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Kim YS, Song JY, Park SH, Lee MM. Effect of functional electrical stimulation-based mirror therapy using gesture recognition biofeedback on upper extremity function in patients with chronic stroke: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e36546. [PMID: 38206692 PMCID: PMC10754587 DOI: 10.1097/md.0000000000036546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Mirror therapy (MT) is an intervention used for upper extremity rehabilitation in stroke patients and has been studied in various fields. Recently, effective MT methods have been introduced in combination with neuromuscular electrical stimulation or with electromyography (EMG)-triggered biofeedback. The purpose of this study was to investigate the effects of functional electrical stimulation (FES)-based MT incorporating a motion recognition biofeedback device on upper extremity motor recovery to chronic stroke patients. METHODS Twenty-six chronic stroke patients with onset of more than 6 months were randomly assigned into experimental group (n = 13) and control group (n = 13). Both groups participated in conventional rehabilitation program, while the control group received conventional MT intervention and the experimental group received FES-based MT with motion recognition biofeedback device. All interventions were conducted for 30 min/d, 5 d/wk, for 4 weeks. Upper limb motor recovery, upper limb function, active-range of motion (ROM), and activities of daily living independence were measured before and after the intervention and compared between the 2 groups. RESULTS The Fugl-Meyer assessment (FMA), manual function test (MFT), K-MBI, and active-ROM (excluding deviation) were significantly improved in both groups (P < .05). Only the experimental group showed significant improvement in upper extremity recovery, ulnar and radial deviation (P < .05). There was a significant difference of change in Brunstrom's recovery level, FMA, MFT, and active-ROM in the experimental group compared to the control group (P < .05). CONCLUSION FES-based MT using gesture recognition biofeedback is an effective intervention method for improving upper extremity motor recovery and function, active-ROM in patients with chronic stroke. This study suggests that incorporating gesture-recognition biofeedback into FES-based MT can provide additional benefits to patients with chronic stroke.
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Affiliation(s)
- Young-Soung Kim
- Department of Physical Therapy, Graduate School, Daejeon University, Daejeon, Republic of Korea
| | - Jun-Young Song
- Department of Physical Therapy, Graduate School, Daejeon University, Daejeon, Republic of Korea
| | - Sam-Ho Park
- Department of Physical Therapy, Daejeon University, Daejeon, Republic of Korea
| | - Myung-Mo Lee
- Department of Physical Therapy, Daejeon University, Daejeon, Republic of Korea
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Kim H, Lee E, Jung J, Lee S. Utilization of Mirror Visual Feedback for Upper Limb Function in Poststroke Patients: A Systematic Review and Meta-Analysis. Vision (Basel) 2023; 7:75. [PMID: 37987295 PMCID: PMC10661272 DOI: 10.3390/vision7040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023] Open
Abstract
Mirror visual feedback (MVF), a noninvasive treatment method, is attracting attention as a possibility to promote the recovery of upper limb function in stroke patients. However, the cognitive effects of this therapy have received limited attention in the existing literature. To address this gap, we conducted a systematic review and meta-analysis to investigate the relationship between upper limb function and cognition in stroke patients and to evaluate the effect of MVF on improving upper limb function. A comprehensive search was performed on the Embase, MEDLINE, and PubMed databases to identify original articles and clinical studies published between 2013 and 2022. Qualitative analysis was performed using the Cochrane Risk of Bias tool, and in the quantitative analysis, a random-effects model was used as the effect model, and standard mean difference (SMD) was used as the effect measure. Eight studies that met the inclusion criteria were entered in the analysis. Data extraction included an assessment tool for upper extremity function. Results of the quantitative analysis demonstrate that MVF was effective in improving upper extremity function in stroke patients (SMD = 0.94, 95% CI 0.69 to 1.20). In conclusion, this systematic review and meta-analysis provides evidence supporting the effectiveness of MVF in improving upper limb function in stroke patients. However, further studies are needed to investigate the cognitive effects of MVF and elucidate the underlying mechanisms.
