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Bajuaifer S, Grey MJ, Hancock NJ, Chandler E, Pomeroy VM. Maximum tolerable daily dose of mirror movement therapy ankle exercises after stroke: an early phase dose screening study. Physiotherapy 2024; 122:30-39. [PMID: 38237263 DOI: 10.1016/j.physio.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 09/28/2023] [Accepted: 10/29/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Mirror movement therapy may reduce lower limb motor impairment after stroke. The dose is unknown. OBJECTIVE identify the maximum tolerable dose a day (MTD) of lower limb mirror movement therapy DESIGN: 3 + 3 cohort rule-based, dose escalation/de-escalation study. After undertaking baseline measures participants performed mirror movement therapy for 14 consecutive days. Participants then undertook outcome measures. Cohort One trained for 15 minutes daily. Subsequent cohorts exercised at a dose set according to pre-set rules and the modified Fibonacci sequence. The study stopped when the difference between set doses for consecutive cohorts was 10% or less. SETTING Participants' homes (intervention) and a movement analysis laboratory (measures). PARTICIPANTS Adults discharged from statutory stroke rehabilitation services. INTERVENTION Mirror movement therapy ankle exercises. OUTCOME MEASURES Motricity Index (primary) and bilateral time symmetry from movement onset to peak activation of Tibialis Anterior muscles during standardised sit-to-stand (secondary). RESULTS Five cohorts of three participants were included (n = 15). Mean (SD) age and time after stroke were 61 (9) years and 35 (42) months respectively. Set daily doses for the five cohorts were: 15, 30, 50, 40 then 35 minutes. The set dose for a subsequent cohort (six) would have been 38 minutes thus the difference from cohort five would have been three minutes i.e., 9% different. Therefore, the study stopped CONCLUSION: The identified MTD of lower limb mirror therapy was 35 minutes daily when frequency was set at seven days a week and duration as two weeks. CLINICAL TRIAL REGISTRATION NUMBER NCT04339803 (ClinicalTrials.gov) CONTRIBUTION OF THE PAPER: This early phase study found that the maximum tolerable dose per day (MTD) of mirror movement therapy ankle exercises was 35 minutes when frequency was set at seven days a week and duration as two weeks. The optimal therapeutic dose will therefore be somewhere in the range of 15 (starting dose) to 35 minutes per day. Further dose articulation studies are required to identify the optimal therapeutic dose before use of findings in clinical practice. This study is the first step in that research process.
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Chen PT, Lee SC, Wu TY, Lee ML, Hsieh CL. Test-Retest Reliability and Responsiveness of the Computerized Adaptive Testing System of the Functional Assessment of Stroke. Arch Phys Med Rehabil 2023; 104:1676-1682. [PMID: 37419234 DOI: 10.1016/j.apmr.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVE To examine the test-retest reliability, responsiveness, and clinical utility of the Computerized Adaptive Testing System of the Functional Assessment of Stroke (CAT-FAS) in persons with stroke. DESIGN Repeated measurements design. SETTING A department of rehabilitation in a medical center. PARTICIPANTS 30 persons with chronic stroke (for test-retest reliability) and 65 persons with subacute stroke (for responsiveness) were recruited. To examine the test-retest reliability, the participants received measurements twice at 1-month intervals. To examine the responsiveness, the data were collected at admission and discharge from hospital. INTERVENTIONS Not applicable. MAIN OUTCOME MEASUREMENT TOOL CAT-FAS. RESULTS The intra-class correlation coefficients of the CAT-FAS were ≥0.82, indicating good to excellent test-retest reliability. The Kazis' effect size and standardized response mean of the CAT-FAS were ≥0.96, indicating good group-level responsiveness. For individual-level responsiveness, approximately two-thirds of the participants exceeded the conditional minimal detectable change. On average, the CAT-FAS was completed within 9 items and 3 minutes per administration. CONCLUSIONS Our results suggest the CAT-FAS is an efficient measurement tool with good to excellent test-retest reliability and responsiveness. In addition, the CAT-FAS can be used routinely in clinical settings to monitor progress of the crucial 4 domains for persons with stroke.
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Affiliation(s)
- Po-Ting Chen
- Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Chie Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Long-Term Care, MacKay Medical College, New Taipei City, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Tzu-Yi Wu
- Department of Occupational Therapy, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Meng-Lin Lee
- Division of Cardiovascular Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Occupational Therapy, College of Medical and Health Sciences, Asia University, Taichung, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
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Li RY, Chen KY, Wang XR, Yu Q, Xu L. Comparison of Different Rehabilitation Techniques of Traditional Chinese and Western Medicine in the Treatment of Motor Dysfunction After Stroke Based on Frequency Method: A Network Meta-analysis. Am J Phys Med Rehabil 2023; 102:504-512. [PMID: 36731006 PMCID: PMC10184820 DOI: 10.1097/phm.0000000000002130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the effect of different traditional Chinese and western medicine rehabilitation techniques on motor dysfunction after stroke using a network meta-analysis. METHODS CNKI, Wanfang, PubMed, Embase, and Cochrane databases were searched from inception to September 2022. We independently searched and screened randomized controlled trials of rehabilitation techniques for poststroke motor dysfunction treatment, evaluated the quality, and analyzed the data using Stata 14.0. RESULTS Seventy-four randomized controlled trials involving nine rehabilitation techniques and 5128 patients were included. The results of network meta-analysis showed the following orders regarding improvement of the total scores of Fugl-Meyer Assessment, Action Research Arm Test, and Berg Balance Scale: biofeedback therapy > mirror therapy > repetitive transcranial magnetic stimulation > acupuncture therapy > transcranial direct current stimulation > Taichi > common therapy, virtual reality > transcranial direct current stimulation > repetitive transcranial magnetic stimulation > mirror therapy > common therapy, and acupuncture therapy > virtual reality > neuromuscular electrical stimulation > mirror therapy > common therapy > transcranial direct current stimulation, respectively. CONCLUSIONS Biofeedback therapy had the best comprehensive effect, while virtual reality was the best intervention for improving the index of action research arm test and Fugl-Meyer Assessment-lower extremity. Acupuncture therapy improved lower limb balance function.
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Mohammed AH, El-Serougy HR, Karim AEA, Sakr M, Sheha SM. Correlation between Selective Motor Control of the Lower Extremities and Balance in Spastic Hemiplegic Cerebral Palsy: a randomized controlled trial. BMC Sports Sci Med Rehabil 2023; 15:24. [PMID: 36872326 PMCID: PMC9987100 DOI: 10.1186/s13102-023-00636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Children with cerebral palsy (CP) have motor deficits caused by spasticity, weakness, contractures, diminished selective motor control (SMC), and poor balance. The purpose of the current study was to evaluate the influence of mirror feedback on lower extremity selective motor control and balance in children with hemiplegic cerebral palsy. Understanding the relationship between SMC and balance will help children with hemiplegic CP receive more appropriate therapies. METHODS Forty-seven children of both sexes diagnosed with hemiplegic CP participated in the study. Group1 (Gr1 - control group) received conventional physical therapy training while group 2 (Gr2 - intervention group) received conventional physical therapy training in addition to bilateral lower extremity mirror therapy (MT). The primary outcome measure used was Selective Control Assessment of Lower Extremity scale (SCALE), while the secondary outcome measure was the Pediatric Balance Scale (PBS). RESULTS There were significant differences in Selective Control Assessment of Lower Extremity Scale (SCALE) and Pediatric Balance Scale (PBS) between both groups in favor of Gr2. After treatment, both groups improved significantly, yet Gr2 outperformed Gr1 by a large margin. CONCLUSION Mirror therapy may be a useful addition to home-based motor interventions for children with hemiplegic CP due to its relative simplicity, low cost, and high patient adherence. Additionally, it may help children improve their selective motor skills and balance. TRIAL REGISTRATION Current Controlled Trials using African Clinical Trials Registry website with ID number PACTR202105604636415 retrospectively registered on 21/01/202.
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Affiliation(s)
- Amira H Mohammed
- Department of Physical Therapy for Pediatric and its Surgery, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
| | - Hager R El-Serougy
- Department of Physical Therapy for Neuromuscular Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, Giza, Egypt.
| | - Amel E Abdel Karim
- Department of Physical Therapy for Pediatric Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, 77, Giza, Egypt
| | - Mohamad Sakr
- Department of Neurology, College of Medicine, Misr University for Science and Technology, 77, Giza, Egypt
| | - Samah M Sheha
- Department of Physical Therapy for Pediatric Diseases and its Surgery, College of Physical Therapy, Misr University for Science and Technology, 77, Giza, Egypt
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Otálora S, Ballen-Moreno F, Arciniegas-Mayag L, Cifuentes CA, Múnera M. Biomechanical Effects of Adding an Ankle Soft Actuation in a Unilateral Exoskeleton. BIOSENSORS 2022; 12:bios12100873. [PMID: 36291010 PMCID: PMC9599070 DOI: 10.3390/bios12100873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/01/2022] [Accepted: 09/05/2022] [Indexed: 06/01/2023]
Abstract
Stroke disease leads to a partial or complete disability affecting muscle strength and functional mobility. Early rehabilitation sessions might induce neuroplasticity and restore the affected function or structure of the patients. Robotic rehabilitation minimizes the burden on therapists by providing repetitive and regularly monitored therapies. Commercial exoskeletons have been found to assist hip and knee motion. For instance, unilateral exoskeletons have the potential to become an effective training system for patients with hemiparesis. However, these robotic devices leave the ankle joint unassisted, essential in gait for body propulsion and weight-bearing. This article evaluates the effects of the robotic ankle orthosis T-FLEX during cooperative assistance with the AGoRA unilateral lower-limb exoskeleton (hip and knee actuation). This study involves nine subjects, measuring muscle activity and gait parameters such as stance and swing times. The results showed a reduction in muscle activity in the Biceps Femoris of 50%, Lateral Gastrocnemius of 59% and Tibialis Anterior of 35% when adding T-FLEX to the AGoRA unilateral lower-limb exoskeleton. No differences were found in gait parameters. Nevertheless, stability is preserved when comparing the two legs. Future works should focus on evaluating the devices in ground tests in healthy subjects and pathological patients.
