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ObjectiveTo investigate the effect of multimodal mirror therapy on upper limb and hand function in stroke patients. MethodsFrom April, 2021 to August, 2022, 60 stroke patients from the Department of Rehabilitation Medicine of Zhejiang Provincial People's Hospital were randomly divided into group A (n = 20), group B (n = 20) and group C (n = 20). All the patients accepted routine rehabilitation, while group B accepted mirror therapy, and group C accepted multimodal mirror therapy, in addition, for six weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Upper Extremity Function Test (UEFT) and modified Barthel Index (MBI), while the maximum grip strength and pinch strength of the affected hand were measured. ResultsThe FMA-UE score, UEFT score, maximum hand grip strength and pinch strength, and MBI scores improved in all groups after treatment (|t| > 7.878, P < 0.001), and it was the most in group C (F > 12.563, P < 0.001). ConclusionMultimodal mirror therapy may further improve the upper limb motor function and hand function of stroke patients, as well as the strength of the affected hand and the activities of daily living.
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ObjectiveTo investigate the effect of mirror therapy with augmented reality on attention of stroke patients. MethodsFrom January, 2020 to December, 2022, 60 stroke patients in the First People's Hospital of Changzhou were randomly divided into control group (n = 30) and observation group (n = 30). Both groups received routine occupational therapy, and the observation group received mirror therapy with augmented reality additionally, for four weeks. They were assessed with Digit Span Test (DST), Digit Cancellation Test (D-CAT3 and D-CAT3P), Symbol Digit Modalities Test (SDMT) and Paced Auditory Serial Addition Test (PASAT) before and after treatment. ResultsBefore treatment, there was no significant difference in the scores of the DST, D-CAT3, D-CAT3P, SDMT and PASAT between two groups (P > 0.05). After treatment, all the indexes improved in the observation group (|t| > 3.663, P < 0.01), and improved more in the observation group than in the control group (|t| > 2.037, P < 0.05). ConclusionThe mirror therapy with augmented reality could effectively improve attention of stroke patients in the short term.
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ObjectiveTo observe the effect of video-based mirror therapy on lower limb motor function, walking ability, and balance of stroke patients at recovery stage. MethodsFrom January to October, 2022, 43 stroke patients in Beijing Bo'ai Hospital were randomly divided into control group (n = 22) and mirror therapy group (n = 21). Both groups received routine rehabilitation, and the mirror therapy group received video-based mirror therapy additionally, for four weeks. They were assessed with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Functional Ambulation Category (FAC) and Berg Balance Scale (BBS) before and after treatment. ResultsAfter treatment, the scores of FMA-LE, FAC and BBS improved significantly in both groups (|t| > 6.205, P < 0.001), and the scores of FMA-LE and BBS were better in the mirror therapy group than in the control group (|t| > 2.164, P < 0.05). ConclusionCombining with video-based mirror therapy could facilitate to improve the lower limb motor function and balance ability of stroke patients at recovery stage.
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ObjectiveTo investigate the effect of 1 Hz repetitive transcranial magnetic stimulation (rTMS) combined with mirror therapy on upper limb motor function and cortical neurophysiological indicators in stroke patients with hemiplegia. MethodsSixty stroke patients who were admitted to Jinshan Hospital of Fudan University, from October, 2022 to March, 2023 were randomly assigned to control group (n = 15), rTMS group (n = 15), mirror therapy group (n = 15) and combined group (n = 15). All groups received routine medicine and rehabilitation. In addition, the control group received sham rTMS and sham mirror therapy, rTMS group received 1 Hz rTMS and sham mirror therapy, the mirror therapy group received sham rTMS and mirror therapy, and the combined group received 1Hz rTMS combined with mirror therapy, for four weeks. Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) were used to evaluate the motor function of the affected upper limb. The motor-evoked potential (MEP) amplitude and central motor conduction time (CMCT) of the affected cortex were measured using a transcranial magnetic stimulation device. ResultsAfter treatment, the scores of FMA-UE and ARAT, and the amplitude of MEP significantly improved in all groups (|t| > 3.854, P < 0.001), while the CMCT significantly shortened (t > 5.967, P < 0.001). Compared to the control group, rTMS group, the mirror therapy group and the combined group showed more significant improvement in the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). When compared to rTMS group and the mirror therapy group, the combined group showed more significant improvement the scores of FMA-UE and ARAT, and the amplitude of MEP, and shorter CMCT (P < 0.05). There was significant positive correlation of the scores of FMA-UE and ARAT with the amplitude of MEP, and negative correlation with the CMCT in all groups (R2 > 0.804, P < 0.001). ConclusionThe combination of 1 Hz rTMS and mirror therapy contributes to the post-stroke brain functional remodeling and facilitates upper limb motor recovery in stroke patients with hemiplegia.
