The Effects of Mirror Therapy on Clinical Improvement in Hemiplegic Lower Extremity Rehabilitation in Subjects with Chronic Stroke

Authors: Hassan M. Abo Salem, Xiaolin Huang

Abstract:

Background: The effectiveness of mirror therapy (MT) has been investigated in acute hemiplegia. The present study examines whether MT, given during chronic stroke, was more effective in promoting motor recovery of the lower extremity and walking speed than standard rehabilitation alone. Methods: The study enrolled 30 patients with chronic stroke. Fifteen patients each were assigned to the treatment group and the control group. All patients received a conventional rehabilitation program for a 4-week period. In addition to this rehabilitation program, patients in the treatment group received mirror therapy for 4 weeks, 5 days a week. Main measures: Passive ankle joint dorsiflexion range of motion, gait speed, Brunnstrom stages of motor recovery, plantar flexor muscle tone by Modified Ashworth Scale. Results: No significant difference was found in the outcome measures among groups before treatment. When compared with standard rehabilitation, mirror therapy improved Ankle ROM, Brunnstrom stages and waking speed (p < 0.05). However, there were no significant differences between two groups on MAS (P > 0.05).Conclusion: Mirror therapy combined with a conventional stroke rehabilitation program enhances lowerextremity motor recovery and walking speed in chronic stroke patients.

Keywords: Mirror therapy, stroke, MAS, walking speed.

Digital Object Identifier (DOI): doi.org/10.5281/zenodo.1099406

References:

[1] L. Liu, D. Wang, K. S. L. Wong, and Y. Wang, “Stroke and stroke care in China,” Stroke, vol. 42, 2011, pp. 3651–3654.
[2] S. C. Johnston, S. Mendis, and CD. Mathers, “Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modeling. Lancet Neurol,” vol.8, 2009, pp. 345–354.
[3] American Heart Association, “Heart disease and stroke statistics,” Dallas, TX, American Heart Association, 2005.
[4] V. S. Ramachandran, D. Rogers-Ramachandran and S. Cobb, “Touching the phantom limb,” Nature, vol. 377, 1995, pp. 489-490.
[5] E. L. Altschuler, S. B. Wisdom SB, L. Stone L, et al., “Rehabilitation of hemiparesis after stroke with a mirror,” Lancet, vol. 353, 1999, pp. 2035-2036.
[6] H. Thieme H, J. Mehrholz, M. Pohl, J. Behrens, and C. Dohle, “Mirror therapy for improving motor function after stroke,” Cochrane Database Syst Rev, vol. 3, 2012, CD008449.
[7] C. S. McCabe, R. C. Haigh, E. F. Ring, P. W. Halligan, P. D. Wall, and D. R. Blake, “A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1),” Rheumatology, vol. 42, 2003, pp. 97-101.
[8] S. Sutbeyaz, G. Yavuzer, N. Sezer, and B.F. Koseoglu, “Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: arandomizedcontrolled trial,” Archives of Physical Medicine and Rehabilitation, vol. 88. No. 5, 2007, pp. 555 –559.
[9] A. H. Bakhtiary, and E. Fatemy, "Does electrical stimulation reduce spasticity after stroke? A randomized controlled study." Clinical Rehabilitation 22, no. 5 (2008): 418-425.
[10] R. W. Bohannon and M. B. Smith MB, “Internal reliability of a modified Ashworth scale of muscle spasticity,” J PhysTher 1987; 67:206–208.
[11] K. S. G. Chua, K. H Kong, and Y. C. Lui, “Botulinum toxin A in the treatment of hemiplegic spastic foot drop: clinical and functional outcomes,” Singapore Med J 2000; 41: 209–213.
[12] J. W. Lance, and J. G. McLeod, A Physiological Approach to Clinical Neurology. London: Butterworth.1981.
[13] C. L. Chen, H. C. Chen, S. F. Tang, C. Y. Wu, P. T. Cheng, and W. H. Hong, “Gait performance with compensatory adaptations in stroke patients with different degrees of motor recovery, ” Am J Phys Med Rehabil 2003; 82:925-35.
[14] D. T. Wade DT. Measurement in neurological. Oxford: Oxford University Press, 1992.
[15] H. Thieme, J. Mehrholz, M. Pohl, J. Behrens, and C. Dohle, “Mirror therapy for improving motor function after stroke,” Stroke, Cochrane Data base Syst Rev 3, vol. 44, 2013, CD008449.
[16] Wade DT, Wood VA, Heller A, Maggs J, Langton Hewer R. Walking after stroke. Measurement and recovery over the .rst 3 months. Scand J Rehabil Med 1987; 19: 25–30.
[17] J. H. Burridge, I. D. Swain, and P. N. Taylor, “Functional electric stimulation: a review of the literature published on common peroneal nerve stimulation for the correction of dropped foot,” Rev ClinGerontol vol. 8, 1998, pp.155-61.
[18] G. Yavuzer, R. Selles, N. Sezer, S. Sütbeyaz, J. B. Bussmann, F. Köseoğlu, M. B. Atay, and H. J. Stam, “Mirror therapy improves hand function in subacute stroke: a randomizedcontr- olled trial,” Arch Phys Med Rehabil. Vol. 89, no. 3, 2008, pp. 393-8.
[19] M. F.Michielsen, R. W. Selles, J. N. Van Der Geest, M. Eckhardt, G. Yavuzer, H. J. Stam, M. Smits, G. M. Ribbers, J. B. and Bussmann, “Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial,”Neurorehabil Neural Repair. 2011, 25(3):223-33.
[20] K. Lamont, M. Chin, and M. Kogan, “Mirror box therapy: seeing is believing,” Explore (New York, N.Y.), vol. 7, no. 6, 2011, pp. 369 e 372.
[21] J. J. Summers, F. A. Kagerer, M. I. Garry, C. Y. Hiraga, and A. Loftus, and J. H. Cauraugh JH, “Bilateral and unilateral movement training on upper limb function in chronic stroke patients: a TMS study,” J NeurolSci 2007; 252:76-82.