Comparison of the Effects of Mirror Therapy,rTMS and Robotic-assisted Hand Therapy in Stroke Patients

It is a test that evaluates the motor development of hemiplegic participants. In this test, the neurophysiological recovery process of the hemiplegic participant is defined as 6 stages. According to this staging, the lowest stage is stage 1 (flaccid, stage without voluntary movement), and the highest stage is stage 6 (stage with isolated joint movement). In Brunnstrom staging, the hand and upper extremity are evaluated separately.

It is a widely used cognitive screening test. The total score is 30 points. It has been stated that scores below 15 indicate low cognitive function, scores between 15-26 indicate medium, and scores above 26 indicate high cognitive level.

The modified Ashworth scale is a muscle tone assessment scale used to assess the resistance experienced during passive range of motion, which does not require any instrumentation and is quick to perform.This scale grades the muscle tone from 0 (normal) to 4 (severe spasticity). Higher scores indicating sever spasticity.

It is used to evaluate rough manual dexterity based on performance (time). 150 small wooden cubes are filled from the box with the participant's hand to be tested into the adjacent box. The participant is asked to throw one cube at a time into the semi-empty box. How many cubes are thrown in 60 seconds is counted. The result gives the score. How many cubes are thrown in 60 seconds is counted. The result gives the score. The higher the score, the higher the success rate.

This test measures dexterity based on performance (in seconds). A wooden board with nine holes on it, 9 short wooden sticks and a box in which the wooden sticks can be placed are placed in front of the participant. Using the hand to be evaluated, the participant is asked to place the wooden sticks in the box into the holes on the panel as quickly as possible. Then, he is asked to put the sticks back into the box one by one. The completion time of the test is determined by a stopwatch. In this test, which evaluates manual dexterity based on performance, the success rate increases as the time gets short

The Pittsburgh Sleep Quality Index (PSQI) is an 18 item questionnaire that assesses sleep quality and disturbances over the past month. The investigators will use the 3-factor scoring, which has been shown to have superior psychometric properties. The component scores are summed to produce a global score (range 0 to 21). Higher scores indicate worse sleep quality

The ABILHAND Hand Questionnaire was developed in 1998 to measure participant perceived dexterity. It contains 23 questions about how difficult the participant has to do the activities. impossible (0 points), difficult (1 point), easily (2 points) options is marked. The total score is 46.Higher scores indicate better hand functional recovery.

The Stroke Impact Scale (SIS) is a stroke specific health status measure. It consists of a total of 59 items and 8 sections. The participant is asked to evaluate the difficulty experienced in completing each item in the last week on a five point Likert scale. A score of one indicates that the participant could not complete the item, and a score of five indicates that the participant had no difficulty in completing it. It also includes a visual analog scale (0: No improvement, 100: Complete recovery) regarding the general perception of recovery after stroke.

Specific Quality Of Life scale (SSQOL) is a participant centered outcome measure intended to provide an assessment of health related quality of life specific to participants with stroke. The original test consists of 49 items encompassing 12 domains. Each item is ranked on a 5 point scale, with higher scores indicating better function.

The SLANSS scale is a scale that helps to distinguish neuropathic pain from nociceptive pain. Unlike the LANSS scale, the physician does not examine the participant in this scale, so it is easier to administer. The S-LANSS scale consists of a total of 7 questions. The participant fills in this scale on his/her own. The first 5 questions ask about pain symptoms, while the last 2 questions include the participant's self administered clinical examination. The answers to the questions are yes/no. Each question has a different score. The total score on the scale is 24. A total score of 12 or more indicates neuropathic pain.

The Beck Depression Scale is a 21 item self report inventory designed to assess the presence and severity in depressive symptoms. Each item is rated on a 4-point Likert type scale ranging from 0 to 3, based on the severity in the last two weeks. Higher scores indicating worse level of depression.

The anxiety level of the participants was assessed using the Beck Anxiety Inventory (BAI). BAI is used to determine the severity of anxiety symptoms experienced by individuals. It is a Likert type scale with 21 headings that participants themselves score between 0-3, the score that can be obtained varies between 0-63, and the higher the score, the greater the anxiety experienced by the individual.

''Neuropathic Pain Questionnaire in 4 Questions'' is a short form designed to detect and diagnose neuropathic pain symptoms. The questionnaire consists of 10 questions to assess the symptoms experienced by the participant. These questions question signs and symptoms specific to neuropathic pain. A score between 0 and 10 is determined.

The participant' musculoskeletal pain severity was assessed with the visual analog scale (VAS). The meanings of the numbers placed from 0 to 10 on a 10 cm line were explained to the participants. It was explained that no pain was 0, the most severe pain felt in life was 10, and moderate pain was 5 points. According to these explanations, the participants were asked to score their pain levels considering the last week.

Neurophysiologic evaluations of all participants will be performed twice before and 4 weeks after treatment. Participants will undergo MEP (motor evoked potential) measurement with TMS stimulation. The MagVenture MagPro R30 (Denmark) transcranial magnetic stimulation device in the Neuromodulation Unit will be used with Figure Eight Coil.