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Affiliation(s)
- Sophia Otálora
- Graduate Program of Electrical Engineering, Federal University of Espirito Santo, Vitoria 29075-910, Brazil
| | - Felipe Ballen-Moreno
- Robotics & Multibody Mechanics (R&MM) Research Group, Department of Mechanical Engineering, Vrije Universiteit Brussel, 1050 Brussels, Belgium
- Flanders Make, 1050 Brussels, Belgium
| | - Luis Arciniegas-Mayag
- Graduate Program of Electrical Engineering, Federal University of Espirito Santo, Vitoria 29075-910, Brazil
| | - Carlos A. Cifuentes
- Bristol Robotics Laboratory, University of the West of England, Bristol BS16 1QY, UK
- School of Engineering, Science and Technology, Universidad del Rosario, Bogota 111711, Colombia
| | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogota 111166, Colombia
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Using Mirror Therapy to Optimize the Efficacy of Balance Programs for Older Adults With Poststroke Balance Impairment. Rehabil Nurs 2022; 47:202-209. [PMID: 36210496 DOI: 10.1097/rnj.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Poststroke rehabilitation is an inevitable element of the treatment for stroke survivors. This study aimed to investigate the effect of balance training with mirror therapy in older adults with poststroke balance impairment. DESIGN/METHODS The study adopted a two-arm randomized clinical trial and included 38 older adults with poststroke balance impairment. The intervention group received balance exercises with mirror therapy, whereas the control group received the same balance exercises without mirror therapy (a nonreflective plate was used instead). The patient outcome, the balance score, was measured using the Berg Balance Scale. Analysis of covariance was used for statistical analysis. RESULTS Results showed that balance exercises combined with mirror therapy were significantly more effective than balance exercises without mirror therapy in improving balance in the stroke survivors (p < .001). CONCLUSION Mirror therapy combined with regular balance exercises is an effective and practical method for enhancing balance in older adults suffering from balance impairment. CLINICAL RELEVANCE Balance training combined with containing mirror therapy may be included in the rehabilitation programs of older adults with poststroke balance impairment.
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He K, Wu L, Ni F, Li X, Liang K, Ma R. Efficacy and Safety of Mirror Therapy for Post-stroke Dysphagia: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:874994. [PMID: 35860492 PMCID: PMC9289191 DOI: 10.3389/fneur.2022.874994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/03/2022] [Indexed: 01/08/2023] Open
Abstract
Background Post-stroke dysphagia is a common symptom after stroke and one of the most frequent and severe complications of stroke. Over the recent years, mirror therapy has generated significant research interest as a non-invasive therapeutic and rehabilitative intervention for post-stroke dysphagia and has been investigated in several randomized controlled trials in single center. Objective In this study, we aimed to evaluate the efficacy and safety of mirror therapy for post-stroke dysphagia. Methods A total of seven databases were searched comprehensively from inception to the 31 December 2021, including PubMed, the Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Service System (SinoMed), Wan-fang database, and the Chinese Scientific Journals Database (VIP) from inception to 31 December 2021. The primary outcome measure was efficacy, as measured by clinical effectiveness rate. Secondary outcomes included the water swallowing test and the incidence of pneumonia. In addition, we applied the Cochrane Risk of Bias Tool to investigate the risk of bias. Potential publication bias was evaluated by applying Egger's bias indicator test and by assessing the symmetry of data when visualized as funnel plots. Results A total of five randomized controlled trials (135 subjects in the experimental group and control group) were found to report the application of mirror therapy for post-stroke dysphagia and were included in this study. No publication bias was detected. Meta-analysis revealed that mirror therapy had a positive effect on the rate of clinical efficacy [odds ratio (OR) = 4.22; 95% confidence interval (CI): 2.3–7.73] and the water swallowing test [mean difference (MD) = −0.76; 95% CI = −1.29 to −0.22]. Moreover, mirror therapy reduced the incidence of pneumonia (OR = 0.13; 95% CI = 0.03–0.49). Subgroup analyses indicated that mirror therapy during the acute phase was robust but was unstable during the convalescent phase. Sensitivity analysis revealed that the results generated by our meta-analysis were robust and stable. Conclusions Available evidence appears to suggest that mirror therapy may have a role in the management of post-stroke dysphagia but has yet to be fully confirmed. Existing evidence from clinical trials suggests that evidence relating to the safety of mirror therapy for patients with post-stroke dysphagia is not yet sufficient. Systematic Review Registration Identifier: CRD42022302733.
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Affiliation(s)
- Kelin He
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Lei Wu
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Fengjia Ni
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Xinyun Li
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Kang Liang
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
| | - Ruijie Ma
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Ruijie Ma
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Mahmood W, Ahmed Burq HSI, Ehsan S, Sagheer B, Mahmood T. Effect of core stabilization exercises in addition to conventional therapy in improving trunk mobility, function, ambulation and quality of life in stroke patients: a randomized controlled trial. BMC Sports Sci Med Rehabil 2022; 14:62. [PMID: 35395819 PMCID: PMC8991663 DOI: 10.1186/s13102-022-00452-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/23/2022] [Indexed: 11/10/2022]
Abstract
Background Stroke is a major cause of disability with mainly affecting trunk mobility and function. The purpose of this study is to determine the effectiveness of core stabilization exercises versus conventional therapy on trunk mobility, function, ambulation, and quality of life of stroke patients. Design Assessor blinded randomized control trial.
Setting Ibrahim polyclinic—Shadman, Ch Muhammad Akram teaching hospital-Raiwind, Rasheed hospital-Defence. Subjects Chronic ischemic stroke patients. Intervention Control group (n = 21) underwent conventional treatment for stroke for 40 min/ day, 5 times/ week for 8 weeks. Experimental group (n = 20) received core stability training for additional 15 min along with conventional treatment. Main measures Main outcome measures were Trunk impairment scale (TIS), functional ambulation category (FAC), stroke specific quality of life (SSQOL) and trunk range of motion (ROM). Results The differences between the control group and experimental group post-treatment were statistically significant for trunk impairment, functional ambulation, quality of life, and frontal plane trunk motion (p-value < 0.05) with higher mean values for core stabilization training. The frontal plane trunk mobility and rotation showed non-significant differences post-treatment (p-value > 0.05). Conclusion This study concluded that core stabilization training is better as compared to the conventional physical therapy treatment for improving trunk impairments, functional ambulation and quality of life among patients of stroke. The core stabilization training is also more effective in improving trunk mobility in sagittal plane. This study is registered in Iranian Registry of Clinical Trials IRCT20210614051578N1 and was approved by the local research ethics committee of Riphah International University.
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Affiliation(s)
- Wajeeha Mahmood
- Department of Physical Therapy, Superior University, Lahore, Pakistan.
| | | | - Sarah Ehsan
- Riphah International University, Islamabad, Pakistan
| | | | - Tahir Mahmood
- Imran Idrees Institute of Rehabilitation Sciences, Sialkot, Punjab, Pakistan
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Cui W, Huang L, Tian Y, Luo H, Chen S, Yang Y, Li Y, Fu J, Yu Q, Xu L. Effect and mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke: A fMRI study. NeuroRehabilitation 2022; 51:65-77. [PMID: 35311718 DOI: 10.3233/nre-210307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mirror therapy has been gradually adopted for lower limb rehabilitation, but its efficacy and neural mechanism are not well understood. OBJECTIVE This study aims to investigate the effect and neural mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke by using resting state functional magnetic resonance imaging (rs-fMRI). METHODS A single-blind and randomized controlled pilot study was conducted. 32 patients with ischemic stroke were included in this study and randomly divided into two groups - the control group (CT, n = 16) and the mirror therapy group (MT, n = 16). Both the CT and MT groups received medication and routine rehabilitation training. In addition, mirror therapy was added to the MT group 5 times a week for 30 minutes each time over a period of 3 weeks. Patients' motor functions, functional connectivity (FC), regional homogeneity (ReHo), and fractional amplitude of low-frequency fluctuations (fALFF) were analyzed both before and immediately after the treatment. RESULTS Patients' motor functions showed significant improvement in both groups compared to those before treatment (p < 0.01). Moreover, the MT group showed significantly better improvement than the CT group after the treatment (p < 0.05). FC, ReHo and fALFF indicated enhanced neuronal activities in motor function-related brain regions in the MT group compared to the CT group. CONCLUSION Mirror therapy promotes the recovery of lower limb motor functions in patients with ischemic stroke. Through the comparative rs-fMRI analysis, it is found that the mirror therapy promotes the functional reorganization of the injured brain.
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Affiliation(s)
- Wei Cui
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Lin Huang
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yang Tian
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Hong Luo
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Shuang Chen
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yan Yang
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yamei Li
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Jing Fu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Qian Yu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Li Xu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
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Lin GH, Li CY, Sheu CF, Huang CY, Lee SC, Huang YH, Hsieh CL. Using Machine Learning to develop a short-form measure assessing 5 functions in patients with stroke. Arch Phys Med Rehabil 2021; 103:1574-1581. [PMID: 34979129 PMCID: PMC9378042 DOI: 10.1016/j.apmr.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/26/2021] [Accepted: 12/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to develop and validate a machine learning based short measure (the ML-5F) to assess 5 functions (activities of daily living (ADL), balance, upper extremity (UE) and lower extremity (LE) motor function, and mobility) in patients with stroke. DESIGN Secondary data from a previous study. A follow-up study assessed patients with stroke using the Barthel Index (BI), Postural Assessment Scale for Stroke (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) at hospital admission and discharge. SETTING A rehabilitation unit in a medical center. PARTICIPANTS A total of 307 patients. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The BI, PASS, and STREAM. RESULTS A machine learning algorithm, Extreme Gradient Boosting, was used to select 15 items from the BI, PASS, and STREAM, and transformed the raw scores of the selected items into the scores of the ML-5F. The ML-5F demonstrated good concurrent validity (Pearson's r = 0.88-0.98) and responsiveness (standardized response mean = 0.28-1.01). CONCLUSIONS The ML-5F comprises only 15 items but demonstrates sufficient concurrent validity and responsiveness to assess ADL, balance, UE and LE functions, and mobility in patients with stroke. The ML-5F shows great potential as an efficient outcome measure in clinical settings.
