Author: Chan, Wing Chiu
Title: Motor recovery of the severely impaired paretic upper limb after intensive mirror therapy in sub-acute stroke
Advisors: Au-yeung, Stephanie (RS)
Degree: DHSc
Year: 2017
Subject: Hong Kong Polytechnic University -- Dissertations
Cerebrovascular disease -- Patients -- Rehabilitation
Cerebrovascular disease -- Exercise therapy
Arm -- Paralysis -- Treatment
Department: Faculty of Health and Social Sciences
Pages: 140 pages : color illustrations
Language: English
Abstract: Introduction: Severely impaired upper limb (UL) function in stroke adversely affects patients' quality of life. Mirror therapy (MT) in early phase of stroke might augment conventional rehabilitation to enhance motor recovery of paretic UL. Objective: This study aimed to determine the effectiveness of high intensity MT on the motor recovery of severely impaired paretic UL of patients in sub-acute stroke stage. Methods: It was a prospective assessor-blind randomized controlled trial. Forty-one patients admitted to Haven of Hope Hospital with diagnosis of first super-tentorial stroke for less than a month, coupled with severe to moderate UL impairment, were recruited and randomized to MT or control (CT) group. In addition to conventional rehabilitation treatment in the hospital, both MT and CT groups received two 30-minute sessions of bilateral UL exercise daily, 5 days a week for 4 consecutive weeks. During MT, the subjects performed a set of structured bilateral UL exercises while watching the reflective image of the non-paretic UL from a mirror placed vertically between the ULs. The CT subjects practiced the same bilateral UL exercises without the presence of a mirror. Fugl-Meyer Assessment Upper Extremity (FMA-UE) and Wolf Motor Functional Test (WMFT) were used to measure the UL outcome. Both tests evaluated on the paretic UL before and after the 4-week intervention. Within-group changes and between-group differences were analyzed by Wilcoxon Signed-Ranks Test and Mann-Whitney U Test respectively, with level of significance being set at 0.05. To delineate effect of conventional rehabilitation program on the motor recovery of paretic UL of stroke patients in our hospital, 12 subjects who were eligible for our study but refused to join additional interventions consented to be reviewed of their UL outcomes on the day of consent and after 4 weeks of conventional rehabilitation (CR).
Results: Thirty-five subjects (MT=15, CT=20) completed the study. Both MT and CT showed within-group improvement in FMA-UE and WMFT after the 4-week intervention but differences in the respective outcomes were not significant between MT and CT groups. Combining MT and CT together for comparison with CR group showed that the improvement in FMA (proximal arm) domain, FMA (wrist) domain, and FMA-UE in combined group were higher than those in CR after 4 week of intervention. Significant differences were found amongst MT, CT and CR groups. Post-hoc analysis showed that FMA (proximal arm) domain was better in MT than CR groups, and FMA (wrist) domain was better in CT than CR groups. Conclusion: This study found that both the MT and CT led to significant motor improvement in the paretic UL in impairment and functional ability in terms of FMA-UE, WMFT-Time, and WMFT-Functional Ability Scale. MT was not different from CT in the promotion of motor recovery in the severely to moderately impaired UL in patients during sub-acute stroke. Both MT and CT promoted more motor recovery than that after CR, suggesting that the outstanding motor improvement in the paretic UL might be resulted from intensive bilateral UL training in both MT and CT.
Rights: All rights reserved
Access: restricted access

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