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Affiliation(s)
- Hyunjoong Kim
- Neuromusculoskeletal Science Laboratory, 306 Jangsin-ro, Gwangju 62287, Republic of Korea;
| | - Eunsang Lee
- Department of Physical Therapy, Gwangju Health University, 73 Bungmun-daero 419, Gwangju 62287, Republic of Korea;
| | - Jihye Jung
- Institute of SMART Rehabilitation, Sahmyook University, 815 Hwarang-ro, Seoul 01795, Republic of Korea;
| | - Seungwon Lee
- Department of Physical Therapy, Sahmyook University, 815 Hwarang-ro, Seoul 01795, Republic of Korea
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3
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Geller D, Nilsen DM, Quinn L, Van Lew S, Bayona C, Gillen G. Home mirror therapy: a randomized controlled pilot study comparing unimanual and bimanual mirror therapy for improved arm and hand function post-stroke. Disabil Rehabil 2022; 44:6766-6774. [PMID: 34538193 DOI: 10.1080/09638288.2021.1973121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To compare home-based unimanual mirror therapy (UMT) and bimanual mirror therapy (BMT) for upper limb recovery in subacute/chronic stroke individuals with moderate-to-severe arm impairment. METHOD Twenty-two participants were randomized into 1 of 3 groups: UMT, BMT or traditional occupational therapy (TOT) home-based programs. The intervention was 6-weeks and consisted of OT 2 days a week, weekly sessions with the research OT, and 30-minutes of the home-based program 5 days a week, according to group allocation. The Action Research Arm Test (ARAT), ABILHAND, Fugl-Meyer Assessment (FMA), grip strength, and Stroke Impact Scale (SIS) were used for outcome measures. RESULTS All groups significantly improved over time on all outcome measures and adhered to the prescribed dosage regardless of group (p<0.05). While there were no between-group differences, effect size and 95% confidence interval data suggest a clinical significance in favor of UMT as compared to the other groups. CONCLUSIONS All participants, regardless of home-based program, adhered to the prescribed dosage and significantly improved over time. Despite no between-group differences, effect size and 95% confidence interval data suggest that UMT may be more beneficial for individuals with moderate-to-severe arm impairment as compared to BMT or TOT. ClinicalTrials.gov: #NCT02780440Implications for RehabilitationHome-based unimanual mirror therapy (UMT), bimanual mirror therapy (BMT), and traditional occupational therapy (TOT), when administered in conjunction with outpatient OT, are helpful for improving upper limb recovery post-stroke.Home-based UMT may be more beneficial than BMT or TOT for improvement in upper limb motor function and activities of daily living of patients with moderate to severe arm impairment post-stroke.
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Affiliation(s)
- Daniel Geller
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dawn M Nilsen
- Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lori Quinn
- Department of Behavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Stephen Van Lew
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA
| | - Claribell Bayona
- Department of Occupational Therapy, New York University Langone Health, Rusk Rehabilitation, New York, NY, USA
| | - Glen Gillen
- Department of Rehabilitation and Regenerative Medicine (Occupational Therapy), Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Munoz-Novoa M, Kristoffersen MB, Sunnerhagen KS, Naber A, Alt Murphy M, Ortiz-Catalan M. Upper Limb Stroke Rehabilitation Using Surface Electromyography: A Systematic Review and Meta-Analysis. Front Hum Neurosci 2022; 16:897870. [PMID: 35669202 PMCID: PMC9163806 DOI: 10.3389/fnhum.2022.897870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background Upper limb impairment is common after stroke, and many will not regain full upper limb function. Different technologies based on surface electromyography (sEMG) have been used in stroke rehabilitation, but there is no collated evidence on the different sEMG-driven interventions and their effect on upper limb function in people with stroke. Aim Synthesize existing evidence and perform a meta-analysis on the effect of different types of sEMG-driven interventions on upper limb function in people with stroke. Methods PubMed, SCOPUS, and PEDro