Introduction: Stroke is the leading cause of long term disability among adults and hemiparesis is the most common impairment after stroke. Longitudinal studies of recovery after stroke suggest that on 50% of patients with significant arm paresis recover useful function [1] WHO estimated that in 1990, out of a total of 9.4 million deaths in India, 619,000 were due to stroke. This gives a stroke mortality rate of 73 per 1000,000 (estimated total population 849 million). It is estimated that 600,000 Americans suffer a first stroke each year, and the nation’s nearly 4 million stroke survivors are living with consequences [2]. Patient diagnosed with stroke often present with a combination of muscle weakness or muscle imbalance, decreased postural control, muscle spasticity, poor voluntary control, and body mal­alignment [3].

Aims of the Study: To analyze the effectiveness of combine motor rehabilitation protocol to improve upper extremity motor recovery in post stroke subjects.

Methods: On the basis of inclusion and exclusion criteria 30 subjects were randomly divided into two groups. 15 subjects in experimental group (Group A) given mirror therapy and thermal stimulation and 15 subjects in controlled group (Group B). Given general exercises of upper extremity for flexors and extensors were carried out for 4 weeks including active exercises and functional training.

Discussion: In the present study, aspect of somatosensory stimulation and mirror illusion of normal movement is taken as a point of reference for treatment in hemiplegic with functional dependence on the basis of UEFI. [5,8]. There is a significant change in post intervention in Group A p  0.05 which approves improvement in functional activity according to UEFI. The use of mirror therapy creates the mirror illusion of normal movement of the affected hand may substitute for decreased proprioceptive information, thereby helping to recruit the premotor cortex and assisting rehabilitation through an intimate connection between visual input and premotor areas. Clinically this study demonstrated that by using mirror therapy and thermal stimulation as a treatment tool, the improvement was seen in upper extremity functional activity of post stroke hemi paretic subjects.

Conclusion: Mirror therapy and thermal stimulation was found to be effective in improving functional independence in upper limb post sub­acute stroke. When mirror therapy and thermal stimulation is administered to patients suffering from sub­acute stroke over a period of 4 weeks, it results in an improvement in reaching forwards, grasping, manipulating objects and also improves other fine motor functions of the hand. 

Future Research: 1. Further studies are recommended to minimize these limitations in such a way that larger sample sizes of both the sexes that include various age groups of people are studied. 2. The duration of study can be increased. 3. The inclusion criterion can be improved so that all the subjects show similar functional independence in upper limb at the beginning of the study. 4. Various outcome measures can be used in order to record the functional independence in a better way. 5. Study can also be done to improve lower extremity functions. 6. Study can be done on chronic patients.

Limitations of the Study: 1. The duration of study was only 4 weeks, so further prognosis and long term benefits could not be recorded. 2. Home exercises were not prescribed to the subjects. 3. Training depends on functional level of patients. 4. Task specificity and stroke severity are important factors in rehabilitation of upper limb. 5. It is difficult to maintain constant temperature. 6.
Thermal stimulation cannot be performed on patients with sensory loss. 

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