The Effects of Mirror Therapy on Upper Extremity in Stroke Patients
Overview
- Phase
- N/A
- Intervention
- Not specified
- Conditions
- Cerebrovascular Accident
- Sponsor
- Taipei Medical University Hospital
- Enrollment
- 60
- Locations
- 1
- Primary Endpoint
- Fugl-Meyer Assessment (FMA)
- Status
- Completed
- Last Updated
- 10 years ago
Overview
Brief Summary
The purpose of this study is to compare treatment efficacy of mirror therapy (MT), mirror therapy combining mesh glove (MG+MT) stimulation, and controlled treatment (CT) in people with stroke.
Detailed Description
55% to 75% of people after stroke have a paretic arm that causes motor impairment. Among novel rehabilitation interventions, MT was found to be beneficial and comparatively low-cost. MT reduced motor impairment possibly in part of recruiting the premotor cortex or balancing the neural activation within the primary motor cortex toward the affected hemisphere. However, the benefits in certain aspects of outcomes are under debate. Another treatment, MG, can be used to normalize muscle tone, suppress muscle spasticity, enhance residual volitional activity of hand and arm, or even increasing walking speed. In addition, providing MG stimulation might result in plastic changes in the primary motor cortex, and induced a long-lasting modulated effect on motor cortical excitability. The possible mechanism of brain plasticity underlying MG is collective with the mechanism behind the MT. Adding MG to MT might augment the cortical reorganization. In sum, combining MT with MG may supplement the disadvantage or uncertain effects of MT and broaden the benefited outcomes.
Investigators
Eligibility Criteria
Inclusion Criteria
- •The onset duration more than 3 months
- •Demonstration of Brunnstrom stage equal to or above stage III of the affected upper extremity
- •No serious cognitive deficits (a score of more than 24 on the Mini Mental State Exam)
- •No serious visual and visual-perception impairments
- •No concurrent participation in other drug or rehabilitation research
- •No serious attention deficits
- •No excessive spasticity in any of the joints of the affected UL exclusion criteria
Exclusion Criteria
- •Exhibit physician determined major medical problems or poor physical conditions that would interfere with participation
- •Excessive pain in any joint that might limit participation
Outcomes
Primary Outcomes
Fugl-Meyer Assessment (FMA)
Time Frame: Baseline, change from baseline in FMA at 4 weeks, change from baseline in FMA at 16 weeks, change from baseline in FMA at 28 weeks
The upper-extremity subscale of the FMA contains 33 items to assess motor impairment. Each item is scored on a 3-point ordinal scale (0-cannot perform, 1-performs partially, 2-performs fully and correctly). The sub-score of a proximal shoulder/elbow (0-42) and a distal hand/wrist (0-24) will be also calculated to investigate the treatment effects on separate upper extremity elements.
Wolf Motor Function Test (WMFT)
Time Frame: Baseline, change from baseline in WMFT at 4 weeks, change from baseline in WMFT at 16 weeks, change from baseline in WMFT at 28 weeks
* The WMFT composed of 3 parts: Time, Functional ability, and Strength * Includes 15 function-based tasks and 2 strength based tasks * Performance time is referred to as WMFT-TIME * Functional ability is referred to as WMFT-FAS * Items 1-6 involve timed functional tasks, items 7-14 are measures of strength, and the remaining 9 items consist of analyzing movement quality when completing various tasks. * Examiner should test the less affected upper extremity followed by the most affected side. * Uses a 6-point ordinal scale * "0" = "does not attempt with the involved arm" to * "5" = "arm does participate; movement appears to be normal." * Maximum score is 75 * Lower scores are indicative of lower functioning levels * WMFT-TIME allows 120 seconds per task
revised Nottingham Sensory Assessment (rNSA)
Time Frame: Baseline, change from baseline in rNSA at 4 weeks, change from baseline in rNSA at 16 weeks, change from baseline in rNSA at 28 weeks
The rNSA examines the sensory function of the affected arm and includes tactile sensation (0=Absent, 1=Impaired, 2=Normal), proprioception (0=Absent, 1=Appreciation of movement sense, 2=Direction of movement sense, 3=Joint position sense), and stereognosis (0=Absent, 1=Impaired, 2=Normal) subtests.
Accelerometers
Time Frame: Baseline, change from baseline in accelerometers at 4 weeks, change from baseline in accelerometers at 16 weeks, change from baseline in accelerometers at 28 weeks
The accelerometers are used to provide a direct and objective measure of the amount of the impaired arm movement outside the laboratory. Acceleration is sampled at 10 Hz and summed over a user- specified epoch. The recording epoch in this study is 2 seconds; recording capacity is approximately 72 hours. A "threshold-filter" will be applied to the raw recordings to obtain an accurate measure of the duration of arm movement.
Secondary Outcomes
- Semmes-Weinstein monofilaments(Baseline, change from baseline in Semmes-Weistein monofilaments at 4 weeks, change from baseline in Semmes-Weistein monofilaments at 16 weeks, change from baseline in Semmes-Weistein monofilaments at 28 weeks)
- Motor Activity Log (MAL)(Baseline, change from baseline in MAL at 4 weeks, change from baseline in MAL at 16 weeks, change from baseline in MAL at 28 weeks)
- Stroke Impact Scale version 3.0 (SIS 3.0)(Baseline, change from baseline in SIS at 4 weeks, change from baseline in SIS at 16 weeks, change from baseline in SIS at 28 weeks)
- Kinematic analyses(Baseline, change from baseline in kinematic parameters at 4 weeks)
- Functional Independence Measure (FIM)(Baseline, change from baseline in FIM at 4 weeks, change from baseline in FIM at 16 weeks, change from baseline in FIM at 28 weeks)
- 8-OHdG(Baseline, change from baseline in 8-OHDG at 4 weeks, change from baseline in 8-OHDG at 16 weeks, change from baseline in 8-OHDG at 28 weeks)