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Affiliation(s)
- Gong-Hong Lin
- Master Program in Long-term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chih-Ying Li
- Department of Occupational Therapy, School of Health Professions, University of Texas Medical Branch, Galveston, Texas
| | - Ching-Fan Sheu
- Institute of Education, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Yu Huang
- Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Shih-Chieh Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Hui Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan.
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Mayag LJA, Múnera M, Cifuentes CA. Human-in-the-Loop Control for AGoRA Unilateral Lower-Limb Exoskeleton. J INTELL ROBOT SYST 2021. [DOI: 10.1007/s10846-021-01487-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bajuaifer S, Grey MJ, Hancock N, Pomeroy VM. User perspectives on the design and setup of lower limb mirror therapy equipment after stroke: a technical report. Physiotherapy 2021; 113:37-43. [PMID: 34555672 DOI: 10.1016/j.physio.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To co-design lower limb mirror therapy (MT) equipment and setup by working directly with stroke survivors and physiotherapists. DESIGN Co-design approach through focus groups. PARTICIPANTS Twenty-six participants. Sixteen stroke survivors and ten physiotherapists. DATA COLLECTION AND ANALYSIS Data were collected in an iterative process through two sets of focus groups. Firstly, prototype one of the MT equipment was presented to the participants. They were encouraged to use and comment on it. Then, the key requirements for ankle exercise with MT were presented, and participants discussed whether the prototype one was able to deliver these requirements. These findings informed iterations to the device, and a second prototype was produced and discussed in the second set of focus groups. The final prototype was then produced based on the participants' feedback. All focus groups were audio-recorded, followed by verbatim transcriptions and thematic analysis. RESULTS Main characteristics required of the lower limb MT device were found to be: the ability to produce MT ankle exercise from an upright sitting posture, an adjustable angle between 5 to 15 degree from the midline to allow clear lower limb reflection during seated exercise, and a lightweight device to enable easy use for stroke survivors. CONCLUSION This work produced an iteratively co-design lower limb MT to be used with stroke survivors.
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Affiliation(s)
- Sarah Bajuaifer
- School of Health Sciences, University of East Anglia, UK; Princess Nourah Bint Abdulrahman University, Saudi Arabia.
| | - Michael J Grey
- School of Health Sciences, University of East Anglia, UK
| | - Nicola Hancock
- School of Health Sciences, University of East Anglia, UK
| | - Valerie M Pomeroy
- School of Health Sciences, University of East Anglia, UK; NIHR Brain Injury MedTech, UK
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Morphological and Functional Changes of the Tibialis Anterior Muscle After Combined Mirror Visual Feedback and Electromyographic Biofeedback in Poststroke Patients: A Randomized Trial. Am J Phys Med Rehabil 2021; 100:766-773. [PMID: 33105154 DOI: 10.1097/phm.0000000000001628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the morphological and functional changes of the tibialis anterior muscle after mirror visual feedback combined with electromyographic biofeedback in poststroke patients. DESIGN A total of 46 poststroke patients were randomly divided into three groups: a mirror visual feedback + electromyographic biofeedback group, a mirror visual feedback group, and a control group. The mirror visual feedback + electromyographic biofeedback group was treated with both mirror visual feedback and electromyographic biofeedback, and the mirror visual feedback group was treated with mirror visual feedback alone. The morphological parameters, including the pennation angle, muscle thickness, and fascicle length, were assessed. RESULTS After 4 wks of treatment, the pennation angle and muscle thickness values were significantly increased in the mirror visual feedback + electromyographic biofeedback and mirror visual feedback groups (P < 0.05). The increase of these values in the mirror visual feedback + electromyographic biofeedback group was significantly greater than that in both metrics in the mirror visual feedback and control groups (P < 0.05), and those in the mirror visual feedback group were greater than those in the control group (P < 0.05). There was no significant difference in the fascicle length value among the three groups as a result of the treatment. After the treatment, the neurological functions were all increased in three groups (P < 0.05). CONCLUSIONS A combination of mirror visual feedback and electromyographic biofeedback seems to be an effective therapy for improving the motor function of the tibialis anterior muscle in poststroke patients.Clinical trial registration number: ChiCTR1800017050.
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Wardhani P, Triyani I, Ardiansyah F, Matos FAD. Finger Exoskeleton in Simple Motor Rehabilitation Therapy on Arm and Hand Muscle Ability of Post-Stroke Sufferers. JURNAL INFO KESEHATAN 2021. [DOI: 10.31965/infokes.vol19.iss1.340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Post-stroke sufferers will generally experience weakness on one side of the body, balance, vision, sensory, motor, and cognitive. In West Kalimantan, the estimated stroke sufferer in 2013 was 25,195 people. Based on data from the Public Hospital of Dr. Soedarso Pontianak shows a significant increase from January 2018 to December 2018 totaling 722 people. The research objective was to assess the effectiveness of the finger exoskeleton tool in simple motor therapy on the ability of the client's arm and hand muscles after a stroke. This study used a quantitative approach with a quasi-experimental design. Pre-test and Post-test Nonequivalent Control Group with two groups, which were the control group of 12 people and the intervention group of 12 people with finger exoskeleton tools. The statistical test used was the independent t test and paired t test. Measurement of muscle ability with the Action Research Arm Test. Analysis of the difference in total scores between before and after treatment in the intervention group using Paired T-Test obtained a p-value of 0.000 (p value <0.05) and in the control group using the Wilcoxon test a p-value of 0.016 (p value <0.05). It shows that there is a significant difference in the total score between before and after finger exoskeleton therapy and range of motion. Intervention of finger exoskeleton assistive devices in simple motor rehabilitation therapy is effective in increasing the ability of the client's arm and hand muscles after stroke. It is recommended to make another finger rehabilitation tool with a more optimal design according to the parameters, which are the severity of the client after stroke, subject kinematics, control of movement torque and adaptation between the subject and the robotic device used.
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Tekeoglu Tosun A, Ipek Y, Razak Ozdincler A, Saip S. The efficiency of mirror therapy on drop foot in Multiple Sclerosis Patients. Acta Neurol Scand 2021; 143:545-553. [PMID: 33270229 DOI: 10.1111/ane.13385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/09/2020] [Accepted: 11/25/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Although the effectiveness of mirror therapy (MT) has been proved in stroke persons, there is no scientific evidence about the results in people with multiple sclerosis. The aim was to investigate whether adding MT to exercise training and neuromuscular electrical stimulation (NMES) has any effect on clinical measurements, mobility, and functionality in people with multiple sclerosis (MS). METHODS Ambulatory people with MS, with unilateral drop foot, were included. MT group (n = 13) applied bilateral ankle exercise program with mirror following NMES for 3 days a week at hospital and exercise program for 2 days a week at home. Control group (n = 13) performed same treatment without mirror box (6 weeks). The later 6 weeks both groups performed only exercise program. Clinical measurements included proprioception, muscle tone of plantar flexor muscles (MAS), muscle strength of dorsiflexor, ankle angular velocity, and range of motion (ROM) of ankle. Functionality (Functional Independence Measurement-FIM), mobility (Rivermead Mobility Index-RMI), ambulation (Functional Ambulation Scale-FAS), duration of stair climb test, and 25-foot walking velocity were assessed at the beginning, in 6th and 12th weeks. RESULTS More positive improvements were obtained in MT group than control group in terms of range of motion (0.012), muscle strength (0.008), proprioception (0.001), 25 feet walking duration (0.015), step test duration (0.001), FAS (0.005), RMI (0.001), and FIM (0.001) after 6 weeks treatment. It was seen that this improvement maintained to 12th week on all clinical and functional measurements (p < .05). CONCLUSION The trial revealed that adding MT to exercise training and NMES has more beneficial effects on clinical measurements, mobility, and functionality in people with multiple sclerosis with unilateral drop foot.
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Affiliation(s)
- Anıl Tekeoglu Tosun
- Division of Physiotherapy and Rehabilitation Faculty of Health Sciences Fenerbahce University Istanbul Turkey
| | - Yeldan Ipek
- Division of Physiotherapy and Rehabilitation Faculty of Health Sciences Istanbul University‐Cerrahpasa Istanbul Turkey
| | - Arzu Razak Ozdincler
- Division of Physiotherapy and Rehabilitation Faculty of Health Sciences Biruni University Istanbul Turkey
| | - Sabahattin Saip
- Department of Neurology Medical School of Cerrahpasa Istanbul University‐Cerrahpasa Istanbul Turkey
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Saha S, Sur M, Ray Chaudhuri G, Agarwal S. Effects of mirror therapy on oedema, pain and functional activities in patients with poststroke shoulder-hand syndrome: A randomized controlled trial. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1902. [PMID: 33675672 DOI: 10.1002/pri.1902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 01/23/2021] [Accepted: 02/07/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To study the effectiveness of mirror therapy along with a Stroke rehabilitation program on oedema, pain intensity and functional activities in patients with shoulder-hand syndrome (SHS) after stroke. DESIGN Randomized controlled trial. SETTINGS Out-patient rehabilitation center. METHODS Thirty-eight SHS patients after stroke, were randomly allocated into two groups; both the groups received a 4-week stroke rehabilitation program, 30 min a day for 5 days a week. Control group patients performed all the exercises of stroke rehabilitation program, while directly visualizing their both limbs. Experimental group patients performed same exercises of stroke rehabilitation program in front of the mirror. OUTCOME MEASURES Oedema (figure-of-eight measurement method), pain intensity (0-10 Numeric Pain Rating Scale [0-10 NPRS]), functional activities (Functional Independence Measure [FIM]). RESULTS After intervention, both groups showed statistically significant (p < 0.05) improvement for all measures (oedema measurement, 0-10 NPRS and FIM). Improvements were more significant (p < 0.05) in the experimental group with mirror therapy for all three measures compared to the control group. Mean differences between groups were 1.40 cm for oedema measurement, 0.87 for NPRS score and 12.20 for FIM score. At 2-week follow-up, the improvements were sustained. CONCLUSION The current study may indicate mirror therapy as an effective central neuromodulatory rehabilitative program to reduce pain, improves functional activities. More distinctively, this preliminary study suggests a decrease in oedema by mirror therapy for SHS after stroke. Improvement of upper limb in SHS after stroke will be more perceptible with the decrease in oedema, being the characteristic sign, following mirror therapy. Clinically, patients during their daily functional activities, shall be more confident to use their upper limb following mirror therapy after reduction in oedema along with pain.
