ABSTRACT
Background: Stroke is a leading cause of disability and majority of the stroke survivors experience upper extremity functional limitations. Therefore, the objective of this study was to evaluate the effectiveness of mirror therapy in addition with a conventional upper limb rehabilitation program in a post stroke hemiplegic patient.Methods: A randomized controlled trial was conducted among 72 post stroke patients aged 35-65 years having hemipa¬resis attending the PMR department, RIMS, Manipur from 2013 to 2016. Assessment was done at baseline, 1 and 6 months for FIM self care, Brunnstrom stages of motor recovery and MAS for spasticity. Both the group participated in a stroke rehabilitation program and study group was given mirror therapy in addition. Descriptive statistics such as mean±SD and inferential statistics like Chi-square test, Student’s t test, and ANOVA were used. A p-value < 0.05 was taken as statistically significant.Results: There was an improvement in Brunnstrom stage and FIM self-care score in both groups, but the post-treatment score was significantly higher in the mirror therapy group. Statistically significant difference in FIM self care and motor recovery between the study and control groups was noted [1.1±0.38 (study) versus 0.88±0.32 (control) for motor recovery and 34.1±2.59 (study) versus 29.5±4.58 (control) for FIM self care]. However, no significant difference was seen in spasticity between the groups.Conclusions: Mirror therapy used in addition to conventional stroke rehabilitation program was found to be effective in the recovery of upper extremity motor functions and daily self care activities in post stroke hemiplegic patients.
ABSTRACT
Background: Upper limbs are very important to motor functionality. However, in majority of stroke patients, arm functions are impaired resulting in disabilities and restrictions to function. Therefore, the objective of this study was to assess the effectiveness of mirror therapy in the motor recovery of upper extremity in the post stroke hemiplegic patient.Methods: A prospective randomized controlled trial was conducted among 72 post stroke patients aged 35-65 years having hemiparesis attending the PMR OPD in RIMS, Manipur from 2013 to 2016. Assessment was done for FIM self care and Brunnstrom stages of motor recovery at baseline and 1 month and 6 month of post treatment. Both the study and control group participated in a stroke rehabilitation programme and study group was given mirror therapy in addition. Descriptive statistics such as mean, standard deviation and inferential statistics like Chi-square test, Student’s t test, and ANOVA were used. A p-value <0.05 was taken as statistically significant.Results: Mean age were 54.56±7.61 years (study) and 55.11±7.99 years (control). Majority of them were males (61.1%). Significant improvement was noted in the study group from baseline to 1 month and 6 months follow up. Mean score comparison of FIM self care between study and control group from baseline to 1 month was (28.28±3.11 to 34.11±2.59 vs 28.00±4.30 to 29.50±4.58) and from 1 to 6 months follow up was (34.11±2.59 to 37.83±2.04 vs 29.50±4.58 to 32.44±4.82) respectively.Conclusions: There was a significant improvement in hand function regarding both motor recovery and daily self care activities in the study group.
ABSTRACT
Objective To determine the utility of musculoskeletal ultrasound imaging to support physical findings in different stages of recovery and in recommending treatment regimens.Methods Forty-three hemiplegic stroke survivors with shoulder pain were enrolled.Physical examinations were performed 3 and 6 months after the stroke using a visual analogue scale (VAS),a modified Ashworth scale,measurements of passive range of motion and Brunnstrom staging.This was coupled with sonography of the long head of the biceps,the subscapularis tendon,the supraspinatus tendon,the infraspinatus tendon,the acromioclavicular joint and the subacromial-subdeltoid bursa.Results Three months after the stroke the average VAS score correlated negatively with the average Brunnstrom stage of the shoulders (r=-0.39,P≤0.01),with the range of passive abduction (r=-0.56,P≤ 0.01),the range of passive external rotation (r=-0.36,P≤ 0.02),and the range of passive flexion (r=-0.37,P≤ 0.02).It was positively correlated with abnormal sonographic findings of the long head tendon of the biceps (r=0.32,P≤ 0.04),the subscapularis tendons (r=0.31,P≤0.04) and the supraspinatus tendons (r=0.53,P≤0.01).However,3 months later the VAS results were negatively correlated with Brunnstrom stage (r=-0.45,P ≤ 0.01),range of passive shoulder abduction (r=-0.60,P≤0.01),range of passive external rotation (r=-0.41,P≤0.01),and passive range of flexion (r=-0.52,P≤ 0.01),but positively correlated with spasticity (r=0.34,P≤ 0.03),biceps tendinopathy (r=0.45,P≤0.01),subscapularis tendinopathy (r=0.33,P≤ 0.03) and supraspinatus tendinopathy (r=0.56,P≤ 0.01).Rotator cuff injury was significantly more severe 6 months after stroke than at 3 months.The incidence of pain in the hemiplegic shoulder and abnormal sonographic findings of the biceps tendon and subscapularis tendon were significantly higher at 6 months than at 3 months after the stroke.Supraspinatus tendon problems were notable both at 3 and 6 months.Conclusions Pain in a hemiplegic shoulder is positively correlated with abnormal sonographic findings but negatively correlated with Brunnstrom stages and passive range of motion 3 and 6 months after stroke.Six months after stroke,pain is positively correlated with muscle tone.The tendon at the long head of the biceps and the rotator cuff are vulnerable to injury,especially at 6 months after stroke.