Abstract
Bimanual cooperation plays a vital role in functions of the upper extremity and daily activities. Based on the principle of bilateral movement, mirror therapy could provide bimanual cooperation training. However, conventional mirror therapy could not achieve the isolation of the mirror. A novel paradigm mirror therapy called associated mirror therapy (AMT) was proposed to achieve bimanual cooperation task-based mirror visual feedback isolating from the mirror. The study was aimed at exploring the feasibility and effectiveness of AMT on stroke patients. We conducted a single-blind, randomized controlled trial. Thirty-six eligible patients were equally assigned into the experimental group (EG) receiving AMT and the control group (CG) receiving bimanual training without mirroring for five days/week, lasting four weeks. The Fugl-Meyer Assessment Upper Limb subscale (FMA-UL) for upper extremity motor impairment was used as the primary outcome. The secondary outcomes were the Box and Block Test (BBT) and Functional Independence Measure (FIM) for motor and daily function. All patients participated in trials throughout without adverse events or side effects. The scores of FMA-UL and FIM improved significantly in both groups following the intervention. Compared to CG, the scores of FMA-UL and FIM were improved more significantly in EG after the intervention. The BBT scores were improved significantly for EG following the intervention, but no differences were found in the BBT scores of CG after the intervention. However, no differences in BBT scores were observed between the two groups. In summary, our study suggested that AMT was a feasible and practical approach to enhance the motor recovery of paretic arms and daily function in stroke patients. Furthermore, AMT may improve manual dexterity for poststroke rehabilitation.
Highlights
Stroke is a leading cause of mortality and long-term disability worldwide [1], which results in a global economic burden for health care [2, 3]
It is remarkable that protocols of bilateral treatment (BT) which involve bilateral training with rhythmic auditory cues, bilateral priming, and device-driven bilateral training have been used as clinical treatments for stroke rehabilitation [10,11,12]
Repetitive, and symmetrical motor principles, most bilateral treatments (BTs) are executed through two independent and paralleled actions, which ignore cooperation between the hands; for instance, Sainburg et al proposed the symmetrical cooperative tasks regarded as a bilateral synergy framework for poststroke rehabilitation [6]
Summary
Stroke is a leading cause of mortality and long-term disability worldwide [1], which results in a global economic burden for health care [2, 3]. About 80% of patients remain having upper extremity motor impairment [4]. Researchers have found that the ipsilesional upper limb suffered motor dysfunction in 3 months after the onset of stroke [5], which hinders physical function and independent daily activities. Compared to the healthy population, stroke patients tend to avoid bilateral motor patterns in daily activities [6]. Lots of daily activities are inseparable from bimanual cooperation, such as twisting the towel, driving the car, and getting dressed. For this reason, bilateral task relearning is essential for stroke patients. Repetitive, and symmetrical motor principles, most bilateral treatments (BTs) are executed through two independent and paralleled actions, which ignore cooperation between the hands; for instance, Sainburg et al proposed the symmetrical cooperative tasks regarded as a bilateral synergy framework for poststroke rehabilitation [6]
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