This one was interesting because the mirror training was for the leg.
Abstract—Background: The effectiveness of mirror therapy
(MT) has been investigated in acute hemiplegia. The present study
examines whether MT, given during chronic stroke, was more
effective in promoting motor recovery of the lower extremity and
walking speed than standard rehabilitation alone. Methods: The study
enrolled 30 patients with chronic stroke. Fifteen patients each were
assigned to the treatment group and the control group. All patients
received a conventional rehabilitation program for a 4-week period.
In addition to this rehabilitation program, patients in the treatment
group received mirror therapy for 4 weeks, 5 days a week. Main
measures: Passive ankle joint dorsiflexion range of motion, gait
speed, Brunnstrom stages of motor recovery, plantar flexor muscle
tone by Modified Ashworth Scale. Results: No significant difference
was found in the outcome measures among groups before treatment.
When compared with standard rehabilitation, mirror therapy
improved Ankle ROM, Brunnstrom stages and waking speed
(p < 0.05). However, there were no significant differences between
two groups on MAS (P > 0.05).Conclusion: Mirror therapy combined
with a conventional stroke rehabilitation program enhances lower extremity
motor recovery and walking speed in chronic stroke
patients.
V. DISCUSSION
This study reveals that MT of the paretic leg in addition to a
conventional rehabilitation program provide additional benefit
in terms of lower-extremity motor recovery and gait speed in
chronic stroke patients. However, we found no effect on
spasticity. Thieme et al. carried out a systematic review to
summarize the effectiveness of MT for improving motor
function, activities of daily living, pain, and visuospatial
neglect in patients after stroke. They reported that MT may
have a positive effect on motor function, ADL, and pain but
they found limited evidence for improving visuospatial neglect
[15]. In a randomized controlled study with subacute stroke
patients, Sutbeyaz et al. reported that MT improved lower
extremity motor and function recovery more than sham
therapy [8]. In the present study, lower extremity motor
recovery was measured with 6 grades Brunnstrom stages for
the lower extremity range from 1 (flaccidity) to 6 (isolated
joint movement). This study has shown improvement in BS
stages of the lower extremity by 80% in the experimental
group and 45% in the control group. To our knowledge, ours
is the first study to investigate the effects of mirror therapy on
gait speed of stroke patients. Gait speed was shown to be a
very important prognostic factor for lower limb recovery after
stroke [16]. Burridge et al. reported that a 10% improvement
in gait velocity was considered to be functionally relevant
[17]. In the present study, only the experimental group (20%)
showed significant improvement in gait speed. These results
showed significant beneficial effects of mirror therapy on
motor recovery and gait speed after stroke, although these
effects were only assessed immediately after the intervention
and no long-term effect of the mirror therapy modality was
assessed by the study. However, other studies showed that the
effects of mirror therapy may last for up to six months in
stroke patients [8], [18]. Sütbeyaz et al. conducted a study in
which 40 stroke patients were randomly assigned to either the
mirror group or control group; there was a significant change
in the FAC score of both groups, but no significant difference
between groups [18]. Previous studies reported that the
treatment only using mirror therapy have no significant effect
in reducing muscle tone in stroke patients [18], [19]. The
results of the present study also showed there was no
significant improvement in MAS in experimental and control
group. Although the mechanism of MBT remains unclear, the
mechanism of the effect of mirror therapy on motor recovery
after stroke has been investigated in a number of studies.
There are several theories, which can be classified into two
common mechanisms: a primary motor cortex mechanism and
a mirror neuron system mechanism [20]. Another possible
mechanism for the effectiveness of the mirror therapy might
be bilateral limb movements [18]. Summers et al. reported that
bilateral training intervention was more effective than
unilateral training in facilitating upper-limb motor function in
chronic stroke patients [21]. In the present study we asked
patients to move the paretic ankle as much as they could while
moving the non-paretic ankle and watching the reflection in
the mirror. The limitations of the present study are the number
of participants was small and we did not use imaging
techniques that might have demonstrated the primary motor
cortex mechanism and the mirror neuron system mechanism
of the mirror therapy. Further studies are needed to investigate
the long-term effects of mirror therapy on spasticity and also
on the functional activity of spastic patients.
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