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Objective:To explore the effects of mirror therapy on upper limb motor function recovery and corticospinal tract remodeling after stroke. Methods:From March, 2017 to March, 2019, 42 subcortical stroke patients with upper limb dysfunction from Shanghai Fifth People's Hospital were randomly divided into control group (n = 21) and observation group (n = 21). Both groups received routine rehabiliation, while the observation group received mirror therapy additionally, for twelve weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), and scanned with diffusion tensor imaging (DTI) before and after treatment. The fractional anisotropy (FA) in posterior limb of internal capsule (PLIC) was obtained. Results:The scores of FMA-UE improved in both groups after treatment (t > 9.560, P < 0.001), and improved more in the observation group than in the control group (t > 2.634, P < 0.05). FA decreased significantly in the affected-lateral PLIC compared with that in the unaffected-lateral PLIC in both groups (t > 11.368, P < 0.001). FA in the affected side increased significantly after treatment in the observation group (t = 2.385, P < 0.05), while there was no significant difference in the control group (t = -0.596, P > 0.05). FA increased more significantly in the observation group than in the control group (t = 2.306, P < 0.05). Conclusion:Mirror therapy can promote the recovery of motor function of upper limb and the corticospinal tract remodeling in stroke patients.
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Objective:To explore the clinical efficacy of myofascial trigger point electric stimulation based on mirror therapy on phantom limb pain after lower limb amputation. Methods:From May to November, 2020, 50 patients with phantom limb pain after lower limb amputation were randomly divided into control group (n = 25) and experiment group (n = 25). Both groups accepted mirror therapy, while the experiment group received myofascial trigger point electric stimulation before mirror therapy, for four weeks. They were assessed with short-form of McGill Pain Questionnaire (SF-MPQ), Pittsburgh Sleep Quality Index (PSQI), Hamilton Anxiety Scale (HAMA), Timed 'Up & Go' Test (TUGT) and 6-minute walk test (6MWT) before and after treatment. Results:All the indexes improved in both groups after treatment (|t| > 8.210, P < 0.001), and improved more in the experiment group than in the control group (|t| > 5.103, P < 0.001), except the present pain intensity of SF-MPQ. Conclusion:Mirror therapy is effective on phantom limb pain after lower limb amputation in terms of pain, sleep, anxiety and walking, and the effect could be stronger after myofascial trigger point electric stimulation.
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Objective:To explore the effects of bilateral arm transcutaneous electrical acupoint stimulation (TEAS) based on mirror therapy (MT) on upper limb function of subacute stroke hemiplegic patients. Methods:From September, 2017 to October, 2019, 48 subacute stroke hemiplegic patients were randomly divided into control group (n = 24) and experimental group (n = 24). All the patients accepted routine rehabilitation and MT, while the experimental group received bilateral arm TEAS and the control group received sham TEAS, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT) and modified Barthel Index (MBI) before and after treatment. Results:All the scores of FMA-UE, ARAT, WMFT and MBI improved in both groups after treatment (|t| > 11.870, P < 0.001), and improved more in the experimental group than in the control group (|t| > 2.678, P < 0.05). Conclusion:Bilateral arm TEAS based on MT can promote the upper limb function of subacute stroke hemiplegic patients.
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Objective:To investigate the effects of combination of transcranial direct current stimulation (tDCS) and mirror therapy (MT) on upper limb motor function after stroke. Methods:From April, 2018 to March, 2019, 78 stroke inpatients were randomly assigned into tDCS group (n = 26), MT group (n = 26) and combined group (n = 26). All the patients received their related therapy, respectively, based on routine medicine and rehabilitation. Their motor-evoked potential cortical latency (CL) and central motor conduction time (CMCT) in affected brain area were measured before and four weeks after treatment, while they were assessed with Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and modified Barthel Index (MBI). Results:All CL, CMCT, and the scores of FMA-UE and MBI improved significantly in all the groups after treatment (|t| > 2.609,P < 0.05), and improved more in the combined group than in both tDCS group and MT group (P < 0.05). Conclusion:Both tDCS and MT could improve excitability of cerebral cortex of the affected brain area and promote the recovery of upper limb motor function for patient after stroke, and it is more effective in combination mode.