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Affiliation(s)
- Sourov Saha
- Department of Physiotherapy, National Institute for Locomotor Disabilities, Kolkata, West Bengal, India
| | - Mainak Sur
- College of Physiotherapy, Nopany Institute of Healthcare Studies, Kolkata, West Bengal, India
| | - Gargi Ray Chaudhuri
- College of Physiotherapy, Nopany Institute of Healthcare Studies, Kolkata, West Bengal, India
| | - Shabnam Agarwal
- College of Physiotherapy, Nopany Institute of Healthcare Studies, Nopany Group of Institutions, Kolkata, West Bengal, India
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Chrastina J, Svízelová H. Mirror therapy in adult stroke patients: a review of possible applications and effectiveness with an emphasis on activities of daily living. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2021. [DOI: 10.15452/cejnm.2020.11.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Shankaranarayana AM, Gururaj S, Natarajan M, Balasubramanian CK, Solomon JM. Gait training interventions for patients with stroke in India: A systematic review. Gait Posture 2021; 83:132-140. [PMID: 33137637 DOI: 10.1016/j.gaitpost.2020.10.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/01/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait is considered to be the most important determinant of functional independence in activities of daily living. The challenges faced by stroke survivors in India differ from the western population due to economic, cultural, and geographical factors and this, in turn, may influence the choice of intervention. Hence, there is a need to understand the current gait training trends for stroke survivors in low resource settings like India. RESEARCH QUESTION To systematically review the literature on interventional strategies for improving gait among stroke survivors in India. METHODS Six databases were searched to identify RCTs delivering gait training to stroke survivors having some gait deficits in terms of speed or any other kinematic parameters. Studies of the English language from India were included. Two independent reviewers screened, extracted data, and assessed the study quality. A descriptive synthesis was undertaken and the data was summarized. RESULTS Of 2112 potentially relevant articles, 12 studies with a total of 412 participants were included after title, abstract and full-text screening. Studies tested the efficacy of interventions such as mirror therapy, motor imagery, transcutaneous electrical nerve stimulation, strengthening, and task-based training. The outcome measures were kinematic gait-analysis, gait velocity, Functional Ambulation Categories, Timed Up and Go, Fugl-Meyer Assessment. From the results of this review, active task-based gait training and strengthening along with motor priming seems to be the most tested interventions. Future studies may need to design interventions targeting both impairment and function to bring about maximum improvement in gait after stroke. SIGNIFICANCE Reviews addressing gait practices in developing countries for people with stroke are scarce. The present review would assist physiotherapists in developing countries to utilize evidence-based criteria for the selection of gait training approaches post-stroke. Due to the environmental and contextual demands, the effect of interventions for recovery among stroke survivors should be improvised in low resource settings. This review can be a source of recommendation in giving effective strategies for clinical practice.
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Affiliation(s)
- Apoorva M Shankaranarayana
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - Sanjana Gururaj
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | | | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India; Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Silva S, Borges LR, Santiago L, Lucena L, Lindquist AR, Ribeiro T. Motor imagery for gait rehabilitation after stroke. Cochrane Database Syst Rev 2020; 9:CD013019. [PMID: 32970328 PMCID: PMC8094749 DOI: 10.1002/14651858.cd013019.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Motor imagery (MI) is defined as a mentally rehearsed task in which movement is imagined but is not performed. The approach includes repetitive imagined body movements or rehearsing imagined acts to improve motor performance. OBJECTIVES To assess the treatment effects of MI for enhancing ability to walk among people following stroke. SEARCH METHODS We searched the Cochrane Stroke Group registry, CENTRAL, MEDLINE, Embase and seven other databases. We also searched trial registries and reference lists. The last searches were conducted on 24 February 2020. SELECTION CRITERIA Randomized controlled trials (RCTs) using MI alone or associated with action observation or physical practice to improve gait in individuals after stroke. The critical outcome was the ability to walk, assessed using either a continuous variable (walking speed) or a dichotomous variable (dependence on personal assistance). Important outcomes included walking endurance, motor function, functional mobility, and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected the trials according to pre-defined inclusion criteria, extracted the data, assessed the risk of bias, and applied the GRADE approach to evaluate the certainty of the evidence. The review authors contacted the study authors for clarification and missing data. MAIN RESULTS We included 21 studies, involving a total of 762 participants. Participants were in the acute, subacute, or chronic stages of stroke, and had a mean age ranging from 50 to 78 years. All participants presented at least some gait deficit. All studies compared MI training versus other therapies. Most of the included studies used MI associated with physical practice in the experimental groups. The treatment time for the experimental groups ranged from two to eight weeks. There was a high risk of bias for at least one assessed domain in 20 of the 21 included studies. Regarding our critical outcome, there was very low-certainty evidence that MI was more beneficial for improving gait (walking speed) compared to other therapies at the end of the treatment (pooled standardized mean difference (SMD) 0.44; 95% confidence interval (CI) 0.06 to 0.81; P = 0.02; six studies; 191 participants; I² = 38%). We did not include the outcome of dependence on personal assistance in the meta-analysis, because only one study provided information regarding the number of participants that became dependent or independent after interventions. For our important outcomes, there was very low-certainty evidence that MI was no more beneficial than other interventions for improving motor function (pooled mean difference (MD) 2.24, 95% CI -1.20 to 5.69; P = 0.20; three studies; 130 participants; I² = 87%) and functional mobility at the end of the treatment (pooled SMD 0.55, 95% CI -0.45 to 1.56; P = 0.09; four studies; 116 participants; I² = 64.2%). No adverse events were observed in those studies that reported this outcome (seven studies). We were unable to pool data regarding walking endurance and all other outcomes at follow-up. AUTHORS' CONCLUSIONS We found very low-certainty evidence regarding the short-term benefits of MI on walking speed in individuals who have had a stroke, compared to other therapies. Evidence was insufficient to estimate the effect of MI on the dependence on personal assistance and walking endurance. Compared with other therapies, the evidence indicates that MI does not improve motor function and functional mobility after stroke (very low-certainty evidence). Evidence was also insufficient to estimate the effect of MI on gait, motor function, and functional mobility after stroke compared to placebo or no intervention. Motor Imagery and other therapies used for gait rehabilitation after stroke do not appear to cause significant adverse events.
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Affiliation(s)
- Stephano Silva
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Lorenna Rdm Borges
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Lorenna Santiago
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Larissa Lucena
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ana R Lindquist
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Tatiana Ribeiro
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
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The effect of mirror therapy on lower extremity motor function and ambulation in post-stroke patients: A prospective, randomized-controlled study. Turk J Phys Med Rehabil 2020; 66:154-160. [PMID: 32760892 DOI: 10.5606/tftrd.2020.2719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 12/12/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to evaluate the effects of mirror therapy (MT) on lower extremity motor function and ambulation in post-stroke patients. Patients and methods A total of 42 post-stroke patients (25 males, 17 females; mean age 58 years; range, 32 to 71 years) were included. All patients were randomly divided into two groups as the control group (n=21) receiving a conventional rehabilitation program for four weeks (60 to 120 min/day for five days a week) and as the MT group (n=21) receiving MT for 30 min in each session in addition to the conventional rehabilitation program. The Brunnstrom stages of stroke recovery, Functional Independence Measure (FIM), Berg Balance Scale (BBS) and Motricity Index (MI) scores, six-minute walking test (6MWT), Functional Ambulation Category (FAC), and the degree of ankle plantar flexion spasticity using the Modified Ashworth Scale (MAS) were evaluated at baseline (Day 0), at post-treatment (Week 4), and eight weeks after the end of treatment (Week 12). Results There were significant differences in all parameters between the groups, except for the degree of ankle plantar flexion spasticity, and in all time points between Week 0 and 4 and between Week 0 and 12 (p<0.05). Conclusion These results suggest that MT in addition to conventional rehabilitation program yields a greater improvement in the lower extremity motor function and ambulation, which sustains for a short period of time after the treatment.
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Gandhi DB, Sterba A, Khatter H, Pandian JD. Mirror Therapy in Stroke Rehabilitation: Current Perspectives. Ther Clin Risk Manag 2020; 16:75-85. [PMID: 32103968 PMCID: PMC7012218 DOI: 10.2147/tcrm.s206883] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/16/2020] [Indexed: 12/30/2022] Open
Abstract
In contrast to varied therapy approaches, mirror therapy (MT) can be used even in completely plegic stroke survivors, as it uses visual stimuli for producing a desired response in the affected limb. MT has been studied to have effects not just on motor impairments but also on sensations, visuospatial neglect, and pain after stroke. This paper attempts to systematically review and present the current perspectives on mirror therapy and its application in stroke rehabilitation, and dosage, feasibility and acceptability in stroke rehabilitation. An electronic database search across Google, PubMed, Web of Science, etc., generated 3871 results. After screening them based on the inclusion and exclusion criteria, we included 28 studies in this review. The data collected were divided on the basis of application in stroke rehabilitation, modes of intervention delivery, and types of control and outcome assessment. We found that most studies intervened for upper limb motor impairments post stroke. Studies were equally distributed between intervention in chronic and acute phases post stroke with therapy durations lasting between 1 and 8 weeks. MT showed definitive motor and sensory improvements although the extent of improvements in sensory impairments and hemineglect is limited. MT proves to be an effective and feasible approach to rehabilitate post-stroke survivors in the acute, sub-acute, and chronic phases of stroke, although its long-term effects and impact on activities of daily living need to be analysed extensively.