databases were systematically searched for eligible randomized clinical trials that utilize sEMG-driven interventions to improve upper limb function assessed by Fugl-Meyer Assessment (FMA-UE) in stroke. The PEDro scale was used to evaluate the methodological quality and the risk of bias of the included studies. In addition, a meta-analysis utilizing a random effect model was performed for studies comparing sEMG interventions to non-sEMG interventions and for studies comparing different sEMG interventions protocols. Results Twenty-four studies comprising 808 participants were included in this review. The methodological quality was good to fair. The meta-analysis showed no differences in the total effect, assessed by total FMA-UE score, comparing sEMG interventions to non-sEMG interventions (14 studies, 509 participants, SMD 0.14, P 0.37, 95% CI –0.18 to 0.46, I2 55%). Similarly, no difference in the overall effect was found for the meta-analysis comparing different types of sEMG interventions (7 studies, 213 participants, SMD 0.42, P 0.23, 95% CI –0.34 to 1.18, I2 73%). Twenty out of the twenty-four studies, including participants with varying impairment levels at all stages of stroke recovery, reported statistically significant improvements in upper limb function at post-sEMG intervention compared to baseline. Conclusion This review and meta-analysis could not discern the effect of sEMG in comparison to a non-sEMG intervention or the most effective type of sEMG intervention for improving upper limb function in stroke populations. Current evidence suggests that sEMG is a promising tool to further improve functional recovery, but randomized clinical trials with larger sample sizes are needed to verify whether the effect on upper extremity function of a specific sEMG intervention is superior compared to other non-sEMG or other type of sEMG interventions.
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Affiliation(s)
- Maria Munoz-Novoa
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Center for Bionics and Pain Research, Mölndal, Sweden
| | - Morten B Kristoffersen
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Section of Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Autumn Naber
- Center for Bionics and Pain Research, Mölndal, Sweden
| | - Margit Alt Murphy
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Max Ortiz-Catalan
- Center for Bionics and Pain Research, Mölndal, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.,Operational Area 3, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Electrical Engineering, Chalmers University of Technology, Gothenburg, Sweden
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Neuromuscular Stimulation as an Intervention Tool for Recovery from Upper Limb Paresis after Stroke and the Neural Basis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12020810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Neuromodulators at the periphery, such as neuromuscular electrical stimulation (NMES), have been developed as add-on tools to regain upper extremity (UE) paresis after stroke, but this recovery has often been limited. To overcome these limits, novel strategies to enhance neural reorganization and functional recovery are needed. This review aims to discuss possible strategies for enhancing the benefits of NMES. To date, NMES studies have involved some therapeutic concerns that have been addressed under various conditions, such as the time of post-stroke and stroke severity and/or with heterogeneous stimulation parameters, such as target muscles, doses or durations of treatment and outcome measures. We began by identifying factors sensitive to NMES benefits among heterogeneous conditions and parameters, based on the “progress rate (PR)”, defined as the gains in UE function scores per intervention duration. Our analysis disclosed that the benefits might be affected by the target muscles, stroke severity and time period after stroke. Likewise, repetitive peripheral neuromuscular magnetic stimulation (rPMS) is expected to facilitate motor recovery, as already demonstrated by a successful study. In parallel, our efforts should be devoted to further understanding the precise neural mechanism of how neuromodulators make UE function recovery occur, thereby leading to overcoming the limits. In this study, we discuss the possible neural mechanisms.
