The Effects of Unilateral and Bilateral Mirror Therapy on Upper Extremity Function in Early Subacute Stroke.

National Taiwan University Hospital Hsin-Chu Branch49 enrolled

Overview

Objective: To comparing the effects of unilateral and bilateral mirror therapy on upper extremity function of stroke at early subacute stage. We hypothesize there are different effects between unilateral and bilateral mirror therapy on stroke patients at early subacute stage. Method: Patients with unilateral stroke and the onset within one month will be recruited and then randomly allocated to one of the three groups (including unilateral mirror therapy, bilateral mirror therapy, and conventional occupational therapy). Patient will receive 20 consecutive sessions of intervention (5 time per week, totally 4 weeks) and assessments before and after the intervention within one week. In each intervention session, patients will receive 30 minutes unilateral or bilateral mirror therapy depending on their allocated groups and then 30 conventional occupational therapy. The patients recruited in the conventional occupational therapy group will receive 60 minute conventional therapy. The outcome measures at pre- and post-treatment will including the Fugl-Meyer Assessment for upper extremity (FMA-UE), the Modified Ashworth Scale (MAS), the Jamar Hydraulic Hand Dynamometer, the Chedoke Arm and Hand Activity Inventory (CAHAI), and the Revised Nottingham Sensory Assessment (rNSA).

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Stroke (Subacute)

unilateral and bilateral mirror therapyOTHER

The mirror box is placed on a table in the sagittal plane of the participant. The affected upper extremity of the participant is hidden in the morror box and the unaffected upper extremity is placed symmetrically. During the unilateral or bilateral mirror therapy, the participant is requested to execute a serial of movements and tasks and pay attention on observing the reflection of the unaffected side in the mirror simultaneously. In the bilateral mirror therapy, the participant also has to move the affected upper extremity simultaneously; while in the unilateral mirror therapy, the participant only keeps the affected side relaxed.

Eligibility

Sex: ALLMin age: 20 YearsMax age: 85 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Unilateral stroke onset within 1 month * The score of Mini-Mental State Examination (MMSE) is more than 24 * The score of Fugl-Meyer Assessment for upper extremity (FMA-UE) is between 18 to 56 * The score of Modified Ashworth Scale (MAS) is less than 3 * Willing to receive 3-5 sessions of the intervention per week, total 20 sessions consecutively * Willing to sign informed consent Exclusion Criteria: * Unstable vital sign or complicating with other symptoms of neurological disease * Auditory or visual function impairment * Complicating with perceptual impairment (e.g., apraxia, neglect, or visual agnosia) * Receiving botulinum toxin injection within 3 months * Complicating with Wernicke's or Broca's aphasia

Outcomes

Primary Outcomes

Fugl-Meyer Assessment for upper extremity (FMA-UE)

The FMA-UE is a commonly used assessment in clinical for the extent of motor impairment of upper extremity post-stroke. The score ranged from 0 to 66. The psychometric properties of the FMA-UE had established, and there was also good responsiveness in the past studies.