Evaluation of the Effects of Neuromuscular Electrical Stimulation and Mirror Therapy in Hemiplegia Rehabilitation

Bursa Yuksek Ihtisas Training and Research Hospital42 enrolled

Overview

In this study, it was aimed to evaluate whether or not NMES in front of the mirror brings an additional benefit to mirror therapy alone or NMES alone on upper extremity motor and functional development, spasticity, anxiety, depression, cognitive function and activities of daily living, and neuropathic pain.

Cerebrovascular diseases are the general name given to clinical neurological pictures that occur as a result of pathological changes in the blood vessels of the primary lesion and / or in the properties of the blood passing through them. Many complications develop in the acute and chronic periods in patients with stroke, and the rate of complication development has been reported to vary between 40-96% in different studies. The aim of hemiplegic upper extremity rehabilitation is to prevent complications and improve lost motor-sensory control. Upper limb rehabilitation is less successful than lower limb rehabilitation because the upper limb is more functional and more complex. For muscle reeducation, NMES is used to strengthen inhibited muscle groups, facilitate voluntary isolated muscle contraction, prevent muscle atrophy, increase metabolism and enzyme activity, change the contractile properties of the muscle, maintain or increase the normal range of motion of the joint, develop voluntary movement and functional gains. NMES has been used in hemiplegia rehabilitation since 1960 for the purpose of functional retraining of muscles. The purpose of this treatment is to enable the muscles with impaired neural function of the electrical current to perform a functional and useful movement. Applications in front of the mirror are thought to trigger the neuronal connections in the motor cortex associated with the imagined movement. Findings obtained from studies with functional magnetic resonance support this theory. Compared to conventional PR, applications in front of the mirror are thought to have more and longer-lasting effects.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Hemiplegia Upper Extremity Dysfunction

Interventions

Group MirrorOTHER

For 30 minutes, ROM exercises will be applied to the solid upper extremity in all directions in front of a real mirror by the practitioner. (3 weeks, 5 days a week, 15 sessions in total)

Group NMESDEVICE

NMES will be applied to the hemiplegic arm(deltoid, elbow extensors and forearm) for 30 minutes by the practitioner (3 weeks, 5 days a week, 15 sessions in total)

Group Mirror+NMESOTHER

The practitioner will be synchronized with visual or auditory stimuli, and ROM exercises in all directions in front of the real mirror for 30 minutes, and NMES therapy for 30 minutes on the paretic upper extremity will be applied together. (3 weeks, 5 days a week, 15 sessions in total)

Eligibility

Sex: ALLMin age: 18 YearsMax age: 85 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Subacute hemiplegia * Patients who can communicate well, are motivated enough and are willing to participate in the study * Patients' medical conditions are stable * Initiation of voluntary extension movement in the wrist (lower limit) Exclusion Criteria: * The presence of more than one previous cerebrovascular disease (except transient ischemic attack). * Presence of flaccid hemiplegia. * Presence of a previous neurological disease causing a decrease in strength in the affected extremity. * Presence of deformity due to a previous fracture, inflammatory arthropathy, etc. in the affected extremity. * Presence of more than grade 3 spasticity in upper extremity according to Modified Ashworth Scale * Use of cardiac pace maker * Presence of fatal cardiac arrhythmia * Presence of seizure history within 2 years.

Locations (1)

Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi

Bursa, Turkey (Türkiye)

Outcomes

Primary Outcomes

Fugl-Meyer Upper Extremity Motor Rating Scale

To analysis the increase in upper limb motor function Motor score: ranges from 0 (hemiplegia) to 100 points (normal motor performance). Divided into 66 points for upper extremity and 34 points for the lower extremity. Sensation: ranges from 0 to 24 points. Divided into 8 points for light touch and 16 points for position sense.

Time frame: Change from Baseline Fugl-Meyer Upper Extremity Motor Rating Scale at 3rd week

Secondary Outcomes

Mini-Mental Test

for cognitive functions

Time frame: Change from Baseline Mini-Mental Test at 3rd week

Numeric Rating Scale

for pain

Time frame: Change from Baseline Numeric Rating Scale at 3rd week

Pain Detect Questionnaire

for neuropathic pain

Time frame: Change from Baseline Pain Detect Questionnaire at 3rd week

Functional Independence Scale (FIM)

for daily life activities

Time frame: Change from Baseline Functional Independence Scale (FIM) at 3rd week

Modified Tardieu Scale

Score, Description 0, No resistance during movement. 1. There is very slight resistance during movement, but no noticeable "catch". 2. There is a noticeable "catch" at a certain angle, followed by relaxation. 3. Clonus occurring at a certain angle and lasting for seconds (ending with fatigue). 4. Uninterrupted clonus occurring at a certain angle and lasting for more than 10 seconds. 5, The joint is too stiff to move (petrified).

Time frame: Change from Baseline Modified Tardieu Scale at 3rd week

Data from ClinicalTrials.gov

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