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Objective:To apply a novel mirror therapy based on left-right coordination and counterbalance in patients with subacute stroke. Methods:From October, 2018 to March, 2019, ten subacute stroke patients received the novel mirror therapy for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Box and Block Test (BBT), Functional Independence Measure (FIM) and Five Times Sit to Stand Test (FTSST) before and after trial. The patients and the therapists were investigated with a questionnaire after trial. Results:All the patients finished the trial. All the indexes above improved after trial (|Z| > 2.527, P < 0.05). The patients and the therapists generally believed that the novel mirror therapy was suitable for stroke patients. Conclusion:The novel mirror therapy based on left-right coordination and counterbalance is safe and feasible for patients with subacute stroke.
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Objective:To evaluate the effect of mirror therapy on lower-limb motor, balance and walking of stroke patients. Methods:Randomized controlled trails (RCTs) about mirror therapy for lower limb function after stroke were recalled in PubMed, Cochrane Library, EMbase, Medline complete, CNKI, Wanfang Data, VIP and CBMdisc. Meta-analysis was conducted using RevMan 5.3 software for eligible RCTs. Results:A total of twelve studies were retrieved, including 590 patients. Mirror therapy improved the scores of Fugl-Meyer Assessment-Lower Extremity (MD = 6.67, 95%CI 5.60 to 7.74; Z = 12.20, P < 0.001), Brunnstrom stages (MD = 0.55, 95%CI 0.28 to 0.82; Z = 3.98, P < 0.001), Berg Balance Scale (MD = 3.45, 95%CI 1.40 to 5.50; Z = 3.30, P = 0.001), mini-BESTest (MD = 1.49, 95%CI 0.65 to 2.33; Z = 3.48, P < 0.001), Brunnel Balance Assessment (MD = 0.66, 95%CI 0.10 to 1.22; Z = 2.32, P = 0.02). However, it was not significant for 10-meter Walking Test (MD = 0.03, 95%CI -0.04 to 0.11; Z = 0.88, P = 0.38) and Timed "Up and Go" Test (MD = -1.43, 95%CI-4.31 to 1.45; Z = 0.97, P = 0.33). Conclusion:Mirror therapy can improve lower extremity motor function after stroke significantly, and somehow for balance. Further research is needed to explore its effects on walking.
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@#Background & Objective: Mirror therapy has been shown to be effective in restoring upper extremity function in stroke patients through changes in the central nervous system. Therefore, it is important to evaluate the effectiveness of various tasks to induce central nervous system excitation. This study investigated the effect of using a complex task with multi-joint-based mirror therapy on upper extremity function and activities of daily living (ADL) in patients with hemiplegia after a stroke. Methods: In this study, 25 stroke patients were recruited and assigned randomly to the experimental or control group. The experimental group received a complex task using multi-joint-based mirror therapy, and the control group received a simple task using single-joint-based mirror therapy. Both groups received the same standard rehabilitation treatment 5 days per week for 4 weeks. An upper extremity evaluation was performed using the Fugl-Meyer Assessment (FMA) and Motor Activity log (MAL). The FMA includes an upper extremity subsection (FMA-UE) as well as upper arm (FMA-UA) and wrist/hand (FMA-WH) subparts. The MAL includes quality of movement (QOM) and amount of use (AOU) subsections. ADL were evaluated using the Korean version of the Modified Barthel Index (K-MBI). Results: Compared with the control group, the experimental group showed greater improvement on the FMA-UE, -UA, and -WH (p = 0.034, 0.047, and 0.013, respectively); MAL-AOU and -QOM (p = 0.048 and 0.034, respectively); and K-MBI (p = 0.031). The following effect sizes (Cohen’s d) were observed: FMA-UE, -UA, and -WH (1.0); MAL-AOU (0.2); MAL-QOM (1.6); and K-MBI (0.2). Conclusions: This study demonstrates that a complex task using multi-joint-based mirror therapy is more effective in restoring upper limb function and ADL in stroke patients than simple task-based mirror therapy.