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Affiliation(s)
- Dorcas Bc Gandhi
- College of Physiotherapy, Christian Medical College & Hospital Ludhiana, Ludhiana, Punjab, India.,Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
| | - Albert Sterba
- Department of Neurology, Christian Medical College & Hospital Ludhiana, Ludhiana, Punjab, India
| | - Himani Khatter
- Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
| | - Jeyaraj D Pandian
- Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
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Morkisch N, Thieme H, Dohle C. How to perform mirror therapy after stroke? Evidence from a meta-analysis. Restor Neurol Neurosci 2019; 37:421-435. [DOI: 10.3233/rnn-190935] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nadine Morkisch
- MEDIAN Klinik Berlin-Kladow, Berlin, Germany
- Center for Stroke Research Berlin, Charité – University Medicine Berlin, Berlin, Germany
| | - Holm Thieme
- First European School of Physiotherapy, Occupational therapy, Speech and Language therapy, Klinik Bavaria Kreischa, Kreischa, Germany
- HAWK University of Applied Sciences and Arts, Faculty of Social Work and Health, Hildesheim, Germany
| | - Christian Dohle
- MEDIAN Klinik Berlin-Kladow, Berlin, Germany
- Center for Stroke Research Berlin, Charité – University Medicine Berlin, Berlin, Germany
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Broderick P, Horgan F, Blake C, Ehrensberger M, Simpson D, Monaghan K. Mirror therapy and treadmill training for patients with chronic stroke: a pilot randomized controlled trial. Top Stroke Rehabil 2018; 26:163-172. [PMID: 30580672 DOI: 10.1080/10749357.2018.1556504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Previous lower-limb mirror therapy research has focused on non-weight bearing interventions. OBJECTIVES The primary aim of this study was to investigate the effect and feasibility of a combination of mirror therapy and treadmill training on post-stroke lower-limb recovery compared to a placebo intervention. METHODS All patients (N = 30) walked on a treadmill for 30 min per day, 3 days per week, for 4 weeks. The mirror therapy and treadmill training group (n = 15) walked on the treadmill while viewing a reflection of their non-paretic limb in a mirror positioned in their mid-sagittal plane. The placebo group (n = 15) received no mirror visual feedback due to an altered mirror position. PRIMARY OUTCOME MEASURES Ten Metre Walk Test (10MWT) and Six Minute Walk Test (6MWT). SECONDARY OUTCOME MEASURES Modified Ashworth Scale (MAS) and Fugl-Meyer Assessment-Lower Extremity (FMA-LE). Feasibility was appraised by examining participant compliance and any adverse events. RESULTS No significant between group differences were demonstrated for the 10MWT, 6MWT or FMA-LE at post-training or 3-month follow-up assessment. A significant between group difference on the MAS was demonstrated in the reduction of ankle dorsiflexion muscle tone (p = 0.006) and ankle plantarflexion muscle tone (p = 0.01) in the mirror therapy group compared to the placebo group at post-training assessment but not at 3-month follow-up. CONCLUSION Our study reveals that in our group of patients with chronic stroke, mirror therapy combined with treadmill training facilitated significant reductions in ankle muscle tone (p < 0.05) compared to a placebo intervention.
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Affiliation(s)
- P Broderick
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
| | - F Horgan
- b School of Physiotherapy , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - C Blake
- c School of Public Health , University College Dublin , Dublin , Ireland
| | - M Ehrensberger
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
| | - D Simpson
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
| | - K Monaghan
- a School of Science , Institute of Technology Sligo , Sligo , Ireland
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Dee M, Lennon O, O'Sullivan C. A systematic review of physical rehabilitation interventions for stroke in low and lower-middle income countries. Disabil Rehabil 2018; 42:473-501. [PMID: 30508495 DOI: 10.1080/09638288.2018.1501617] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose: Approximately 70% of strokes occur in low and middle income countries, yet the effectiveness of physical rehabilitation in these contexts remains undetermined. This systematic review identifies and summarises the current evidence supporting physical rehabilitation interventions post-stroke in low and lower-middle income countries.Methods: Five databases were comprehensively searched (April 2017) for randomised controlled trials, clinical controlled trials, and cohort studies testing rehabilitation interventions post-stroke in these countries. The Effective Public Health Practice Project Tool assessed quality of included studies.Results: Sixty-two studies (2115 participants) were included. Interventions addressed upper limb (n = 26), lower limb (n = 22), and other (n = 14) outcomes. Seven studies were rated as strong in quality, 16 moderate and 39 rated as weak. Overall, in addition to usual care, physical rehabilitation interventions improved outcomes for stroke survivors. Best evidence synthesis provides level I (b) evidence supporting constraint induced movement therapy and mirror therapy to improve upper limb functional outcomes. Level I (b) evidence supports multimodal interventions that include lower limb motor imagery to improve gait parameters. Level II (b) evidence supports sit-to-stand training to improve balance outcomes.Conclusions: Exercise-based and brain training interventions improved functional outcomes post-stroke in low and lower-middle income countries. Further high-quality studies including participation outcomes are required.Implications for RehabilitationLow-cost physical rehabilitation interventions requiring minimal resources can improve functional outcomes after stroke in low and lower-middle income countries.Exercise-based interventions can improve upper limb, lower limb, gait, and balance outcomes after stroke.Brain training paradigms such as mirror therapy and motor imagery, when included in therapy packages, can improve upper limb and gait outcomes.The proven efficacy for rehabilitation interventions in improving stroke outcomes in low and lower-middle income countries supports the need to strengthen the rehabilitation workforce in this context.
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Affiliation(s)
- Muireann Dee
- UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Olive Lennon
- UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Cliona O'Sullivan
- UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
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Lin IH, Tsai HT, Wang CY, Hsu CY, Liou TH, Lin YN. Effectiveness and Superiority of Rehabilitative Treatments in Enhancing Motor Recovery Within 6 Months Poststroke: A Systemic Review. Arch Phys Med Rehabil 2018; 100:366-378. [PMID: 30686327 DOI: 10.1016/j.apmr.2018.09.123] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/19/2018] [Accepted: 09/21/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the effects of various rehabilitative interventions aimed at enhancing poststroke motor recovery by assessing their effectiveness when compared with no treatment or placebo and their superiority when compared with conventional training program (CTP). DATA SOURCE A literature search was based on 19 Cochrane reviews and 26 other reviews. We also updated the searches in PubMed up to September 30, 2017. STUDY SELECTION Randomized controlled trials associated with 18 experimented training programs (ETP) were included if they evaluated the effects of the programs on either upper extremity (UE) or lower extremity (LE) motor recovery among adults within 6 months poststroke; included ≥10 participants in each arm; and had an intervention duration of ≥10 consecutive weekdays. DATA EXTRACTION Four reviewers evaluated the eligibility and quality of literature. Methodological quality was assessed using the PEDro scale. DATA SYNTHESIS Among the 178 included studies, 129 including 7450 participants were analyzed in this meta-analysis. Six ETPs were significantly effective in enhancing UE motor recovery, with the standard mean differences (SMDs) and 95% confidence intervals outlined as follow: constraint-induced movement therapy (0.82, 0.45-1.19), electrostimulation (ES)-motor (0.42, 0.22-0.63), mirror therapy (0.71, 0.22-1.20), mixed approach (0.21, 0.01-0.41), robot-assisted training (0.51, 0.22-0.80), and task-oriented training (0.57, 0.16-0.99). Six ETPs were significantly effective in enhancing LE motor recovery: body-weight-supported treadmill training (0.27, 0.01-0.52), caregiver-mediated training (0.64, 0.20-1.08), ES-motor (0.55, 0.27-0.83), mixed approach (0.35, 0.15-0.54), mirror therapy (0.56, 0.13-1.00), and virtual reality (0.60, 0.15-1.05). However, compared with CTPs, almost none of the ETPs exhibited significant SMDs for superiority. CONCLUSIONS Certain experimented interventions were effective in enhancing poststroke motor recovery, but little evidence supported the superiority of experimented interventions over conventional rehabilitation.
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Affiliation(s)
- I-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Han-Ting Tsai
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yung Wang
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
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Lin GH, Huang YJ, Lee YC, Lee SC, Chou CY, Hsieh CL. Development of a Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke: A Simulation and Validation Study. Arch Phys Med Rehabil 2018; 100:899-907. [PMID: 31030732 DOI: 10.1016/j.apmr.2018.09.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/10/2018] [Accepted: 09/28/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The authors aimed to develop and validate the Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke (CAT-5F) based on the Barthel Index (BI), Postural Assessment Scale for Stroke patients (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) to improve the efficiency of assessment. The purposes of the CAT-5F assessment are to describe patients' levels of impairments or disabilities in the 5 functions and to serve as an outcome measure in patients with stroke. DESIGN This is a data-mining study based on data from a previous study using simulation analysis to develop and validate the CAT-5F. SETTING One rehabilitation unit in a medical center in Taiwan served as the setting for this study. PARTICIPANTS Data were retrieved from totals of 540 (initial assessment) and 309 (discharge assessment) participants with stroke assessed in a previous study. The assessment data (N=540) were from the BI, PASS, and STREAM. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The outcome measures for this study were from BI, PASS, and STREAM. RESULTS The CAT-5F using the optimal stopping rule (limited reliability increased <0.010) had good Rasch reliability across the 5 functions (0.86-0.96) and needed 12.7 items, on average, for the whole administration. The concurrent validity (Pearson product-moment correlation coefficient, r=0.91-0.96) and responsiveness (standardized response mean=0.33-0.91) of the CAT-5F were sufficient in the patients. CONCLUSION The CAT-5F has sufficient administrative efficiency, reliability, concurrent validity, and responsiveness to simultaneously assess basic activities of daily living, postural control, upper extremity/lower extremity motor functions, and mobility in patients with stroke.
