Acute Effect of Mirror Therapy on Rehabilitation of Paretic Upper Extremity After Chronic Stroke

Not Applicable

• Conditions: Stroke
• Interventions: Other: Mirror Therapy; Other: Control Intervention

• Registration Number: NCT03371290
• Lead Sponsor: Federal University of Health Science of Porto Alegre

Brief Summary

Objective: To investigate the acute effect of mirror therapy (MT) on motor control, manual dexterity and spasticity of the paretic upper extremity (UE) of individuals with chronic hemiparesis after stroke, during reaching task.

Design: Randomized cross-over single-blinded trial. Subjects: Thirty-three patients post chronic stroke were recruited of the study.

Intervention: Patients who first participated in the MT intervention performed a single session of MT, whereas in the control intervention a single session composed of the same exercises was performed, but without the mirror. After a month washout, the patients switched groups.

Main measure: The primary outcome measure was motor control. The secondary outcome measure was manual dexterity and UE spasticity.

The data will be expressed as mean and 95% confidence interval (continuous variable) and absolute frequency (categorical variables). To compare the outcomes of the different experimental sessions and at the different moments (pre and post session), the Generalized Estimating Equations with post hoc LSD (Least Significant Difference) methods will be used. For all analysis the significance level was set at α = 0.05 and statistical software SPSS (Statistical Package for Social Sciences for Mac, version 22.0, IBM, USA) will be used.

Key words: Stroke, mirror therapy, upper extremity, kinematic analysis

Detailed Description

Not available

Study Timeline

• Study Start: 2017-09-27
• Primary Completion: 2017-09-28
• Study First Submitted: 2017-11-27
• Status Verified: 2017-12
• Study First Submitted QC: 2017-12-11
• Last Update Submitted: 2017-12-11
• Study First Posted: 2017-12-13
• Last Update Posted: 2017-12-13
• Study Completion: 2017-12-30

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 40

Inclusion Criteria

1. to have a diagnosis of unilateral, ischemic or hemorrhagic, stroke for at least 6 months and at most 5 years ; 2) age between 30 and 80 years; 3) cognitive ability to follow the instructions of the study (Mini-Mental score ≥ 18 for schooling and ≥ 13 for illiterate);4) mild or moderate motor sensory impairment (Fugl-Meyer Assessment Scale - mild: 58-64 points, moderate: 39-57 points); 5) spasticity ≤ 2 in the flexor elbow and wrist muscles, and horizontal shoulder adductor (Modified Ashworth Scale); 6) muscle strength ≥ 3 in the flexor muscles of the shoulder, elbow and wrist, and elbow and wrist extensors (Kendall assessement).

Exclusion Criteria

• Patients with visual impairment; history of severe depression or severe psychiatric disorder; other neurological or musculoskeletal disorders in the UE; visuospatial heminegligence; or pain file ≥ 4 on the compromised UE (Visual Analog Pain Scale), were excluded from the study.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Mirror Therapy Intervention	Mirror Therapy	-
Control Intervention	Control Intervention	-

Primary Outcome Measures

Name	Time	Method
Change Average Jerk (AJ)	changes from baseline at 30 minutes after each session	measure of the movement smoothness, this index decreases with increased smoothness
Change Adjusting Sway (AS)	changes from baseline at 30 minutes after each session	measure of the adjustments made to reach the target, decreases as the movement precision increases
Change Movement Cycle Time (MCT)	changes from baseline at 30 minutes after each session	The time to perform the cycle of movement in seconds, which includes the going and return phase of the arm to the table
Change Index of Curvature (IC)	changes from baseline at 30 minutes after each session	representative of the movement straightness during the going phase, an IC equal to 1 indicates a perfectly rectilinear motion
Change Mean Movement Velocity (MMV)	changes from baseline at 30 minutes after each session	fingernail marker mean velocity during the going phase, an increased MMV indicates an improves task performance
Change Range of motion	changes from baseline at 30 minutes after each session	Range of motion of shoulder (flexion/extension, abduction/adduction) and elbow (flexion/extension).

Secondary Outcome Measures

Name	Time	Method
Change Spasticity of paretic upper extremity	changes from baseline at 30 minutes after each session	The Modified Ashworth Scale (MAS) was used to assess spasticity, evaluating the resistance to passive movement. The patients stayed in a sitting position to the assessment of the muscle tone of the elbow flexors, wrist flexors and horizontal shoulder adductor of the paretic UE, with three mobilizations for each muscle group. Higher scores correspond to spasticity or increase in tone, while lower scores indicate normal muscle tone.
Change Manual dexterity	changes from baseline at 30 minutes after each session	Box and Block Test (BBT) was used to assess the gross manual dexterity. The test consists in moving, one by one, the largest possible number of blocks from one box compartment to the other, first with the uncommitted UE and then with the paretic UE. The recorded score is equivalent to the number of blocks moved from one side of the box to the other in 60 seconds

Trial Locations

Locations (1)

Federal University of Health Sciences of Porto Alegre; 🇧🇷 Porto Alegre, RS, Brazil