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Luo Z, Zhou Y, He H, Lin S, Zhu R, Liu Z, Liu J, Liu X, Chen S, Zou J, Zeng Q. Synergistic Effect of Combined Mirror Therapy on Upper Extremity in Patients With Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:155. [PMID: 32300326 PMCID: PMC7144801 DOI: 10.3389/fneur.2020.00155] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/18/2020] [Indexed: 01/06/2023] Open
Abstract
Background: There is an increasing trend for researchers to combine mirror therapy with another rehabilitation therapy when treating the upper extremity of patients with stroke. Objective: To evaluate the synergistic effect of combined mirror therapy (MT) on the upper extremity in patients with stroke and to judge efficacies of four combined mirror therapy subgroups [EMGBF group: electromyographic biofeedback (EMGBF) + MT; MG group: mesh glove (MG) + MT; AT group: acupuncture (AT) + MT; ES group: EMG-triggered electrical stimulation (ES) + MT]. Methods: CNKI, Wan Fang, VIP, Web of Science, ScienceDirect, PubMed, OVID LWW, and Cochrane were used. We searched these databases for randomized controlled trials published from January 2013 to August 2019, which presented results of combining mirror therapy with other rehabilitation therapies. Quality assessments were performed using the Cochrane Handbook criteria in order to accurately review interventions. The primary outcomes were measured by the Fugl–Meyer Assessment—upper extremity (FMA-UE). Results: Ten trials, with a total of 444 patients whose upper limb functions were damaged after stroke, were included in the meta-analysis. Compared with the control group, a remarkable effect of combined mirror therapy [all: weight mean difference in random effects model (WMD): 8.07, 95% confidence interval (CI) 5.87, 10.26] on functional recovery of the upper limb was detected. However, a high value of heterogeneity (χ2 = 20.09, df = 9; I2 = 55%) was found. The subgroup analysis (EMGBF group: WMD = 8.95, 95% CI 6.33, 11.58; ES group: WMD = 10.14, 95% CI: 5.67, 15.01) showed moderate improvement in functional recovery of the upper extremity in patients with stroke when mirror therapy was combined with conventional therapy. Furthermore, no difference in efficacy on upper extremity in patients with stroke was observed between the EMGBF group and the ES group. Conclusion: Despite the heterogeneity, the results indicate that combining mirror therapy with another rehabilitation therapy on the upper extremity in patients with stroke is better than single rehabilitation therapy. However, more randomized controlled clinical trials and larger sample sizes are required for an in-depth meta-analysis.
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Affiliation(s)
- Zhonghua Luo
- First Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Yuqing Zhou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - He He
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shanshan Lin
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Zhu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhen Liu
- Department of Rehabilitation Medicine, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Jiemei Liu
- Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoli Liu
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shuping Chen
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Jihua Zou
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Qing Zeng
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
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7
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Gandhi DB, Sterba A, Khatter H, Pandian JD. Mirror Therapy in Stroke Rehabilitation: Current Perspectives. Ther Clin Risk Manag 2020; 16:75-85. [PMID: 32103968 PMCID: PMC7012218 DOI: 10.2147/tcrm.s206883] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/16/2020] [Indexed: 12/30/2022] Open
Abstract
In contrast to varied therapy approaches, mirror therapy (MT) can be used even in completely plegic stroke survivors, as it uses visual stimuli for producing a desired response in the affected limb. MT has been studied to have effects not just on motor impairments but also on sensations, visuospatial neglect, and pain after stroke. This paper attempts to systematically review and present the current perspectives on mirror therapy and its application in stroke rehabilitation, and dosage, feasibility and acceptability in stroke rehabilitation. An electronic database search across Google, PubMed, Web of Science, etc., generated 3871 results. After screening them based on the inclusion and exclusion criteria, we included 28 studies in this review. The data collected were divided on the basis of application in stroke rehabilitation, modes of intervention delivery, and types of control and outcome assessment. We found that most studies intervened for upper limb motor impairments post stroke. Studies were equally distributed between intervention in chronic and acute phases post stroke with therapy durations lasting between 1 and 8 weeks. MT showed definitive motor and sensory improvements although the extent of improvements in sensory impairments and hemineglect is limited. MT proves to be an effective and feasible approach to rehabilitate post-stroke survivors in the acute, sub-acute, and chronic phases of stroke, although its long-term effects and impact on activities of daily living need to be analysed extensively.
