Effects of Mirror Therapy and Bilateral Arm Training on Hemiparetic Upper Extremity in Patients With Chronic Stroke

Not Applicable

Completed

• Conditions: Stroke; Hemiplegia
• Interventions: Behavioral: Mirror Therapy; Behavioral: Bilateral arm training

• Registration Number: NCT04242316
• Lead Sponsor: The Hong Kong Polytechnic University

Brief Summary

The aim of this study included (1) to compare the effectiveness of mirror therapy (MT) and bimanual arm training (BAT) in improving motor and functional performance of hemiplegic upper extremity for adults with chronic stroke; (2) to examine whether recruitment of the mirror neurons, as reflected in mu rhythm suppression, mediates recognition of the mirror illusion in pre/post MT, as compared to BAT without a mirror in clients with chronic stroke, as compared to healthy participants.

Detailed Description

Mirror Therapy (MT) appeared to have beneficial effects on the recovery of distal function of the hemiplegic hand in the evidence recently, however, it is not known whether the incongruent visual feedback induced by mirror in bilateral arm training (BAT) is beneficial to the motor performance of upper extremity than without the mirror in patients with chronic stroke. This study aimed to compare the effectiveness of MT and bimanual arm training (BAT) in improving motor and functional performance of hemiplegic upper extremity for adults with chronic stroke. Participants with chronic stroke were recruited by convenience sampling from a convalescent hospital and self-help groups in the community in Hong Kong. Participants were randomly assigned to the MT group or BAT group and participated in a 6-week upper limb training programme which consisted of two 45-minute training sessions per week. Both kinds of training were equivalent to each other except that there was a mirror used in the MT group. Main outcome measures were upper extremity motor and functional tests, and grip strength. Participants were evaluated at baseline, post-treatment and 3-month follow-up. EEG was assessed before and after the training in a group of stroke patients and healthy controls, in order to evaluate the recruitment of the mirror neurons, as reflected in mu rhythm suppression.

Study Timeline

• Study Start: 2014-01-01
• Primary Completion: 2017-01-01
• Study Completion: 2019-01-01
• Status Verified: 2020-01
• Study First Submitted: 2020-01-22
• Study First Submitted QC: 2020-01-22
• Last Update Submitted: 2020-01-22
• Study First Posted: 2020-01-27
• Last Update Posted: 2020-01-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 101

Inclusion Criteria

1. neurological condition with unilateral hemiparesis;
2. a Functional Test of Hemiplegic Upper Extremity (FTHUE) score between levels 2 to 6;
3. chronic stroke with onset of neurological condition more than 6 months previously;
4. ability to understand and follow simple verbal instructions;
5. ability to participate in a therapy session lasting at least 30 minutes;
6. community ambulant with or without aids.

Exclusion Criteria

Individuals with severe neglect and severe spasticity (Modified Ashworth Scale >3) would be excluded.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Mirror Therapy	Mirror Therapy	Patients performed customized bimanual upper limb exercises with a mirror. They can observe the mirror visual feedback of their non-paretic hand during the movements.
Bilateral arm training	Bilateral arm training	Patients performed customized bimanual upper limb exercises without a mirror.

Primary Outcome Measures

Name	Time	Method
Fugl-Meyer assessment (FMA)	3-month after the completion of training	FMA-UE is a standard upper limb motor impairment assessment for stroke survivors. FMA-UE assesses voluntary movement, reflex activity, grasp and coordination.

Secondary Outcome Measures

Name	Time	Method
Action Research Arm Test (ARAT)	3-month after the completion of training	ARAT is a standard upper limb functional performance assessment for stroke survivors. ARAT assesses a patient's ability to handle objects differing in size, weight and shape. ARAT consists of 19 items grouped into four subscales: grasp, grip, pinch, and gross movement.
Wolf Motor Function Test (WMFT)	3-month after the completion of training	WMFT assesses the functional limitation of upper limb after a neurological condition. This test evaluates both strength (2 items) and function-based task performance (15 items).