = SD= , where SD =

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Table - 5.1 Description of mean pre and post treatment TSE on Action
research arm test scores

VARIABL Conditio N Mean S.D. t-test p-value

E n
ARAT PRE 15 21.80 4.26 4.44 <0.05
POST 15 32.87 8.67
Above table no.
5.1 shows the result of the effect of task specific exercises on Action research arm test in post stroke
hemiplegic patients. Mean values of action research arm test in pre and post Task Specific Exercises
are 21.80 and 32.87. There is a significant difference between mean. Calculated t-value is 4.44 which is
significant at the degree of freedom 28 at 0.05 level of significant because calculated t-value is greater than
(2.05) minimum value of 0.05 significant level.
So we can say that there is a significant difference in action research arm test in pre and post
condition of Task specific exercises . There is a significant effect of Task Specific exercises on action
research arm test in post stroke hemiplegic patients.

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Table - 5.2 Description of mean pre and post treatment TSE on UEF I

Variable Conditio N Mean S.D. T-Test P-value

n
UEFI PRE 15 22.07 5.13 3.75 <0.05
POST 15 31.53 8.33
table no. 5.2 shows the result of the effect of Task specific exercises on upper extremity functional
index in post stroke hemiplegic patients. Mean values of upper extremity functional index in pre
and post condition of Task specific exercises are 22.07 and 31.53. There is a significant difference
between mean. Calculated t-value is 3.75 which is significant at the degree of freedom 28 at 0.05 level of
significant because calculated t-value is greater than (2.05) minimum value of 0.05 significant level.
So we can say that there is a significant difference in upper extremity functional index in pre and post
condition of Task specific exercises . There is a significant effect of Task specific exercises on upper
extremity functional index in post stroke hemiplegic patients

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Table - 5.03 Description of mean pre and post treatment MT on Action
research arm test scores

Variable Condition N Mean S.D. T-Test P-value

ARAT Pre 15 21.93 2.58 2.50 <0.05
Post 15 24.13 2.23

table no. 5.03 shows the result of the effect of Merrior therapy on action research arm test in post
stroke hemiplegic patients. Mean values of Action research arm test in pre and post condition of effect
of mirror therapy are 21.93 and 24.13. There is a significant difference between mean. Calculated t-value
is 2.50 which is significant at the degree of freedom 28 at 0.05 level of significant because calculated t-
value is greater than (2.05) minimum value of 0.05 significant level. So we can say that there is a significant
difference in Action research arm test in pre and post condition of effect of mirror therapy. There is a
significant effect of effect of mirror therapy on action research arm test in post stroke hemiplegic
patients.

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Table - 5.04 Description of mean pre and post treatment MT on UEFI
test scores

Variable Conditio N Mean S.D. T-Test P-value

n
UEFI Pre 15 18.40 5.08 2.25 <0.05
Post 15 22.87 6.07

table no. 5.4 shows the result of the effect of Mirror therapy on upper extremity functional index in
post stroke hemiplegic patients. Mean values of upper extremity functional index in pre and post
condition of mirror therapy are 18.40 and 22.87. There is a significant difference between mean.
Calculated t-value is 2.25 which is significant at the degree of freedom 28 at 0.05 level of significant
because calculated t-value is greater than (2.05) minimum value of 0.05 significant level.
So we can say that there is a significant difference in upper extremity functional arm index in
pre and post condition of Mirror therapy. There is a significant effect of Mirror therapy on upper
extremity functional index in post stroke hemiplegic patients.

Table - 5.05 Comparison of group A and group B based , pre and post
treatment, TSE and MT on ARAT score in two groups.

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 Variable Therapy N Mean S.D. T-Test P-
value
ARAT Task Specific 15 32.87 8.67 3.77 <0.05
Exercises
Mirror Therapy 15 24.13 2.23

Above table no. 5 .5 shows the result of Comparison in effect of Task specific exercises and Mirror
Therapy on Action research arm test in post stroke hemiplegic patients. Mean values of action
research arm test in pre and post condition of effect of mirror therapy are 32.87 and 24.13. There is a
significant difference between mean. Calculated t-value is 3.77 which is significant at the degree of freedom
28 at 0.05 level of significant because calculated t-value is greater than (2.05) minimum value of 0.05
significant level.
So we can say that there is a significant difference in Action research arm test in post condition of Task
specific exercises and mirror therapy. The mean value of Action research arm test in post condition of
Task specific exercises is greater than post condition of Mirror Therapy .There is a significant effect of
effect of Task specific exercises on Action research arm test in post stroke hemiplegic patients.
Task specific exercises is more effective than Mirror Therapy to improve upper limb function in
post stroke hemiplegic patients.