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OBJECTIVE@#To explore the effect of dynamic scalp acupuncture combined with task-oriented mirror therapy (TOMT) for upper limb motor function and activity ability of daily living in patients with hemiplegia after ischemic stroke.@*METHODS@#Seventy-eight patients with hemiplegia after ischemic stroke were randomly divided into a dynamic scalp acupuncture group, a TOMT group, and a scalp acupuncture group, 26 cases in each group (1 case dropped off in the TOMT group and the scalp acupuncture group respectively). All three groups received routine rehabilitation training and medication treatment. The TOMT group was treated with TOMT for 40 min a day, 5 days a week for 8 weeks. The scalp acupuncture group was treated with TOMT after the scalp acupuncture, and the dynamic scalp acupuncture group was treated with TOMT during the scalp acupuncture treatment. The scalp acupuncture treatment was applied at ipsilateral up 1/5 and mid 2/5 of and , and the needles were retained for 40 min. The scalp acupuncture treatment was given once a day, 5 days a week for 8 weeks. Before treatment and after 4 weeks and 8 weeks of treatment, the functions of upper limb and hand were evaluated by simplified Fugl-Meyer assessment (FMA) scale upper limb part and functional test for the hemiplegic upper extremity-Hong Kong version (FTHUE-HK) grade, the muscle tension of the upper extremity flexor elbow muscle group was assessed by modified Ashworth scale (MAS) and the activity ability of daily living was assessed by modified Barthel index (MBI).@*RESULTS@#After 4 weeks and 8 weeks of treatment, the FMA scores, FTHUE-HK grades and MBI scores in the three groups were better than those before treatment (<0.01, <0.05), and MAS scores after 4 weeks of treatment in the three groups were better than those before treatment (<0.05). After 4 weeks and 8 weeks of treatment, the FMA scores, FTHUE-HK grades and MBI scores in the dynamic scalp acupuncture group were better than those in the TOMT group and the scalp acupuncture group (<0.05), and these items in the scalp acupuncture group were better than those in the TOMT group (<0.05).@*CONCLUSION@#The dynamic scalp acupuncture combined with TOMT treatment can effectively improve the upper limb function and the activities ability of daily living in patients with hemiplegia after ischemic stroke, which is better than TOMT after scalp acupuncture and simple TOMT treatment.
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Objective The purpose of this study was to compare the effectiveness of task-oriented therapy and mirror therapy on improving hand function in post-stroke patients. Subjects and Methods Total subjects 30 were randomly divided into two groups: the task-oriented group (15 patients) and the mirror therapy group (15 patients). The task-oriented group underwent task-oriented training for 45mins a day for 5 days a week for 4 weeks. The mirror therapy group underwent a mirror therapy program under the same schedule as task-oriented therapy. The manual dexterity and motor functioning of the hand were evaluated before the intervention and 4 weeks after the intervention by using FMA (Fugl-Meyer assessment) and BBT (Box & Block test). Results Hand function of all patients increased significantly after the 4-week intervention program on the evaluation of motor function and manual dexterity by FMA and BBT in both the groups of Task-Oriented approach and Mirror therapy, but Group A Task-oriented approach improved more significantly when compared to Group B Mirror therapy. Conclusion The treatment effect was more in patients who received a Task-Oriented approach compared to Mirror therapy. These findings suggest that the Task-Oriented approach was more effective in post stoke hand function rehabilitation.
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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.
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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.
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Objective To investigate the effect of early intervention with mirror therapy on hemiparetie survivors of ischemic stroke.Methods Thirty-six hemiplegic patients within one month after a stroke were randomly divided into a mirror therapy group (MT group,n=18) and a routine rehabilitation control group (RRC group,n=18).The participants in the MT group received MT for 45 min/d,5 d/wk for 3 weeks in addition to conventional stroke rehabilitation.Those in the RRC group received exercise therapy at the same frequency without the mirror protocol.The Fugl-Meyer assessment (FMA),Wolf motor function test (WMFT),functional ambulation category scale (FAC),Brunnstrom stages of motor recovery,and the modified Ashworth scale (MAS) were used to assess changes in the upper limb,gross hand dexterity and lower limb recovery before and right after the interventions,as well as one and two months after the treatment.Results Significant improvement was observed in the limb function of both groups after the treatment.Compared with the RRC group,there was significantly greater improvement observed in the MT group.This was true of the FMA ratings at all time points,the average WMFT scores one and two months after the intervention,the FAC ratings two months after the intervention,and the Brunnstrom stages at both one and two months after the intervention.However,no significant difference between the two groups in terms of the average MAS scores was observed at any time point.Conclusion Early intervention with MT can significantly accelerate the recovery of a paretic upper limb aud improve walking ability after stroke.Such intervention is worthy of promotion and application in clinical practice.