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Affiliation(s)
- Dorcas Bc Gandhi
- College of Physiotherapy, Christian Medical College & Hospital Ludhiana, Ludhiana, Punjab, India.,Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
| | - Albert Sterba
- Department of Neurology, Christian Medical College & Hospital Ludhiana, Ludhiana, Punjab, India
| | - Himani Khatter
- Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
| | - Jeyaraj D Pandian
- Faculty of Medicine, Masaryk University, Stroke Brno, International Clinical Research Center, St. Anne´s University Hospital, Brno, Czech Republic
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Yang JD, Liao CD, Huang SW, Tam KW, Liou TH, Lee YH, Lin CY, Chen HC. Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials. Clin Rehabil 2019; 33:1286-1297. [PMID: 30977379 DOI: 10.1177/0269215519839165] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study is to investigate the effectiveness of electrical stimulation in arm function recovery after stroke. METHODS Data were obtained from the PubMed, Cochrane Library, Embase, and Scopus databases from their inception until 12 January 2019. Only randomized controlled trials (RCTs) reporting the effects of electrical stimulation on the recovery of arm function after stroke were selected. RESULTS Forty-eight RCTs with a total of 1712 patients were included in the analysis. The body function assessment, Upper-Extremity Fugl-Meyer Assessment, indicated more favorable outcomes in the electrical stimulation group than in the placebo group immediately after treatment (23 RCTs (n = 794): standard mean difference (SMD) = 0.67, 95% confidence interval (CI) = 0.51-0.84) and at follow-up (12 RCTs (n = 391): SMD = 0.66, 95% CI = 0.35-0.97). The activity assessment, Action Research Arm Test, revealed superior outcomes in the electrical stimulation group than those in the placebo group immediately after treatment (10 RCTs (n = 411): SMD = 0.70, 95% CI = 0.39-1.02) and at follow-up (8 RCTs (n = 289): SMD = 0.93, 95% CI = 0.34-1.52). Other activity assessments, including Wolf Motor Function Test, Box and Block Test, and Motor Activity Log, also revealed superior outcomes in the electrical stimulation group than those in the placebo group. Comparisons between three types of electrical stimulation (sensory, cyclic, and electromyography-triggered electrical stimulation) groups revealed no significant differences in the body function and activity. CONCLUSION Electrical stimulation therapy can effectively improve the arm function in stroke patients.
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Affiliation(s)
- Jheng-Dao Yang
- 1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei
| | - Chun-De Liao
- 1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei.,2 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei
| | - Shih-Wei Huang
- 1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei.,3 Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Ka-Wai Tam
- 4 Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, Taipei.,5 Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,6 Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, Taipei
| | - Tsan-Hon Liou
- 1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei.,3 Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Yu-Hao Lee
- 1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei
| | - Chia-Yun Lin
- 7 Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei Medical University, Taipei
| | - Hung-Chou Chen
- 1 Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei.,3 Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,6 Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, Taipei
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9
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Monte-Silva K, Piscitelli D, Norouzi-Gheidari N, Batalla MAP, Archambault P, Levin MF. Electromyogram-Related Neuromuscular Electrical Stimulation for Restoring Wrist and Hand Movement in Poststroke Hemiplegia: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2019; 33:96-111. [DOI: 10.1177/1545968319826053] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Clinical trials have demonstrated some benefits of electromyogram-triggered/controlled neuromuscular electrical stimulation (EMG-NMES) on motor recovery of upper limb (UL) function in patients with stroke. However, EMG-NMES use in clinical practice is limited due to a lack of evidence supporting its effectiveness. Objective. To perform a systematic review and meta-analysis to determine the effects of EMG-NMES on stroke UL recovery based on each of the International Classification of Functioning, Disability, and Health (ICF) domains. Methods. Database searches identified clinical trials comparing the effect of EMG-NMES versus no treatment or another treatment on stroke upper extremity motor recovery. A meta-analysis was done for outcomes at each ICF domain (Body Structure and Function, Activity and Participation) at posttest (short-term) and follow-up periods. Subgroup analyses were conducted based on stroke chronicity (acute/subacute, chronic phases). Sensitivity analysis was done by removing studies rated as poor or fair quality (PEDro score <6). Results. Twenty-six studies (782 patients) met the inclusion criteria. Fifty percent of them were considered to be of high quality. The meta-analysis showed that EMG-NMES has a robust short-term effect on improving UL motor impairment in the Body Structure and Function domain. No evidence was found in favor of EMG-NMES for the Activity and Participation domain. EMG-NMES had a stronger effect for each ICF domain in chronic (≥3 months) compared to acute/subacute phases. Conclusion. EMG-NMES is effective in the short term in improving UL impairment in individuals with chronic stroke.
