Mirror Therapy Improves Hand Function in Subacute Stroke: A Randomized Controlled Trial
Stroke rehabilitation is an intensive, time-consuming process whose outcome is frequently dissatisfying. Exercise and task-specific activities are central to training but a variety of other approaches, such as biofeedback, robotics, and imagery, have been used to improve its benefits. Yavuzer and colleagues assess the potential benefits of mirror-assisted feedback in a randomized controlled trial involving 40 patients with an average stroke duration of 5.5 months. All 40 were enrolled in an intensive inpatient conventional stroke rehabilitation program. In addition, half underwent 30 minutes each day of training in which they attempted to mimic the reflected movements of their intact upper extremity with their hidden impaired limb. The control group devoted the same amount of time to the process with the sole difference that the mirror was reversed and they did not see a reflected image. The results are intriguing in that while spasticity was not affected, the mirror group displayed statistically significant improvements in their upper-extremity Brunnstrom and FIM self-care scores over their control counterparts. These improvements lessened with time but persisted at follow-up 6 months later. • SEE PAGE 393
Georg Ebersbach, MD
Daniela Edler, MD
Olaf Kaufhold
Joerg Wissel, MD
Whole Body Vibration Versus Conventional Physiotherapy to Improve Balance and Gait in Parkinson’s Disease
Vibration is known for its ability to enhance muscle recruitment. Attention has recently focused on its potential for the training of balance and gait in patients with conditions such as stroke and Parkinson’s disease (PD). In a randomized controlled trial, Ebersbach and colleagues compare the effects of whole body vibration and conventional physiotherapy on gait and balance in 27 patients with PD. All subjects underwent an inpatient 3-week rehabilitation program in which they received 2.5 hours of rehabilitation per day. There was only 1 difference in treatment: half the subjects, who were assigned to a vibration group (n=13), stood on an oscillating platform for two 15-minute sessions/day while the other half (n=14) received equal amounts of conventional balance training and tilt board exercises. Tinetti score improvements (3.5 vs 3.4 points in the vibration and control groups) were nearly identical at the end of the study and at 4-week follow-up. Secondary measures (with the exception of dynamic posturography where the vibration group improved and the control group did not) revealed no intergroup differences. The investigators conclude that at least in this setting that there is no evidence that whole body vibration is more effective than conventional balance training.• SEE PAGE 399
Bonnie G. Steele, PhD, ARNP
Basia Belza, PhD
Kevin C. Cain, PhD
Jeff Coppersmith, MS, PT
Sambasiva Lakshminarayan, MD
JoEllen Howard, BS, PT
Jodie K. Haselkorn, MD
A Randomized Clinical Trial of an Activity and Exercise Adherence Intervention in Chronic Pulmonary Disease
Effective rehabilitation often requires continuation of an exercise program after completion of formal training. Compliance, unfortunately, is notoriously poor. Steele and colleagues addressed this issue by assessing the effectiveness of a12-week counseling and coaching program on the activity levels, exercise performance, and exercise capacity of 106 patients who completed an 8-week pulmonary rehabilitation program. Subjects were divided into 2 groups. One group received home visits and weekly phone calls that focused on coaching, monitoring, and maintaining a home exercise program. The other received usual care. Activity levels (as measured by an accelerometer), exercise adherence (as recorded in an exercise diary), and exercise capacity in the form of the six-minute walk test were assessed at the beginning and end of the intervention as well as 8 months later. The results are interesting in that while the intervention group had somewhat better exercise measures at the end of the intervention period, the groups’ activity levels did not differ. Eight months later, the groups were indistinguishable on both of these measures. The authors conclude that while the accuracy of their activity monitoring could be questioned, that the coaching program appeared to be of no value. • SEE PAGES 404
Suzanne Novak, MD, PhD
William C. Nemeth, MD
The Basis for Recommending Repeating Epidural Steroid Injections for Radicular Low Back Pain: A Literature Review
There is an ongoing debate over use of epidural steroid injections (ESIs) in the treatment of radicular low back pain. Aspects ranging from a frank questioning by some of risk and cost-benefit ratio of ESIs to an uncertainty about the appropriate indications, timing and number of injections by others are debated. Novak and Nemeth examine 1 part of this question in a review of the evidence supporting guidelines for the timing and need for repeat ESIs. They found that while no studies specifically addressed the issue, 11 randomized controlled trials, 3 prospective uncontrolled trials, 1 survey, and 5 review articles dealt with, in one way or another, the issue of injection frequency. Novak and Nemeth conclude: (1) that the evidence supporting need for either a repeat ESI or the timing of a sequence of ESIs is limited; (2) that while “limited research” suggests that repeat ESIs may improve outcomes, the evidence is not strong enough to form a conclusion; and (3) that specifically designed randomized controlled trials are needed to address this important issue. • SEE PAGES 543
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