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Affiliation(s)
- Gong-Hong Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Jing Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ya-Chen Lee
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Shih-Chieh Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Yeh Chou
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Occupational Therapy, College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Louie DR, Lim SB, Eng JJ. The Efficacy of Lower Extremity Mirror Therapy for Improving Balance, Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2018; 28:107-120. [PMID: 30314760 DOI: 10.1016/j.jstrokecerebrovasdis.2018.09.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/09/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Mirror therapy is less commonly used to target the lower extremity after stroke to improve outcomes but is simple to perform. This review and meta-analysis aimed to evaluate the efficacy of lower extremity mirror therapy in improving balance, gait, and motor function for individuals with stroke. METHODS PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and PsychINFO were searched from inception to May 2018 for randomized controlled trials (RCTs) comparing lower extremity mirror therapy to a control intervention for people with stroke. Pooled effects were determined by separate meta-analyses of gait speed, mobility, balance, and motor recovery. RESULTS Seventeen RCTs involving 633 participants were included. Thirteen studies reported a significant between-group difference favoring mirror therapy in at least one lower extremity outcome. In a meta-analysis of 6 trials that reported change in gait speed, a large beneficial effect was observed following mirror therapy training (standardized mean differences [SMD] = 1.04 [95% confidence interval [CI] = .43, 1.66], I2 = 73%, and P < .001). Lower extremity mirror therapy also had a positive effect on mobility (5 studies, SMD = .46 [95% CI = .01, .90], I2 = 43%, and P = .05) and motor recovery (7 studies, SMD = .47 [95% CI = .21, .74], I2 = 0%, and P < .001). A significant pooled effect was not found for balance capacity. CONCLUSIONS Mirror therapy for the lower extremity has a large effect for gait speed improvement. This review also found a small positive effect of mirror therapy for mobility and lower extremity motor recovery after stroke.
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Affiliation(s)
- Dennis R Louie
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Canada
| | - Shannon B Lim
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Canada
| | - Janice J Eng
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Canada; Department of Physical Therapy, University of British Columbia, Canada.
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Thieme H, Morkisch N, Mehrholz J, Pohl M, Behrens J, Borgetto B, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev 2018; 7:CD008449. [PMID: 29993119 PMCID: PMC6513639 DOI: 10.1002/14651858.cd008449.pub3] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mirror therapy is used to improve motor function after stroke. During mirror therapy, a mirror is placed in the person's midsagittal plane, thus reflecting movements of the non-paretic side as if it were the affected side. OBJECTIVES To summarise the effectiveness of mirror therapy compared with no treatment, placebo or sham therapy, or other treatments for improving motor function and motor impairment after stroke. We also aimed to assess the effects of mirror therapy on activities of daily living, pain, and visuospatial neglect. SEARCH METHODS We searched the Cochrane Stroke Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED, PsycINFO and PEDro (last searched 16 August 2017). We also handsearched relevant conference proceedings, trials and research registers, checked reference lists, and contacted trialists, researchers and experts in our field of study. SELECTION CRITERIA We included randomised controlled trials (RCTs) and randomised cross-over trials comparing mirror therapy with any control intervention for people after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on the inclusion criteria, documented the methodological quality, assessed risks of bias in the included studies, and extracted data. We assessed the quality of the evidence using the GRADE approach. We analysed the results as standardised mean differences (SMDs) or mean differences (MDs) for continuous variables, and as odds ratios (ORs) for dichotomous variables. MAIN RESULTS We included 62 studies with a total of 1982 participants that compared mirror therapy with other interventions. Of these, 57 were randomised controlled trials and five randomised cross-over trials. Participants had a mean age of 59 years (30 to 73 years). Mirror therapy was provided three to seven times a week, between 15 and 60 minutes for each session for two to eight weeks (on average five times a week, 30 minutes a session for four weeks).When compared with all other interventions, we found moderate-quality evidence that mirror therapy has a significant positive effect on motor function (SMD 0.47, 95% CI 0.27 to 0.67; 1173 participants; 36 studies) and motor impairment (SMD 0.49, 95% CI 0.32 to 0.66; 1292 participants; 39 studies). However, effects on motor function are influenced by the type of control intervention. Additionally, based on moderate-quality evidence, mirror therapy may improve activities of daily living (SMD 0.48, 95% CI 0.30 to 0.65; 622 participants; 19 studies). We found low-quality evidence for a significant positive effect on pain (SMD -0.89, 95% CI -1.67 to -0.11; 248 participants; 6 studies) and no clear effect for improving visuospatial neglect (SMD 1.06, 95% CI -0.10 to 2.23; 175 participants; 5 studies). No adverse effects were reported. AUTHORS' CONCLUSIONS The results indicate evidence for the effectiveness of mirror therapy for improving upper extremity motor function, motor impairment, activities of daily living, and pain, at least as an adjunct to conventional rehabilitation for people after stroke. Major limitations are small sample sizes and lack of reporting of methodological details, resulting in uncertain evidence quality.
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Affiliation(s)
- Holm Thieme
- Erste Europäische Schule für Physiotherapie, Ergotherapie und Logopädie, Klinik Bavaria KreischaKreischa, SachsenGermany
- Martin Luther University Halle‐WittenbergInstitute for Health and Nursing Science, German Center for Evidence‐based NursingHalle/SaaleGermany
- Fakultät Soziale Arbeit und GesundheitHAWK Hochschule für angewandte Wissenschaft und KunstHildesheimGermany31134
| | - Nadine Morkisch
- Charité ‐ University Medicine BerlinCenter for Stroke Research BerlinCharitéplatz 1BerlinGermany0117
- MEDIAN Klinik Berlin‐KladowKladower Damm 223BerlinGermany14089
| | - Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Johann Behrens
- Martin Luther University Halle‐WittenbergInstitute for Health and Nursing Science, German Center for Evidence‐based NursingHalle/SaaleGermany
| | - Bernhard Borgetto
- Fakultät Soziale Arbeit und GesundheitHAWK Hochschule für angewandte Wissenschaft und KunstHildesheimGermany31134
| | - Christian Dohle
- Charité ‐ University Medicine BerlinCenter for Stroke Research BerlinCharitéplatz 1BerlinGermany0117
- MEDIAN Klinik Berlin‐KladowKladower Damm 223BerlinGermany14089
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Yang Y, Zhao Q, Zhang Y, Wu Q, Jiang X, Cheng G. Effect of Mirror Therapy on Recovery of Stroke Survivors: A Systematic Review and Network Meta-analysis. Neuroscience 2018; 390:318-336. [PMID: 29981364 DOI: 10.1016/j.neuroscience.2018.06.044] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 11/26/2022]
Abstract
Mirror therapy (MT) as a relatively new rehabilitation technique has been widely applied in stroke patients. A number of randomized controlled trials (RCTs) have investigated the effects of MT for stroke survivors. The main purpose of this network meta-analysis was to investigate the effects of MT on motor function, activities of daily living (ADL), and pain perception in stroke survivors. Several databases were searched to identify RCTs evaluating the effects of MT in stroke patients to perform this network meta-analysis. Thirty-seven RCTs (42 analyses, 1685 subjects) were eligible for inclusion in the meta-analysis. Standard meta-analysis showed that MT significantly improved of motor function according to the increased Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), and decreased Modified Ashworth Scale (MAS) score. In addition, ADL was promoted by MT as the elevated Modified Barthel Index (MBI) and Motor Activity Log (MAL) score. Moreover, MT effectively relieved the pain of stroke patients as the Visual Analog Scale (VAS) score was reduced. Subgroup analyses and meta-regressions identified that the sources of heterogeneity might be different intervention arms and duration of interventions. Network meta-analysis showed that MT combined with electrical stimulation (ES) for less than 4 weeks along with conventional rehabilitation therapy (CT), and MT accompanied with CT for less than 4 weeks might be the most suitable interventions for improvement of motor function and ADL, respectively. Overall, MT could effectively improve motor function and ADL, as well as relieve pain for stroke survivors. The study was registered at PROSPERO (CRD42017081742).
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Affiliation(s)
- Yue Yang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Qingchun Zhao
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Yingshi Zhang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Qiong Wu
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Xiaowen Jiang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Gang Cheng
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China.
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Broderick P, Horgan F, Blake C, Ehrensberger M, Simpson D, Monaghan K. Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis. Gait Posture 2018; 63:208-220. [PMID: 29775908 DOI: 10.1016/j.gaitpost.2018.05.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/07/2018] [Accepted: 05/11/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Mirror therapy has been proposed as an effective intervention for lower limb rehabilitation post stroke. RESEARCH QUESTION This systematic review with meta-analysis examined if lower limb mirror therapy improved the primary outcome measures of muscle tone and motor function and the secondary outcome measures balance characteristics, functional ambulation, walking velocity, passive range of motion (PROM) for ankle dorsiflexion and gait characteristics in patients with stroke compared to other interventions. METHODS Standardised mean differences (SMD) and mean differences (MD) were used to assess the effect of mirror therapy on lower limb functioning. RESULTS Nine studies were included in the review. Among the primary outcome measures there was evidence of a significant effect of mirror therapy on motor function compared with sham and non-sham interventions (SMD 0.54; 95% CI 0.24-0.93). Furthermore, among the secondary outcome measures there was evidence of a significant effect of mirror therapy for balance capacity (SMD -0.55; 95% CI -1.01 to -0.10), walking velocity (SMD 0.71; 95% CI 0.35-1.07), PROM for ankle dorsiflexion (SMD 1.20; 95% CI 0.71-1.69) and step length (SMD 0.56; 95% CI -0.00 to 1.12). SIGNIFICANCE The results indicate that using mirror therapy for the treatment of certain lower limb deficits in patients with stroke may have a positive effect. Although results are somewhat positive, overly favourable interpretation is cautioned due to methodological issues concerning included studies.
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Affiliation(s)
- P Broderick
- Institute of Technology Sligo, Sligo, Ireland.
| | - F Horgan
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - C Blake
- University College Dublin, Dublin, Ireland.
| | | | - D Simpson
- Institute of Technology Sligo, Sligo, Ireland.
| | - K Monaghan
- Institute of Technology Sligo, Sligo, Ireland.