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Affiliation(s)
- Katia Monte-Silva
- Universidade Federal de Pernambuco, Recife, Brazil
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
| | - Daniele Piscitelli
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
- McGill University, Montreal, Quebec, Canada
| | - Nahid Norouzi-Gheidari
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
- McGill University, Montreal, Quebec, Canada
| | - Marc Aureli Pique Batalla
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
- Maastricht University, Maastricht, Netherlands
| | - Philippe Archambault
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
- McGill University, Montreal, Quebec, Canada
| | - Mindy F. Levin
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Canada
- McGill University, Montreal, Quebec, Canada
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10
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The effect of task-oriented electromyography-triggered electrical stimulation of the paretic wrist extensors on upper limb motor function early after stroke: a pilot randomized controlled trial. Int J Rehabil Res 2018; 42:74-81. [PMID: 30540619 DOI: 10.1097/mrr.0000000000000333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The combined effect of task-oriented motor training and electromyography (EMG)-triggered electrical stimulation (ES) has been examined in chronic stroke, but there are no published reports in patients with early stroke. Therefore, the purpose of this study was to determine the short-term and long-term effects of task-oriented EMG-triggered ES on upper limb motor function in acute/subacute stroke. Twenty-seven patients with stroke within the first 3 months after stroke onset were randomly allocated to an experimental group and a control group. Twenty-three patients (12 patients in the experimental group and 11 patients in the control group) completed the study. The control group received a conventional physical therapy for 20 sessions, and the experimental group received task-oriented EMG-triggered ES therapy for the wrist/finger extensors in addition to conventional physical therapy for 5 sessions a week for 4 weeks. Primary outcome measures were the Action Research Arm Test, the Brunnstrom stages of the hand/upper extremity, and the motor Functional Independence Measure. All patients were evaluated before the treatment, after the treatment, and at 3 months. The parametric and nonparametric statistics at the 5% level of significance (α=0.05) was used for testing the differences between the two groups at each main end point. At the end of the treatment, the experimental group showed significantly greater improvements in Brunnstrom stages and ARAT grasp/grip/pinch scores, but not motor Functional Independence Measure scores, when compared with the control group. The differences between the 3-months and postintervention evaluations were not significant between the two groups suggesting retention of the postintervention gains. Our results indicate that task-oriented EMG-triggered ES training may result in improvements in the paretic upper limb function in patients with acute/subacute stroke that are superior to the conventional treatment.
