Comparison of the Effects of Mirror Therapy,Repetitive Transcranial Magnetic Stimulation and Robotic-assisted Hand Therapy Added to Neurological Rehabilitation on Upper Extremity Functions, Quality of Life and Pain in Stroke Patients
Overview
- Phase
- N/A
- Intervention
- Procedure: Mirror therapy
- Conditions
- Stroke
- Sponsor
- Afyonkarahisar Health Sciences University
- Enrollment
- 120
- Locations
- 1
- Primary Endpoint
- Fugl Meyer Upper Extremity Assessment Questionnaire
- Status
- Recruiting
- Last Updated
- last month
Overview
Brief Summary
The aim of the study is to investigate the comparison of the effects of mirror therapy, Repetitive Transcranial Magnetic Stimulation and robot-assisted hand therapy added to conventional neurological rehabilitation on upper extremity function, quality of life and pain in stroke.
Detailed Description
Stroke is the second leading cause of death in adults and an important cause of long term disability. Functional limitations that develop in the post stroke period affect participants quality of life and activities of daily living. Today, despite advances in rehabilitation and new pharmacologic strategies, stroke related upper extremity function, quality of life and pain treatment may not always achieve the desired results. There are new approaches in stroke rehabilitation such as mirror therapy, Repetitive Transcranial Magnetic Stimulation, robot-assisted hand therapy. Three groups will take part in this study. All three groups will receive a total of 20 sessions of conventional neurological rehabilitation program 5 days a week for 4 weeks. In addition to the first group, a total of 20 sessions of upper extremity mirror therapy program will be applied for 4 weeks, 5 sessions per week. The second group will receive Repetitive Transcranial Magnetic Stimulation (rTMS) to the contralateral M1 upper extremity motor cortex region at low frequency (1Hz) and at an intensity of 100%-110 of the resting motor threshold, 5 sessions per week for a total of 20 sessions for 4 weeks. The third group will receive a total of 20 sessions of robot-assisted hand therapy using AMADEO (Tyromotion Austria) 5 days a week for 4 weeks.These three groups will be compared in terms of upper extremity function, quality of life and pain.Brunstroom, Mini Mental Test, Modified Ashworth Scale, Fugl Meyer Upper Extremity Motor Assessment Scale, Box Block Test, Nine Hole Pag Test, ABILHAND Stroke Hand Function Questionnaire, Stroke Impact Questionnaire, Stroke Specific Quality of Life Scale, Visual Analog Scale , LANNS neuropathic pain assessment scale, 4 Question Neuropathic Pain Questionnaire, Beck Depression Inventory, Beck Anxiety Scale, Pittsburgh Sleep Quality Index, MEP (motor evoked potential) measurement will be done . Participants will be evaluated by a physician twice at the beginning and at the end of treatment (4th week).
Investigators
Selma Eroğlu
Associate Professor
Afyonkarahisar Health Sciences University
Eligibility Criteria
Inclusion Criteria
- •Patients who applied to Afyonkarahisar Health Sciences University Hospital Physical Medicine and Rehabilitation Polyclinic with the diagnosis of hemiplegia after a cerebrovascular accident in the inpatient ward or as an outpatient for neurological rehabilitation after taking the anamnesis and physical examination, who met the inclusion criteria and eliminated the
Exclusion Criteria
- •Female and male patients between the ages of 40-80
- •stroke at least 3 months ago
- •voluntarily agreed to participate in the study regularly, whose health status is suitable for rehabilitation and who are medically stable
- •mini mental test score of 15 and above
- •Neurologically stable patient
- •Exclusion Criteria:
- •significant comorbidities such as serious heart disease (aortic stenosis, angina, hypertrophic cardiomyopathy, arrhythmia, pacemaker) and uncontrolled hypertension
- •history of epilepsy, antiepileptic drug use
- •intracranial metal objects
- •intraauricular implants
Arms & Interventions
Experimental: Mirror therapy
The first group of participants will receive mirror therapy for 4 weeks, 5 sessions per week for a total of 20 sessions of upper extremity mirror therapy.
Intervention: Procedure: Mirror therapy
Experimental: Low Frequency rTMS Protocol
The second group will receive a total of 20 sessions of Repetitive Transcranial Magnetic Stimulation (rTMS) to the contralateral M1 upper extremity motor cortex region at low frequency (1Hz) and intensity of 100%-110% of the resting motor threshold, 5 sessions per week for 4 weeks.
Intervention: Device: Low Frequency rTMS Protocol
Experimental: Robotic-assisted hand therapy
In the Robot Assisted Therapy group, a total of 20 sessions will be applied to the hemiplegic upper extremity with AMADEO (Tyromotion Austria) 5 days a week for 4 weeks.
Intervention: Robotic-assisted hand therapy
Outcomes
Primary Outcomes
Fugl Meyer Upper Extremity Assessment Questionnaire
Time Frame: Baseline and Post-treatment (4th week)
The Fugl Meyer Upper Extremity Motor Assessment Scale was developed to quantitatively assess sensorimotor recovery after stroke. It was prepared based on Brunnstrom's stages of motor recovery. The FMUE Scale consists of 33 items, each scored from 0 to 2, where 0 = cannot perform, 1 = partially performs, and 2 = fully performs. The total score is 66. A range of data is available for the minimum clinically important differences for the FMUE Scale. A change of 4 to 7 points in chronic stroke, 12 points in subacute stroke, and 9 to 10 points is considered clinically significant.Higher scores indicate better upper limb functional recovery.
Secondary Outcomes
- Brunnstrom Staging(Baseline and Post-treatment (4th week))
- Mini Mental Test(Baseline)
- Modified Ashworth Scale(Baseline and Post-treatment (4th week))
- Box Block Test(Baseline and Post-treatment (4th week))
- Nine Hole Peg Test(Baseline and Post-treatment (4th week))
- Pittsburgh Sleep Quality Index (PSQI)(Baseline and Post-treatment (4th week))
- ABILHAND Stroke Hand Function Questionnaire(Baseline and Post-treatment (4th week))
- Stroke Impact Scale(Baseline and Post-treatment (4th week))
- Stroke Specific Quality of Life Scale(Baseline and Post-treatment (4th week))
- The Self Assessment of Neuropathic Symptoms and Signs (S-LANSS)(Baseline and Post-treatment (4th week))
- Beck Depression Scale(Baseline and Post-treatment (4th week))
- Beck Anxiety Inventory(Baseline and Post-treatment (4th week))
- Neuropathic Pain Questionnaire in 4 Questions(Baseline and Post-treatment (4th week))
- Visual Analog Scale (VAS)(Baseline and Post-treatment (4th week))
- Neurophysiological Measurements(Baseline and Post-treatment (4th week))