Abstract
Objective: 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.