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11
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Thieme H, Morkisch N, Mehrholz J, Pohl M, Behrens J, Borgetto B, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev 2018; 7:CD008449. [PMID: 29993119 PMCID: PMC6513639 DOI: 10.1002/14651858.cd008449.pub3] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mirror therapy is used to improve motor function after stroke. During mirror therapy, a mirror is placed in the person's midsagittal plane, thus reflecting movements of the non-paretic side as if it were the affected side. OBJECTIVES To summarise the effectiveness of mirror therapy compared with no treatment, placebo or sham therapy, or other treatments for improving motor function and motor impairment after stroke. We also aimed to assess the effects of mirror therapy on activities of daily living, pain, and visuospatial neglect. SEARCH METHODS We searched the Cochrane Stroke Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED, PsycINFO and PEDro (last searched 16 August 2017). We also handsearched relevant conference proceedings, trials and research registers, checked reference lists, and contacted trialists, researchers and experts in our field of study. SELECTION CRITERIA We included randomised controlled trials (RCTs) and randomised cross-over trials comparing mirror therapy with any control intervention for people after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on the inclusion criteria, documented the methodological quality, assessed risks of bias in the included studies, and extracted data. We assessed the quality of the evidence using the GRADE approach. We analysed the results as standardised mean differences (SMDs) or mean differences (MDs) for continuous variables, and as odds ratios (ORs) for dichotomous variables. MAIN RESULTS We included 62 studies with a total of 1982 participants that compared mirror therapy with other interventions. Of these, 57 were randomised controlled trials and five randomised cross-over trials. Participants had a mean age of 59 years (30 to 73 years). Mirror therapy was provided three to seven times a week, between 15 and 60 minutes for each session for two to eight weeks (on average five times a week, 30 minutes a session for four weeks).When compared with all other interventions, we found moderate-quality evidence that mirror therapy has a significant positive effect on motor function (SMD 0.47, 95% CI 0.27 to 0.67; 1173 participants; 36 studies) and motor impairment (SMD 0.49, 95% CI 0.32 to 0.66; 1292 participants; 39 studies). However, effects on motor function are influenced by the type of control intervention. Additionally, based on moderate-quality evidence, mirror therapy may improve activities of daily living (SMD 0.48, 95% CI 0.30 to 0.65; 622 participants; 19 studies). We found low-quality evidence for a significant positive effect on pain (SMD -0.89, 95% CI -1.67 to -0.11; 248 participants; 6 studies) and no clear effect for improving visuospatial neglect (SMD 1.06, 95% CI -0.10 to 2.23; 175 participants; 5 studies). No adverse effects were reported. AUTHORS' CONCLUSIONS The results indicate evidence for the effectiveness of mirror therapy for improving upper extremity motor function, motor impairment, activities of daily living, and pain, at least as an adjunct to conventional rehabilitation for people after stroke. Major limitations are small sample sizes and lack of reporting of methodological details, resulting in uncertain evidence quality.
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Affiliation(s)
- Holm Thieme
- Erste Europäische Schule für Physiotherapie, Ergotherapie und Logopädie, Klinik Bavaria KreischaKreischa, SachsenGermany
- Martin Luther University Halle‐WittenbergInstitute for Health and Nursing Science, German Center for Evidence‐based NursingHalle/SaaleGermany
- Fakultät Soziale Arbeit und GesundheitHAWK Hochschule für angewandte Wissenschaft und KunstHildesheimGermany31134
| | - Nadine Morkisch
- Charité ‐ University Medicine BerlinCenter for Stroke Research BerlinCharitéplatz 1BerlinGermany0117
- MEDIAN Klinik Berlin‐KladowKladower Damm 223BerlinGermany14089
| | - Jan Mehrholz
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| | - Marcus Pohl
- Helios Klinik Schloss PulsnitzNeurological RehabilitationWittgensteiner Str. 1PulsnitzSaxonyGermany01896
| | - Johann Behrens
- Martin Luther University Halle‐WittenbergInstitute for Health and Nursing Science, German Center for Evidence‐based NursingHalle/SaaleGermany
| | - Bernhard Borgetto
- Fakultät Soziale Arbeit und GesundheitHAWK Hochschule für angewandte Wissenschaft und KunstHildesheimGermany31134
| | - Christian Dohle
- Charité ‐ University Medicine BerlinCenter for Stroke Research BerlinCharitéplatz 1BerlinGermany0117
- MEDIAN Klinik Berlin‐KladowKladower Damm 223BerlinGermany14089
