Abstract
Specific Aims: To study the effectiveness of mirror therapy and limb activation vs limb activation alone in the treatment of stroke patients with unilateral neglect. Significance: Hemi spatial neglect is a major disability after stroke. There are no effective therapies available so far. This study is a randomized controlled trial and has been carried out since January 2011 in Stroke Unit & College of Physiotherapy, Christian Medical College & Hospital. All stroke patients with thalamic and parietal lobe lesions and unilateral neglect after 48 hours of stroke were included in the study. Approach: Patients were randomized to treatment and control groups. Treatment group was given mirror therapy with limb activation and the control group received only limb activation. The treatment sessions were 1-2 hours/day for 5 days/week, for 4 weeks period. Unilateral neglect and outcome measures were assessed using picture identification task, star cancellation & line bisection tests, Catherine Bergego scale & Functional Independence Measure (FIM). The outcome was documented by a blinded assessor at 6 months. Fishers exact test & independent t-test was used (SPSS version 16.0) for statistical analysis. The mean difference in baseline scores & at follow-up was compared between the two groups. Innovation: Twenty five patients were enrolled; analysis was confined to 23 patients (14 in treatment group & 9 in control group; 2 patients died). The treatment group performed better in the picture identification task (treatment group: mean difference 4.9 confidence interval (CI): 3.9-5.8) vs control group (2.1, CI: 1.4-2.8; p<0.001). The mean change in the star cancellation score in the treatment group was 31.5 (CI: 24.4-38.6) vs control group 14.3 (CI: 7.7-20.9); p=0.001. The mean change in line bisection test was 11.0 (CI: 9.0-13.1) in the treatment group vs 6.7 (CI: 4.3-9.2); p=0.008 in the control group. The proportion of patients with no neglect in Catherine Bergego scale in the treatment group was 12 (85.7%) vs 0 (0%); p=<0.001 in the control group. Three patients (21.4%) were independent in FIM in the treatment group vs. 0 (0%); p=0.25 in the control group. Mirror therapy with limb activation is effective in improving unilateral neglect in stroke patients in this ongoing trial.
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