Mirror Therapy Combined With Biofeedback Functional Electrical Stimulation for Motor Recovery of Upper Extremities After Stroke: A Pilot Randomized Controlled Trial

Abstract

The objective of this study was to evaluate the effects of mirror therapy in combination with biofeedback functional electrical stimulation (BF-FES) on motor recovery of the upper extremities after stroke. Twenty-nine patients who suffered a stroke > 6 months prior participated in this study and were randomly allocated to three groups. The BF-FES + mirror therapy and FES + mirror therapy groups practiced training for 5 × 30 min sessions over a 4-week period. The control group received a conventional physical therapy program. The following clinical tools were used to assess motor recovery of the upper extremities: electrical muscle tester, electrogoniometer, dual-inclinometer, electrodynamometer, the Box and Block Test (BBT) and Jabsen Taylor Hand Function Test (JHFT), the Functional Independence Measure, the Modified Ashworth Scale, and the Stroke Specific Quality of Life (SSQOL) assessment. The BF-FES + mirror therapy group showed significant improvement in wrist extension as revealed by the Manual Muscle Test and Range of Motion (p < 0.05). The BF-FES + mirror therapy group showed significant improvement in the BBT, JTHT, and SSQOL compared with the FES + mirror therapy group and control group (p < 0.05). We found that BF-FES + mirror therapy induced motor recovery and improved quality of life. These results suggest that mirror therapy, in combination with BF-FES, is feasible and effective for motor recovery of the upper extremities after stroke.

Effects of Electrical Stimulation in Spastic Muscles After Stroke

“…In 3 studies 12,37,38 the stimulation frequencies with NMES ranged from 80 to 100 Hz and pulse duration from 0.1 to 0.3 ms. Four studies [39][40][41][42] did not describe the stimulation characteristics. The time of intervention the studies was averaged 3038.75 minutes.…”

The Effect of Mirror Therapy on Functional Recovery of Upper Extremity after Stroke: A Randomized Pilot Study

“…Mirror therapy is a cognitive induced intervention that makes the patient see his/ her motions of the non-paretic side through a mirror after covering the paretic arm with the mirror to provide the patient with illusory motor sensation of the normal movements of the paretic arm and induce visual illusion thereby activating the damaged brain region [Ramachandran & Rogers-Ramachandran, 1996;Caligiore, et al, 2016] Mirror therapy is known to be effective on the phantom sense and phantom pain due to the amputation of the extremity, postoperative rehabilitation, and pain due to CRPS [Ramachandran & Rogers-Ramachandran, 1996;Yıldırım & Kanan, 2016;Barbin, et al, 2016], and is also known to be effective for paretic side motor recovery after a stroke [Arya & Pandian, 2013;Amasyali & Yaliman, 2016;Kim & Lee, 2015]. However, because previous studies of mirror therapy presented diverse kinds of mirror therapy programs and used different intervention periods such as the time of therapy applied [Dohle, et al, 2009;Yun, Chun, Park, & Kim, 2011], lead to confusion for applies to standard format.…”

Avaliação Da Influência Da Terapia Do Espelho Nas Limitações Funcionais Em Pacientes Hemiparéticos Pós Acidente Vascular Encefálico

“…Deste modo, com a ativação do sistema de neurônios-espelho e também do trato córtico-espinal, a TE acelera a recuperação de hemiparéticos promovendo uma reorganização cortical. Essa reorganização acarreta em ganhos funcionais e motores, resultando, desta forma, na eficácia terapêutica (PEREIRA et al, 2013;MEDEIROS et al, 2014 Nos estudos em questão, cinco foram realizados com pacientes na fase crônica (YAVUZER et al, 2008;WU et al, 2013;LEE et al, 2014;SAMUELKAMALESHKUMAR et al, 2014;LEE, 2015), cinco na fase aguda e subaguda (SUTBYAZ et al, 2007;THIEME et al, 2012;PANDIAN et al, 2014;CRISTINA et al, 2015;DOHLE et al, 2015) e um não foi mencionado em qual fase o paciente se encontrava (INVERNIZZI et al, 2012).…”

“…Outros autores utilizaram os movimentos padrões e adicionaram outros movimentos. Wu et al (2013);Samuelkamaleshkumar et al (2014);Lee et al(2015) adicionaram em seu protocolo tarefas de motricidade fina como apertar uma esponja, colocar pinos em buracos e tocar teclado. Lee et al (2015) adicionou movimentos de segurar um copo, abrir a mão e bater levemente na mesa.…”

“…Wu et al (2013);Samuelkamaleshkumar et al (2014);Lee et al(2015) adicionaram em seu protocolo tarefas de motricidade fina como apertar uma esponja, colocar pinos em buracos e tocar teclado. Lee et al (2015) adicionou movimentos de segurar um copo, abrir a mão e bater levemente na mesa. Pandian et al (2014) por sua vez, utilizou em seu protocolo outros movimentos relacionados a pegar objetos e coloca-los na mesa, beber de um copo e pentear.…”