Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study

Abstract

Objective: To investigate the effectiveness of mirror therapy combined with neuromuscular electrical stimulation in promoting motor recovery of the lower limbs and walking ability in patients suffering from foot drop after stroke. Design: Randomized controlled study. Setting: Inpatient rehabilitation center of a teaching hospital. Subjects: Sixty-nine patients with foot drop. Intervention: Patients were randomly divided into three groups: control, mirror therapy, and mirror therapy + neuromuscular electrical stimulation. All groups received interventions for 0.5 hours/day and five days/week for four weeks. Main measures: 10-Meter walk test, Brunnstrom stage of motor recovery of the lower limbs, Modified Ashworth Scale score of plantar flexor spasticity, and passive ankle joint dorsiflexion range of motion were assessed before and after the four-week period. Results: After four weeks of intervention, Brunnstrom stage (P = 0.04), 10-meter walk test (P < 0.05), and passive range of motion (P < 0.05) showed obvious improvements between patients in the mirror therapy and control groups. Patients in the mirror therapy + neuromuscular electrical stimulation group showed better results than those in the mirror therapy group in the 10-meter walk test (P < 0.05). There was no significant difference in spasticity between patients in the two intervention groups. However, compared with patients in the control group, patients in the mirror therapy + neuromuscular electrical stimulation group showed a significant decrease in spasticity (P < 0.001). Conclusion: Therapy combining mirror therapy and neuromuscular electrical stimulation may help improve walking ability and reduce spasticity in stroke patients with foot drop.

<p>Mirror Therapy in Stroke Rehabilitation: Current Perspectives</p>

“…28,29,32,[34][35][36][37][38][39][40] Two other studies reported no significant difference with MT, in outcomes measuring motor, sensory, and ADL components. 41,42 Only 4 studied the effects of MT on spasticity, out of which 3 reported no improvement as recorded on the Modified Ashworth scale 28,37,43 and one showed improvement on the Ashworth scale, 44 with 6 weeks of MT along with conventional rehabilitation. Sensory impairments were measured in 6 studies, and 4 report improved response to either noxious, tactile, or temperature stimuli.…”

“…32,40,45,47 Motor -Lower Limb/Gait/Balance Six studies reported on effects of MT on lower extremity impairment/function, gait, and balance. 33,39,43,[48][49][50] Records identified through database searching (n =3871) These studies showed improved motor recovery as recorded on Brunnstrom stages and improved lower extremity function through improved walking speed, single limb stance, step and stride lengths, static and dynamic balance, and decreased mediolateral and anteroposterior sway in standing. Two studies also reported a reduction in lower extremity impairment.…”

“…Fourteen studies did not contain any information about feasibility or adherence at all. [28][29][30][31]36,38,[40][41][42][43][46][47][48]51,53 Apart from several occasional and short-lived episodes of fatigue, soreness, or swelling in the paretic limb, 33,42 the MT was generally well tolerated and no serious adverse effects were reported. 33,34,37,39,42,44,50,54,55 Overall, adherence to the MT is assumed to be high, regarding that the majority of trials employ directly supervised intervention; 33 two studies even explicitly stated a 100% participation rate.…”

“…29,31,33,37,38,40,41,43,45,46,49,52,53,55 Additionally, the absence of follow-up did not allow assessment of long-term retention of functional improvement in patients after rehabilitation. 28,31,[34][35][36][37]41,43,44,46,47,49,53,55 A number of studies reported difficulties with generalisation of the outcomes due to specific pre-selection criteria 32,36,38,47,48,51 or because they included patients with a distinct level of functional impairment and time post ictus. 29,31,32,39,41,52 Another complication to the interpretation of the MT effectiveness was that three studies observed a difference in baseline measurements between the experimental and control groups.…”

“…37,52 Second, the design of the mirror box precludes movements such as shoulder overhead motion and rotation, which might be the cause of less pronounced improvement in the upper arm movement compared to the wrist and hand in the intervention group. 46 Third, several authors expressed the lack of quality of movement 46,49 or the active range of motion 43 assessment as one of their limitations. When applying attention-dependent rehabilitation techniques, a comprehensive cognition and depression evaluation both before and during or after the treatment would be of value.…”