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Yang Y, Zhao Q, Zhang Y, Wu Q, Jiang X, Cheng G. Effect of Mirror Therapy on Recovery of Stroke Survivors: A Systematic Review and Network Meta-analysis. Neuroscience 2018; 390:318-336. [PMID: 29981364 DOI: 10.1016/j.neuroscience.2018.06.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 11/26/2022]
Abstract
Mirror therapy (MT) as a relatively new rehabilitation technique has been widely applied in stroke patients. A number of randomized controlled trials (RCTs) have investigated the effects of MT for stroke survivors. The main purpose of this network meta-analysis was to investigate the effects of MT on motor function, activities of daily living (ADL), and pain perception in stroke survivors. Several databases were searched to identify RCTs evaluating the effects of MT in stroke patients to perform this network meta-analysis. Thirty-seven RCTs (42 analyses, 1685 subjects) were eligible for inclusion in the meta-analysis. Standard meta-analysis showed that MT significantly improved of motor function according to the increased Fugl-Meyer Assessment (FMA), Functional Independence Measure (FIM), and decreased Modified Ashworth Scale (MAS) score. In addition, ADL was promoted by MT as the elevated Modified Barthel Index (MBI) and Motor Activity Log (MAL) score. Moreover, MT effectively relieved the pain of stroke patients as the Visual Analog Scale (VAS) score was reduced. Subgroup analyses and meta-regressions identified that the sources of heterogeneity might be different intervention arms and duration of interventions. Network meta-analysis showed that MT combined with electrical stimulation (ES) for less than 4 weeks along with conventional rehabilitation therapy (CT), and MT accompanied with CT for less than 4 weeks might be the most suitable interventions for improvement of motor function and ADL, respectively. Overall, MT could effectively improve motor function and ADL, as well as relieve pain for stroke survivors. The study was registered at PROSPERO (CRD42017081742).
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Affiliation(s)
- Yue Yang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Qingchun Zhao
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Yingshi Zhang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Qiong Wu
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Xiaowen Jiang
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China; Department of Pharmacy, General Hospital of Shenyang Military Area Command, Shenyang 110840, PR China
| | - Gang Cheng
- Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, PR China.
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Abstract
BACKGROUND Mechanical injury in patients with spinal cord injury (SCI) rarely transects the cord completely, even when the injury is classified as complete. These patients can show sub-clinical evidence of spared motor connections, which might be amenable to targeted rehabilitation. Neurophysiological evaluations can complement the clinical evaluation by providing objective data about conduction across the SCI site. CASE DESCRIPTION A twenty-four year old patient with SCI was admitted to a rehabilitation centre 49 days post traumatic SCI. His injury was categorized as motor and sensory complete (AIS A) with a neurological level of C4. The strength of his triceps bilaterally was recorded 0/5 repeatedly by his therapists during the five-month period post-injury. As a result, no training was provided for these muscles during the rehabilitation program. Neurophysiological Assessment: Motor evoked potentials (MEPs) were recorded from his left triceps with transcranial magnetic stimulation (TMS) which confirmed the existence of spared corticospinal connections to this muscle post-injury. INTERVENTION He completed a series of active-assisted exercises with an EMG-triggered neuromuscular stimulation (NMS) device for his left triceps comprising 20-minutes elbow extension (15 trials), three times per day for 4 weeks. OUTCOME The strength of his left triceps gradually improved to 2/5. DISCUSSION Neurophysiological evaluation can be useful in identifying residual function below the level of injury, which can, in turn, be enhanced through appropriate rehabilitation strategies.
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Affiliation(s)
- Maryam Zoghi
- a Department of Rehabilitation , Nutrition and Sport, School of Allied Health, La Trobe University , Melbourne, Australia
| | - Mary P Galea
- b Department of Medicine , University of Melbourne , Melbourne, Australia
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Cortez BV, da Silva Coêlho CK, Silva DRC, Oliveira MDCB, de Oliveira GBVP, de Sousa e Silva FM, Frederico ÉHFF, de Sá-Caputo DDC, Bernardo-Filho M, de Moraes Silva J. Effects of Mirror Therapy on the Lower Limb Functionality Hemiparesis after Stroke. Health (London) 2016. [DOI: 10.4236/health.2016.814144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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