Effects of home-based mirror therapy and cognitive therapeutic exercise on the improvement of the upper extremity functions in patients with severe hemiparesis after a stroke: a protocol for a pilot randomised clinical trial

Abstract

IntroductionNeuroplasticity is defined as the capacity of the brain to reorganise new neuronal pathways. Mirror therapy (MT) and cognitive therapeutic exercise (CTE) are two neurorehabilitation techniques based on neuroplasticity and designed to improve the motor functions of the affected upper extremity in patients with severe hemiparesis after a stroke. Home-based interventions are an appropriate alternative to promote independence and autonomy. The objective of this study is to evaluate which of these techniques, MT and CTE, combined with task-oriented training, is more effective in functional recovery and movement patterns of the upper extremities in patients with severe hemiparesis after a stroke.Methods and analysisThis is a home-based, single-blind, controlled, randomised clinical trial with three parallel arms, including 154 patients who had a stroke aged above 18 years. The primary outcome will be the functionality of the affected upper extremity measured using the Fugl-Meyer Assessment. Secondary variables will include cognitive performance, emotional state, quality of life and activities of daily living. During 6 weeks, one of the intervention groups will receive a treatment based on MT and the other one on CTE, both combined with task-oriented training. No additional interventions will be provided to the control group. To assess the progress of patients who had a stroke in the subacute phase, all variables will be evaluated at different visits: initial (just before starting treatment and 4 weeks post-stroke), post-intervention (6 weeks after initial) and follow-up (6 months).Ethics and disseminationThis protocol has been approved by the Institutional Review Board (CEIm-2.134/2.019) and registered at ClinicalTrials.gov (NCT04163666). The results will be disseminated through open-access peer-reviewed journals, conference presentation, broadcast media and a presentation to stakeholders. These study results will provide relevant and novel information on effective neurorehabilitation strategies and improve the quality of intervention programmes aimed at patients after a stroke.Trial registration numberClinicalTrials.gov (NCT04163666).

Move Bit: um Jogo Sério que melhora a função motora do membro superior de hemiparéticos

“…Destaca-se que a hemiparesia é o quadro mais frequente, sendo caracterizada por uma perda parcial da força muscular (FM) no hemicorpo contralateral à lesão encefálica 5 . Esse quadro limita a capacidade funcional, refletindo em dificuldades para realização de atividades de vida diárias (AVD's) 6 , especialmente pelo fato de muitas dessas atividades envolverem os membros superiores 7 .…”

“…A fisioterapia possui inúmeros recursos convencionais que podem ser utilizados, como técnicas de posicionamento, cinesioterapia passiva e ativa para mobilização precoce, exercícios resistidos, estimulação sensorial, uso de órteses, eletroestimulação, terapia do espelho, exercícios terapêuticos cognitivos, entre outros 6,9 . Embora estas abordagens já tenham demonstrado efeitos terapêuticos positivos, de forma frequente, são consideradas pelos pacientes como tarefas repetitivas, monótonas e entediantes 4,9,10 .…”

Lower Extremity Rehabilitation in Patients with Post-Stroke Sequelae through Virtual Reality Associated with Mirror Therapy

“…This approach exploits the brain’s preferences to prioritize the visual reaction over the somatosensory reaction regarding limb position [ 9 , 10 , 11 ]. New research is evaluating MT efficiency when combined with other techniques, such as cognitive therapeutic exercise, and other research shows that MT combined with other types of therapies has a better effect on the physical rehabilitation of post-stroke patients [ 12 , 13 ].…”