Table - 5. 6 Comparison of group A and group B based , pre and post

treatment, TSE and MT on UEFI in two groups.

Variable Therapy N Mean S.D. T- P-

Value value
UEFI Task Specific Exercises 15 31.53 8.33 3.25 <0.05
Mirror Therapy 15 22.87 6.07

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Above table no. 5 . 6 shows the result of Comparison in effect of Task Specific Exercises and Mirror
Therapy on upper extremity functional index in post stroke hemiplegic patients. Mean values of
upper extremity functional index in pre and post condition of effect of mirror therapy are 31.53 and
22.87. There is a significant difference between mean. Calculated t-value is 3.25 which is significant at the
degree of freedom 28 at 0.05 level of significant because calculated t-value is greater than (2.05) minimum
value of 0.05 significant level.
So we can say that there is a significant difference in upper extremity functional index in post
condition of Task Specific Exercises and mirror therapy.
The mean value of upper extremity functional index in post condition of Task Specific Exercises
(TSE) is greater than post condition of Mirror Therapy .There is a significant effect of effect of Task
Specific Exercises on upper extremity functional index in post stroke hemiplegic patients. Task
Specific Exercises is more effective than Mirror Therapy to improve upper extremity functional
index and upper limb function in post stroke hemiplegic patients.

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 DISCUSSION

The present study evaluated the efficacy of Task specific exercises and
Mirror therapy along with conventional therapy in improving the upper limb
hand functions of stroke hemiplegic patients.

It four weeks study, 30 - minute and 30 patients with stroke hemiplegia were
selected based on the inclusion criteria. Using the simple random sampling
method, subjects/participants were divided into 2 groups- Group

A and Group B with 15 subjects in each group. Both the groups received
conventional therapy Rehabilation program, along with this, Group A
received Task specific exercises & Group B received Mirror therapy. Patients’
assessment was done prior to treatment and then on the final day. Action
Research Arm Test and The Upper Extremity Functional Index Test was
used as an outcome measure of assessment.

Intervention program aimed the affected upper extremity hand, so in that

case the Action Research Arm Test and The Upper Extremity Functional
Index was the most suitable tool for measuring the change, as it is most
sensitive to minute and precise change specially in wrist, Hand and fingers.

In this research work, the pre-treatment values of Action Research Arm

Test and The Upper Extremity Functional Index did not show any
significant difference between the groups. Due to homogenous character of
the basal values, the post treatment scores were compared.

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Task Specific Exercise Patients in Group A received Task Specific Exercises along
with conventional physiotherapy. The mean difference in pre- and post-intervention
Action research arm test scores was Mean values of Action research arm test in pre
and post task specific exercises are 21.80 and 32.87. There is a significant difference
between mean. Calculated t-value is 4.44 which is significant at the degree of freedom 28 at
0.05 level of significant because calculated t-value is greater than (2.05) minimum value of
0.05 significant level.

Mean values of upper extremity functional index in pre and post condition of task
specific exercises are 22.07 and 31.53. There is a significant difference between mean.
Calculated t-value is 3.75 which is significant at the degree of freedom 28 at 0.05 level of
significant because calculated t-value is greater than (2.05) minimum value of 0.05
significant level. These results show that there is statistically significant improvement
in all outcome measures seen in Group on intra-group comparison.

Result shows that there was a significant difference in action research arm test and Upper
extremity functional index in pre and post condition of Task Specific Exercises. It also
show that there was a significant effect of Task Specific Exercises on action research
arm test and Upper extremity functional index in post stroke hemiplegic patients. It
meant that Task Specific Exercises effective to improve action research arm test in post
stroke hemiplegic patients.

These results could be due to improved motor control, functional recovery and
increased strength and motor relearning and Neuroplasticity is the ability of neural
networks in the brain to change through growth and reorganization of upper limb.
TSE has also been linked to improve cortical reorganization. Animal studies have
demonstrated that Task specific exercises can restore function by using non-affected
parts of the brain which are generally adjacent to the lesion and recruiting
supplementary areas of the brain. Neural plastic changes have also been
demonstrated in the human brain following stroke and task specific intervention.