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Objective To investigate the effect of graded motor imagery ( GMI) therapy combined with rou-tine occupational therapy on the recovery of upper extremity function after stroke. Methods Thirty stroke survivors who met inclusion criteria were randomly assigned to a control group ( n=15) or a GMI group ( n=15) . The control group received routine medication, conventional physical therapy and routine occupational therapy ( one hour a day) , while the GMI group received 30 minutes of routine occupational therapy and 30 minutes of graded motor imagery therapy every day in addition to conventional medication and physical therapy. Before and after four weeks of treat-ment, the patients in both groups were evaluated using the Fugl-Meyer Assessment for the Upper Extremities ( FMA-UE) , the Box and Block Test ( BBT) and Brunnstrom arm and hand staging. Surface electromyography of the biceps brachii and triceps brachii was performed as the affected elbow flexed and stretched in maximum isometric contrac-tions, and the co-contraction ratios ( CRs) were calculated. Results After the treatment, the average FMA-UE score, Brunnstrom arm and hand stage, BBT and CR scores in both groups had improved significantly. The average improvement in the GMI group was significantly greater than in the control group. Conclusions Graded motor im-agery therapy can significantly promote motor recovery of the upper extremities of hemiplegic patients after a stroke.
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Objective:To analyze the current status and hotspots of mirror therapy in recent 20 years. Methods:The literatures about mirror therapy in science citation index expanded (SCI-E) of Web of Science (WOS) from 1998 to 2019 were researched. CiteSpace was used to map the cooperative network of authors, countries and research institutions of relevant literatures; the keywords were taken as nodes for co-occurrence analysis and conduct clustering analysis, time evolution analysis and Burst analysis; the cited literatures and cited journals were taken as nodes to draw co-cited maps. In addition, the cited literatures were dealt with Burst analysis. Results:Totally, 435 articles were included. The high yield authors were Mosaley G L and Tsao J W. The high yield countries were the United States, Germany and England. The high yield institutions were Heidelberg University and University of South Australia. Prediction of phantom limb pain, complex regional pain syndrome, the improvement of motor function especially upper limb function, and augmented reality after stroke will be the focus of mirror therapy in the future. Conclusion:The research of mirror therapy is still in its infancy, with rapid development but insufficient influence.
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Objective:To explore the effects of robot-assisted therapy combined with mirror therapy (MT) on upper limbs in patients with hemiplegia after stroke. Methods:From January, 2017 to June, 2018, 56 patients with hemiplegia after stroke were randomly divided into control group (n = 28) and observation group (n = 28). The control group received conventional therapy, and the treatment group received robot-assisted therapy combined with MT, additionally. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Wolf Motor Function Test (WMFT), Functional Independence Measure (FIM) and modified Barthel Index (MBI) before and four weeks after treatment. Results:Four weeks after treatment, the scores of FMA-UE, WMFT and MBI were better in both groups (t > 2.959, P < 0.05), and were better in the observation group than in the control group (t > 4.732, P < 0.001). Conclusion:Robot-assisted therapy combined with MT could improve the function of upper limb and activities of daily living in patients with hemiplegia after stroke.
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Objective:To explore the effects of repetitive transcranial magnetic stimulation (rTMS) combined with mirror therapy (MT) on upper limb and hand function after stroke. Methods:A patient after right basal ganglia hemorrhage accepted intermittent routine rehabilitation for more than three months, and did not satisfy in upper limb and hand function recovery. Then, he accepted rTMS combined with MT for six weeks. He was assessed with Brunnstrom stage, Fugl-Meyer Assessment, limb function evaluation of hemiplegia, modified Ashworth Scale, modified Barthel Index, Minnesota Rate of Manipulation Test and Jebsen Hand Function Test before and after treatment. Results:The patient improved in motor function, Minnesota Rate of Manipulation Test and Jebsen Hand Function Test, with spasm relief after treatment. Conclusion:rTMS combined with MT can be applied for rehabilitation of upper limbs and hands after stroke.