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Li Y, Wei Q, Gou W, He C. Effects of mirror therapy on walking ability, balance and lower limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2018; 32:1007-1021. [PMID: 29644880 DOI: 10.1177/0269215518766642] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective: To investigate the effects of mirror therapy on walking ability, balance and lower limb motor recovery in patients with stroke. Method: MEDLINE, EMBASE, Web of Science, CENTRAL, PEDro Database, CNKI, VIP, Wan Fang, ClinicalTrials.gov, Current controlled trials and Open Grey were searched for randomized controlled trials that investigated the effects of mirror therapy on lower limb function through January 2018. The primary outcomes included were walking speed, mobility and balance function. Secondary outcomes included lower limb motor recovery, spasticity and range of motion. Quality assessments were performed with the PEDro scale. Results: A total of 13 studies ( n = 572) met the inclusion criteria. A meta-analysis demonstrated a significant effect of mirror therapy on walking speed (mean difference (MD) 0.1 m/s, 95% confidence interval (CI): 0.08 to 0.12, P < 0.00001), balance function (standard mean difference (SMD) 0.66, 95% CI: 0.43 to 0.88, P < 0.00001), lower limb motor recovery (SMD 0.83, 95% CI: 0.62 to 1.05, P < 0.00001) and passive range of motion of ankle dorsiflexion (MD 2.07°, 95% CI: 082 to 3.32, P = 0.001), without improving mobility (SMD 0.43, 95% CI: −0.12 to 0.98, P = 0.12) or spasticity of ankle muscles (MD −0.14, 95% CI: −0.43 to 0.15, P = 0.35). Conclusion: The systematic review demonstrates that the use of mirror therapy in addition to some form of rehabilitation appears promising for some areas of lower limb function, but there is not enough evidence yet to suggest when and how to approach this therapy.
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Affiliation(s)
- Yi Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Qingchuan Wei
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Wei Gou
- Department of Rehabilitation Medicine, Pidu District People’s Hospital, Chengdu, People’s Republic of China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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Broderick P, Horgan F, Blake C, Hickey P, O'Reilly J, Ehrensberger M, Simpson D, Roberts D, Monaghan K. Mirror therapy and treadmill training for a patient with chronic stroke: A case report. Physiother Theory Pract 2018; 35:478-488. [PMID: 29589777 DOI: 10.1080/09593985.2018.1453903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION A large proportion of patients with chronic stroke have permanent lower limb functional disability leading to reduced levels of independent mobility. Individually, both mirror therapy and treadmill training have been shown to improve aspects of lower limb functioning in patients with stroke. This case report examined whether a new combination of both interventions would lead to improvements in lower limb functional disability for a patient with chronic stroke. CASE DESCRIPTION The participant was a 50-year-old female who had a left middle cerebral artery infarction (47 months' post stroke). Due to hemiparesis, she had lower limb motor impairment and gait deficits. INTERVENTION The participant engaged in a combination of mirror therapy and treadmill training for 30 minutes per day, 3 days per week, for 4 weeks. OUTCOMES Modified Ashworth Scale, Fugl-Meyer Assessment-Lower Extremity and the 10 m Walk Test demonstrated clinically meaningful change. The 6 Minute Walk Test did not demonstrate meaningful change. DISCUSSION The positive outcomes from this new combination therapy for this participant are encouraging given the relatively small dose of training and indicate the potential benefit of mirror therapy as an adjunct to treadmill training for enhancing lower limb muscle tone, motor function and walking velocity in patients with chronic stroke.
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Affiliation(s)
- Patrick Broderick
- a Department of Science , Institute of Technology Sligo , Sligo , Ireland
| | - Frances Horgan
- b Department of Physiotherapy , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Catherine Blake
- c Department of Health Science , University College Dublin , Dublin , Ireland
| | - Paula Hickey
- d Department of Geriatrics , Sligo University Hospital , Sligo , Ireland
| | - Joanne O'Reilly
- e Department of Physiotherapy , Sligo University Hospital , Sligo , Ireland
| | | | - Daniel Simpson
- a Department of Science , Institute of Technology Sligo , Sligo , Ireland
| | - David Roberts
- f Department of Design , Institute of Technology Sligo , Sligo , Ireland
| | - Kenneth Monaghan
- g Department of Health Science , Institute of Technology Sligo , Sligo , Ireland
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Lin GH, Huang YJ, Lee SC, Huang SL, Hsieh CL. Development of a Computerized Adaptive Testing System of the Functional Assessment of Stroke. Arch Phys Med Rehabil 2017; 99:676-683. [PMID: 29042171 DOI: 10.1016/j.apmr.2017.09.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/23/2017] [Accepted: 09/24/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To develop a computerized adaptive testing system of the Functional Assessment of Stroke (CAT-FAS) to assess upper- and lower-extremity (UE/LE) motor function, postural control, and basic activities of daily living with optimal efficiency and without sacrificing psychometric properties in patients with stroke. DESIGN Simulation study. SETTING One rehabilitation unit in a medical center. PARTICIPANTS Patients with subacute stroke (N=301; mean age, 67.3±10.9; intracranial infarction, 74.5%). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The UE and LE subscales of the Fugl-Meyer Assessment, Postural Assessment Scale for Stroke Patients, and Barthel Index. RESULTS The CAT-FAS adopting the optimal stopping rule (limited reliability increase of <.010) had good Rasch reliability across the 4 domains (.88-.93) and needed few items for the whole administration (8.5 items on average). The concurrent validity (CAT-FAS vs original tests, Pearson r=.91-.95) and responsiveness (standardized response mean, .65-.76) of the CAT-FAS were good in patients with stroke. CONCLUSIONS We developed the CAT-FAS, and our results support that the CAT-FAS has sufficient efficiency, reliability, concurrent validity, and responsiveness in patients with stroke. The CAT-FAS can be used to simultaneously assess patients' functions of UE, LE, postural control, and basic activities of daily living using, on average, no more than 10 items; this efficiency is useful in reducing the assessment burdens for both clinicians and patients.
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Affiliation(s)
- Gong-Hong Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Jing Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shih-Chieh Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sheau-Ling Huang
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Arya KN, Pandian S, Kumar V. Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial. Neuropsychol Rehabil 2017; 29:1193-1210. [DOI: 10.1080/09602011.2017.1377087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kamal Narayan Arya
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Shanta Pandian
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
| | - Vikas Kumar
- Pandit Deendayal Upadhayaya National Institute for Persons with Physical Disabilities, New Delhi, India
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Salhab G, Sarraj AR, Saleh S. Mirror therapy combined with functional electrical stimulation for rehabilitation of stroke survivors' ankle dorsiflexion. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:4699-4702. [PMID: 28325013 DOI: 10.1109/embc.2016.7591776] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study investigates the effect of combining both mirror therapy with Electrical Stimulation (ES) on improvement of the function of lower extremity compared to conventional therapy. 18 stroke survivors (sub acute stage) were recruited, 9 of them were randomly assigned to receive conventional treatment and another 9 started the mirror therapy combined with ES treatment. Duration of each session in both interventions was 50 minutes, done 4 times per week over two weeks. After 2 weeks, subjects took one week rest before switching they type of treatment; those started with conventional therapy continued with mirror therapy combined with ES, and vice versa. The duration of this phase was 2 weeks with same schedule as the 1st one. Ankle dorsi-flexion range of motion, lower extremity sensory-motor function, and walking duration were measured at baseline, after 1st 2 weeks, and immediately after the last two weeks, and 4 weeks after end of training (retention test). Repeated Measures ANCOVA was done to compare outcome measures scores in both groups and between all testing days, and paired T-test was used measure the difference between groups. Significant increase in all outcome measures was found after the (MT+ES) training, which is higher than conventional therapy training (p<;0.0001). In conclusion, the results suggest that combination of mirror therapy and ES is more effective than conventional therapy in improving lower limb motor function after stroke.
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Crosby LD, Marrocco S, Brown J, Patterson KK. A novel bilateral lower extremity mirror therapy intervention for individuals with stroke. Heliyon 2016; 2:e00208. [PMID: 27995202 PMCID: PMC5154979 DOI: 10.1016/j.heliyon.2016.e00208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/08/2016] [Accepted: 11/24/2016] [Indexed: 10/28/2022] Open
Abstract
Despite improvements made in stroke rehabilitation, motor impairment and gait deficits persist at discharge. New interventions are needed. Mirror therapy has promise as one element of a rehabilitation program. The primary objectives were to 1) describe a bilateral, lower extremity mirror therapy (LE-MT) device and training protocol and 2) investigate the feasibility of LE-MT. A LE-MT device was constructed to train bilateral LE movements for 30 min, 3 times/week for 4 weeks, as an adjunct to physiotherapy in three individuals post-stroke. Sessions were digitally recorded and reviewed to extract feasibility measures; repetitions, rests and session duration. Pre and post measures of gait and motor impairment were taken. Two participants completed 100% of the sessions and a third completed 83% due to a recurrence of pre-existing back pain. Repetitions increased and session duration was maintained. Number of rests decreased for two participants and increased for one participant. Participants reported fatigue and mild muscle soreness but also that the intervention was tolerable. Positive gait changes included increased velocity and decreased variability. LE motor impairment also improved. A bilateral LE-MT adjunct intervention for stroke is feasible and may have positive effects. A history of low back pain should be a precaution.
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Affiliation(s)
- Lucas D Crosby
- Faculty of Health and Rehabilitation Science, Western University, London, ON, Canada; Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
| | - Stephanie Marrocco
- Faculty of Health and Rehabilitation Science, Western University, London, ON, Canada
| | - Janet Brown
- School of Physical Therapy, Western University, London, ON, Canada
| | - Kara K Patterson
- School of Physical Therapy, Western University, London, ON, Canada; Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto ON, Canada; Toronto Rehab, University Health Network, Toronto, ON, Canada
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Effects of mirror therapy integrated with task-oriented exercise on the balance function of patients with poststroke hemiparesis: a randomized-controlled pilot trial. Int J Rehabil Res 2016; 39:70-6. [PMID: 26658524 DOI: 10.1097/mrr.0000000000000148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study aimed to explore the effects of mirror therapy integrated with task-oriented exercise on balance function in poststroke hemiparesis. Twenty patients with poststroke hemiparesis were assigned randomly to an experimental group (EG) and a control group (CG), with 10 individuals each. Participants of the EG and CG received a task-oriented exercise program with a focus on the strengthening of the lower limb and the practice of balance-related functional tasks. An additional option for the EG was front and side wall mirrors to provide visual feedback for their own movements while performing the exercise. The program was performed for 30 min, twice a day, five times per week for 4 weeks. Outcome measures included the Berg balance scale, the timed up-and-go test, and quantitative data (balance index and dynamic limits of stability). In the EG and CG, all variables showed significant differences between pretest and post-test (P<0.05), and post-test values of all variables appeared to be significantly different between two groups (P<0.05). Furthermore, in the EG, the change values between pretest and post-test values of Berg balance scale (13.00±3.20 vs. 6.60±4.55 scores), and timed up-and-go test (6.45±3.00 vs. 3.61±1.84 s), balance index (2.29±0.51 vs. 0.96±0.65 scores), dynamic limits of stability (7.70±3.83 vs. 3.70±4.60 scores) were significantly higher than those of the CG (P<0.05). The findings suggest that a mirror therapy may be used as a beneficial therapeutic option to facilitate the effects of a task-oriented exercise on balance function of patients with poststroke hemiparesis.