Jang SH et. al. also noted decase in the unaffected and an increase in the affected
primary sensorimotor cortex activities along with functional recovery in stroke
patients who received TSE. 48

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 Classen et al. using focal transcranial magnetic stimulation has shown that Task-
Specific Exercises , in comparison to traditional stroke rehabilitation, yields long-
lasting cortical reorganization specific to the corresponding areas being used. 49

Both Karni et al.using functional magnetic resonance imaging and Classen et al.
using TMS reported a slowly evolving, long-term, experience-dependent
reorganization of the adult primary motor cortex after daily practice of task specific
motor activities. Patients in this group practiced repeated meaningful tasks by
affected upper limb . Most researchers recommend that the more the task is
practiced, the better the overall performance. 50

Improved Group B received Mirror therapy along with conventional physiotherapy. The
mean difference in pre- and post-intervention Action research arm test scores was 21.93
and 24.13. There is a significant difference between mean. Calculated t-value is 2.50 which is
significant at the degree of freedom 28 at 0.05 level of significant because calculated t-value is greater
than (2.05) minimum value of 0.05 significant level.

upper limb extremity functional index in post stroke hemiplegic patients. Mean
values of upper limb extremity function index in pre and post condition of mirror
therapy are 18.40 and 22.87. There is a significant difference between mean. Calculated t-
value is 2.25 which is significant at the degree of freedom 28 at 0.05 level of significant
because calculated t-value is greater than (2.05) minimum value of 0.05 significant level.

Result shows that there was a significant difference in Action research arm test upper
extremity functional index in pre and post condition of Mirror therapy. It found that there
was a significant effect of mirror therapy on action research arm test and upper
extremity functional index in post stroke hemiplegic patients. It meant that mirror
therapy effective to improve action research arm test and upper extremity functional
index in post stroke hemiplegic patients.

However Michielsen et al. reported that mirror illusion caused increased activity in
the precuneus and the posterior cingulate cortex, these areas are associated with
awareness of the self and spatial attention. The authors concluded that, by increasing
awareness of the affected limb, the Mirror illusion might reduce learnt non-use. 51
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Another study conducted Results similar to the present study were reported by
Gunes Yavuzer et al. They found that hand function improved more after Mirror
therapy in addition to a conventional rehabilitation program as compared with
control treatment immediately after 4 weeks of treatment and at 6-month follow-up.
52

Comparison in effect of Task Specific Exercises and Mirror Therapy on Action

research arm test in post stroke hemiplegic patients. Mean values of action research
arm test in pre and post condition of effect of mirror therapy are 32.87 and 24.13. There
is a significant difference between mean.

shows that there was a significant difference in effect of Task Specific Exercises and
Mirror Therapy on Action research arm test in post stroke hemiplegic patients. It
found that there was a significant effect of Task Specific Exercises on Action research
arm test in post stroke hemiplegic patients. It meant that Task Specific Exercises more
effective than mirror therapy to improve Action research arm test in post stroke
hemiplegic patients.

Comparison in effect of Task Specific Exercises and Mirror Therapy on upper

extremity functional index in post stroke hemiplegic patients. Mean values of upper
limb extremity functional index in pre and post condition of effect of Mirror therapy
are 31.53 and 22.87. There is a significant difference between mean.

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LIMITATIONS AND FUTURE RECOMMENDATIONS:

Limitations of the Study

1. The duration of study was only 4 weeks, so further prognosis and longterm
benifits could not be recorded.

2. Training depending on functional level of patients.

3. Home exercises was prescribed to subject.

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 CONCLUSION

The present study conducted that four week duration treatment program
This study compares the effect of Task specific exercises and Mirror therapy in
improving upper limb functional hand integrity of post stroke hemiplegic
patients. significant difference in Action research arm test and upper extremity
functional index in post condition of Task Specific Exercises and Mirror therapy.

Task Specific Exercises is greater than post condition of Mirror Therapy.There is a

significant effect of effect of Task Specific Exercises in post stroke hemiplegic patients.
Task Specific Exercises is more effective than Mirror Therapy to improve upper
extremity functional index and upper limb function in post stroke hemiplegic
patients.

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