Abstract
Objective: The aim of this trial was to compare the effect of movement-based mirror therapy (MMT) and task-based mirror therapy (TMT) on improving upper limb functions in patients with stroke.Methods: A total of 34 patients with sub-acute stroke with mildly to moderately impaired upper limb motor functions. The participants were randomly allocated to one of three groups: MMT, TMT, and conventional treatment (CT). The MMT group underwent movement-based mirror therapy for around 30 min/day, 5 days/week, for 4 weeks, whereas the TMT group underwent dose-matched TMT. The CT group underwent only conventional rehabilitation. The MMT and TMT groups underwent CT in addition to their mirror therapy. Blinded assessments were administered at baseline and immediately after the intervention. Upper limb motor functions, measured using Fugl-Meyer Assessment-upper extremity (FMA-UE), Wolf Motor Function Test (WMFT), and hand grip strength; upper limb spasticity, measured using the modified Ashworth scale (MAS); and activities of daily living, measured using the modified Barthel index (MBI).Results: A significant time-by-group interaction effect was noted in FMA-UE. Post-hoc analysis of change scores showed that MMT yielded a better effect on improving FMA-UE than the other two therapies, at a marginally significant level (P = 0.050 and 0.022, respectively). No significant interaction effect was noted in WMFT, hand grip strength, MAS, and MBI.Conclusion: Both MMT and TMT are effective in improving the upper limb function of patients with mild to moderate hemiplegia due to stroke. Nevertheless, MMT seems to be superior to TMT in improving hemiplegic upper extremity impairment. Further studies with larger stroke cohorts are expected to be inspired by this pilot trial.Trial registration number: No. ChiCTR1800019043 (http://www.chictr.org.cn/index.aspx)
Highlights
Mirror therapy (MT) has been shown to be a useful intervention for rehabilitation of upper limb functions following stroke, since the first attempt by Altschuler et al (1)
In a recent study comparing the effects of action observation training and MT on gait and balance in patients with stroke, the results showed that action observation training had significantly better effects on the improvement of balance functions than MT (22), indicating that action observation may be different from MT in terms of their neural mechanisms
Our results suggested that movement-based MT (MMT) seemed to be better than task-based MT (TMT) in terms of improving hemiplegic upper limb motor impairment, as indicated by the FuglMeyer Assessment-upper extremity (FMA-UE), among patients with sub-acute stroke
Summary
Mirror therapy (MT) has been shown to be a useful intervention for rehabilitation of upper limb functions following stroke, since the first attempt by Altschuler et al (1). The first theory hypothesizes that the neural correlate of MT is the mirror neuron system (MNS), which is defined as a class of neurons that fire during action observation and action execution (3). The second theory, supported by several studies with transcranial magnetic stimulation (TMS), suggests that a potential neural mechanism underlying the effect of MT can be the recruitment of the ipsilesional corticospinal pathway. Many TMS studies have demonstrated the increment of motor-evoked potentials of the ipsilesional primary motor cortex in participants with stroke when viewing MVF (7), which indicates a facilitatory effect of MVF on the ipsilesional corticospinal pathway. The last theory attributes the effect of MT to the compensation of restricted proprioception input from the affected limb and the enhancement of attention toward the paretic upper limb (8), which may contribute to the reduction of the learned non-use in patients with stroke (1)
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