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Hartman K, Altschuler EL. Mirror Therapy for Hemiparesis Following Stroke: A Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2016. [DOI: 10.1007/s40141-016-0131-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Guo F, Xu Q, Abo Salem HM, Yao Y, Lou J, Huang X. The neuronal correlates of mirror therapy: A functional magnetic resonance imaging study on mirror-induced visual illusions of ankle movements. Brain Res 2016; 1639:186-93. [DOI: 10.1016/j.brainres.2016.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/27/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
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Hung GKN, Li CTL, Yiu AM, Fong KN. Systematic Review: Effectiveness of Mirror Therapy for Lower Extremity Post-Stroke. Hong Kong J Occup Ther 2015. [DOI: 10.1016/j.hkjot.2015.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background/Objective This study reviewed the current evidence on the effectiveness of mirror therapy (MT) on improving the motor functions of the hemiplegic lower extremity (LE) in adult clients with stroke. Methods A systematic review was conducted of studies published in English in the 10-year period 2005–2015, retrieved from seven electronic databases: Medline, PubMed, CINAHL, Psychlnfo, Science Direct, Cochrane and TBI Rehabilitation. Only articles that focused on the effects of MT on hemiparesis affecting LE function and performance were included. The methodological quality of the studies was appraised using the Physiotherapy Evidence Database Scale (PEDro). Results The literature search yielded 14 studies that satisfied the selection criteria, of which five (4 randomised controlled trials and 1 case study) were reviewed after screening. Despite the heterogeneity of the studies, they showed MT to be effective in improving some of the motor functions of the LE at different stages of stroke. However, they offered little evidence on MT's long-term effects and for when is the optimal stage to start MT after stroke onset. Conclusion Further research is needed to determine the best treatment regimen and optimal time to initiate MT intervention in terms of the phases of stroke. No firm conclusions can be drawn on the effectiveness of MT on the hemiplegic LE until more evidence is available.
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Affiliation(s)
- Goris Kin Nga Hung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Cabbee Tsz Lui Li
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Alexander Miles Yiu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Kenneth N.K. Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
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Yeldan I, Huseyınsınoglu BE, Akıncı B, Tarakcı E, Baybas S, Ozdıncler AR. The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients. J Phys Ther Sci 2015; 27:3519-24. [PMID: 26696729 PMCID: PMC4681936 DOI: 10.1589/jpts.27.3519] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 08/19/2015] [Indexed: 12/02/2022] Open
Abstract
[Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy
program on functional improvement of the upper extremity in acute stroke patients.
[Subjects] Eight stroke patients who were treated in an acute neurology unit were included
in the study. [Methods] The patients were assigned alternatively to either the mirror
therapy group receiving mirror therapy and neurodevelopmental treatment or the
neurodevelopmental treatment only group. The primary outcome measures were the upper
extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity
score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres
Southern California Sensory Integration Test, and the Barthel Index were used as secondary
outcome measures. [Results] No statistically significant improvements were found for any
measures in either group after the treatment. In terms of minimally clinically important
differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both
mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this
pilot study revealed that very early mirror therapy has no additional effect on functional
improvement of upper extremity function in acute stroke patients. Multicenter trials are
needed to determine the results of early application of mirror therapy in stroke
rehabilitation.
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Affiliation(s)
- Ipek Yeldan
- Department of Neurological Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Turkey
| | - Burcu Ersoz Huseyınsınoglu
- Department of Neurological Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Turkey
| | - Buket Akıncı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Biruni University, Turkey
| | - Ela Tarakcı
- Department of Neurological Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Turkey
| | - Sevim Baybas
- Department of Neurology, Bakirkoy Research and Training Hospital for Neurologic and Psychiatric Diseases, Turkey
| | - Arzu Razak Ozdıncler
- Department of Neurological Physiotherapy and Rehabilitation, Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, Turkey
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Yang YR, Chen YH, Chang HC, Chan RC, Wei SH, Wang RY. Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study. Clin Rehabil 2014; 29:987-93. [DOI: 10.1177/0269215514564898] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/29/2014] [Indexed: 11/17/2022]
Abstract
Objective: We investigated the effects of a computer-generated interactive visual feedback training program on the recovery from pusher syndrome in stroke patients. Design: Assessor-blinded, pilot randomized controlled study. Participants: A total of 12 stroke patients with pusher syndrome were randomly assigned to either the experimental group ( N = 7, computer-generated interactive visual feedback training) or control group ( N = 5, mirror visual feedback training). Main outcome measures: The scale for contraversive pushing for severity of pusher syndrome, the Berg Balance Scale for balance performance, and the Fugl-Meyer assessment scale for motor control were the outcome measures. Patients were assessed pre- and posttraining. Results: A comparison of pre- and posttraining assessment results revealed that both training programs led to the following significant changes: decreased severity of pusher syndrome scores (decreases of 4.0 ±1.1 and 1.4 ±1.0 in the experimental and control groups, respectively); improved balance scores (increases of 14.7 ±4.3 and 7.2 ±1.6 in the experimental and control groups, respectively); and higher scores for lower extremity motor control (increases of 8.4 ±2.2 and 5.6 ±3.3 in the experimental and control groups, respectively). Furthermore, the computer-generated interactive visual feedback training program produced significantly better outcomes in the improvement of pusher syndrome ( p < 0.01) and balance ( p < 0.05) compared with the mirror visual feedback training program. Conclusions: Although both training programs were beneficial, the computer-generated interactive visual feedback training program more effectively aided recovery from pusher syndrome compared with mirror visual feedback training.
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Affiliation(s)
- Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Hua Chen
- Department of Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Heng-Chih Chang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Rai-Chi Chan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shun-Hwa Wei
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
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Kim TW, Kim YW. Treadmill sideways gait training with visual blocking for patients with brain lesions. J Phys Ther Sci 2014; 26:1415-8. [PMID: 25276026 PMCID: PMC4175247 DOI: 10.1589/jpts.26.1415] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 03/09/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of this study was to verify the effect of sideways treadmill training
with and without visual blocking on the balance and gait function of patients with brain
lesions. [Subjects] Twenty-four stroke and traumatic brain injury subjects participated in
this study. They were divided into two groups: an experimental group (12 subjects) and a
control group (12 subjects). [Methods] Each group executed a treadmill training session
for 20 minutes, three times a week, for 6 weeks. The sideways gait training on the
treadmill was performed with visual blocking by the experimental group and with normal
vision by the control group. A Biodex Gait Trainer 2 was used to assess the gait function.
It was used to measure walking speed, walking distance, step length, and stance time on
each foot. The Five-Times-Sit-To-Stand test (FTSST) and Timed Up and Go test (TUG) were
used as balance measures. [Results] The sideways gait training with visual blocking group
showed significantly improved walking speed, walking distance, step length, and stance
time on each foot after training; FTSST and TUG times also significantly improved after
training in the experimental group. Compared to the control group, the experimental group
showed significant increases in stance time on each foot. [Conclusion] Sideways gait
training on a treadmill with visual blocking performed by patients with brain lesions
significantly improved their balance and gait function.
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Affiliation(s)
- Tea-Woo Kim
- Department of Rehabilitation Science, The Graduate School, Jeonju University, Republic of Korea
| | - Yong-Wook Kim
- Department of Physical Therapy, College of Medical Sciences, Jeonju University, Republic of Korea
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Notarnicola A, Maccagnano G, Pesce V, Di Pierro S, Tafuri S, Moretti B. Effect of teaching with or without mirror on balance in young female ballet students. BMC Res Notes 2014; 7:426. [PMID: 24996519 PMCID: PMC4102331 DOI: 10.1186/1756-0500-7-426] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 06/27/2014] [Indexed: 12/04/2022] Open
Abstract
Background In literature there is a general consensus that the use of the mirror improves proprioception. During rehabilitation the mirror is an important instrument to improve stability. In some sports, such as dancing, mirrors are widely used during training. The purpose of this study is to evaluate the effectiveness of the use of a mirror on balance in young dancers. Sixty-four young dancers (ranging from 9–10 years) were included in this study. Thirty-two attending lessons with a mirror (mirror- group) were compared to 32 young dancers that attended the same lessons without a mirror (non-mirror group). Balance was evaluated by BESS (Balance Error Scoring System), which consists of three stances (double limb, single limb, and tandem) on two surfaces (firm and foam). The errors were assessed at each stance and summed to create the two subtotal scores (firm and foam surface) and the final total score (BESS). The BESS was performed at recruitment (T0) and after 6 months of dance lessons (T1). Results The repeated measures ANOVA analysis showed that for the BESS total score there is a difference due to the time (F = 3.86; p < 0.05). No other differences due to the group or to the time of measurement were found (p > 0.05). The analysis of the multiple regression model showed the influence of the values at T0 for every BESS items and the dominance of limb for stability on an unstable surface standing on one or two legs. Conclusions These preliminary results suggest that the use of a mirror in a ballet classroom does not improve balance acquisition of the dancer. On the other hand, improvement found after 6 months confirms that at the age of the dancers studied motor skills and balance can easily be trained and improved.
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Affiliation(s)
- Angela Notarnicola
- Course of Motor and Sports Sciences, Department of Neuroscience and Organs of Sense, Faculty of Medicine and Surgery, University of Study of Bari, Lungomare Starita 1, 70123 Bari, Italy.
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