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Mirror Therapy Enhances Motor Performance in the Paretic Upper Limb After Stroke: A Pilot Randomized Controlled Trial

      Abstract

      Objective

      To investigate the effectiveness of mirror therapy (MT) combined with bilateral arm training and graded activities to improve motor performance in the paretic upper limb after stroke.

      Design

      Randomized, controlled, assessor-blinded study.

      Setting

      Inpatient stroke rehabilitation center of a tertiary care teaching hospital.

      Participants

      Patients with first-time ischemic or hemorrhagic stroke (N=20), confined to the territory of the middle cerebral artery, occurring <6 months before the commencement of the study.

      Intervention

      The MT and control group participants underwent a patient-specific multidisciplinary rehabilitation program including conventional occupational therapy, physical therapy, and speech therapy for 5 d/wk, 6 h/d, over 3 weeks. The participants in the MT group received 1 hour of MT in addition to the conventional stroke rehabilitation.

      Main Outcome Measures

      The Upper Extremity Fugl-Meyer Assessment for motor recovery, Brunnstrom stages of motor recovery for the arm and hand, Box and Block Test for gross manual hand dexterity, and modified Ashworth scale to assess the spasticity.

      Results

      After 3 weeks of MT, mean change scores were significantly greater in the MT group than in the control group for the Fugl-Meyer Assessment (P=.008), Brunnstrom stages of motor recovery for the arm (P=.003) and hand (P=.003), and the Box and Block Test (P=.022). No significant difference was found between the groups for modified Ashworth scale (P=.647).

      Conclusions

      MT when combined with bilateral arm training and graded activities was effective in improving motor performance of the paretic upper limb after stroke compared with conventional therapy without MT.

      Keywords

      List of Abbreviations:

      BBT (Box and Block Test), CI (confidence interval), FMA (Fugl-Meyer Assessment), MAS (modified Ashworth scale), MT (mirror therapy)
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      References

        • Yavuzer G.
        • Selles R.
        • Sezer N.
        • et al.
        MT improves hand function in subacute stroke: a randomized controlled trial.
        Arch Phys Med Rehabil. 2008; 89: 393-398
        • Dhole C.
        • Pullen J.
        • Nakaten A.
        • Kust J.
        • Rietz C.
        • Karbe H.
        MT promotes recovery from severe hemiparesis: a randomized controlled trial.
        Neurorehabil Neural Repair. 2009; 23: 209-217
        • Kwakkel G.
        • Wagenaar R.C.
        • Twisk J.W.
        • Lankhorst G.J.
        • Koetsier J.C.
        Intensity of leg and arm training after primary middle-cerebral artery stroke: a randomized trial.
        Lancet. 1999; 354: 191-196
        • Platz T.
        • Eickhof C.
        • Van Kaick S.
        • et al.
        Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial.
        Clin Rehabil. 2005; 19: 714-724
        • Ring H.
        • Rosenthal N.
        Controlled study of neuroprosthetic functional electrical stimulation in sub-acute post-stroke rehabilitation.
        J Rehabil Med. 2005; 37: 32-36
        • Masiero S.
        • Celia A.
        • Rosati G.
        • Armani M.
        Robotic-assisted rehabilitation of the upper limb after acute stroke.
        Arch Phys Med Rehabil. 2007; 88: 142-149
        • Summers J.J.
        • Kagerer F.A.
        • Garry M.I.
        • Hiraga C.Y.
        • Loftus A.
        • Cauraugh J.H.
        Bilateral and unilateral movement training on upper limb function in chronic stroke patients: a TMS study.
        J Neurol Sci. 2007; 252: 76-82
        • Taub E.
        • Uswatte G.
        • Pidikiti R.
        Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation—a clinical review.
        J Rehabil Res Dev. 1999; 36: 237-251
        • Wolf S.L.
        Electromyographic biofeedback applications to stroke patients: a critical review.
        Phys Ther. 1983; 63: 1448-1455
        • Stevens J.A.
        • Stoykov M.E.
        Using motor imagery in the rehabilitation of hemiparesis.
        Arch Phys Med Rehabil. 2003; 84: 1090-1092
        • Wu C.Y.
        • Huang P.C.
        • Chen Y.T.
        • Lin K.C.
        • Yang H.W.
        Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial.
        Arch Phys Med Rehabil. 2013; 94: 1023-1030
        • Ramachandran V.S.
        • Rogers-Ramachandran D.
        Synaesthesia in phantom limbs induced with mirrors.
        Proc R Soc Lond B Biol Sci. 1996; 263: 377-386
        • Ramachandran V.S.
        Plasticity and functional recovery in neurology.
        Clin Med. 2005; 5: 368-373
        • de Vries S.
        • Mulder T.
        Motor imagery and stroke rehabilitation: a critical discussion.
        J Rehabil Med. 2007; 39: 5-13
        • Ramachandran V.S.
        • Altschuler E.L.
        The use of visual feedback, in particular mirror visual feedback, in restoring brain function.
        Brain. 2009; 132: 1693-1710
        • Altschuler E.L.
        • Wisdom S.B.
        • Stone L.
        • et al.
        Rehabilitation of hemiparesis after stroke with a mirror.
        Lancet. 1999; 353: 2035-2036
        • Lee M.M.
        • Cho H.-Y.
        • Song C.H.
        The MT program enhances upper-limb motor recovery and motor function in acute stroke patients.
        Am J Phys Med Rehabil. 2012; 91: 689-700
        • Thieme H.
        • Bayn M.
        • Wurg M.
        • Zange C.
        • Pohl M.
        • Behren J.
        MT for patients with severe arm paresis after stroke—a randomized controlled trial.
        Clin Rehabil. 2013; 27: 314-324
        • Sanford J.
        • Moreland J.
        • Swanson L.R.
        • Stratford P.W.
        • Gowland C.
        Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke.
        Phys Ther. 1993; 73: 447-454
        • Gladstone D.J.
        • Danells C.J.
        • Black S.E.
        The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties.
        Neurorehabil Neural Repair. 2002; 16: 232-240
        • Shah S.K.
        Reliability of the Original Brunnstrom Recovery Scale following hemiplegia.
        Aust Occup Ther J. 1984; 31: 144-151
        • Higgins J.
        • Mayo N.E.
        • Desrosiers S.J.
        • Salbach N.M.
        • Ahmed S.
        Upper-limb function and recovery in the acute phase post stroke.
        J Rehabil Res Dev. 2005; 42: 65-76
        • Desrosiers J.
        • Bravo G.
        • Hébert R.
        • Dutil É.
        • Mercier L.
        Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity and norms studies.
        Arch Phys Med Rehabil. 1994; 75: 751-755
        • Gregson J.M.
        • Leathley M.
        • Moore A.P.
        • Sharma A.K.
        • Smith T.L.
        • Watkins C.L.
        Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity.
        Arch Phys Med Rehabil. 1999; 80: 1013-1016
        • Wolf S.L.
        • Winstein C.J.
        • Miller J.P.
        Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial.
        JAMA. 2006; 296: 2095-2104
        • Basmajian J.V.
        • Gowland C.
        • Brandstater M.E.
        • Swanson L.
        • Trotter J.
        EMG feedback treatment of upper limb in hemiplegic stroke patients: a pilot study.
        Arch Phys Med Rehabil. 1982; 63: 613-616
        • Carson R.G.
        Neural pathways mediating bilateral interactions between the upper limbs.
        Brain Res Rev. 2005; 49: 641-662