To investigate the effectiveness of mirror therapy combined with neuromuscular electrical stimulation in promoting motor recovery of the lower limbs and walking ability in patients suffering from foot drop after stroke.
Randomized controlled study.
Inpatient rehabilitation center of a teaching hospital.
Sixty-nine patients with foot drop.
Patients were randomly divided into three groups: control, mirror therapy, and mirror therapy + neuromuscular electrical stimulation. All groups received interventions for 0.5 hours/day and five days/week for four weeks.
10-Meter walk test, Brunnstrom stage of motor recovery of the lower limbs, Modified Ashworth Scale score of plantar flexor spasticity, and passive ankle joint dorsiflexion range of motion were assessed before and after the four-week period.
After four weeks of intervention, Brunnstrom stage (P = 0.04), 10-meter walk test (P < 0.05), and passive range of motion (P < 0.05) showed obvious improvements between patients in the mirror therapy and control groups. Patients in the mirror therapy + neuromuscular electrical stimulation group showed better results than those in the mirror therapy group in the 10-meter walk test (P < 0.05). There was no significant difference in spasticity between patients in the two intervention groups. However, compared with patients in the control group, patients in the mirror therapy + neuromuscular electrical stimulation group showed a significant decrease in spasticity (P < 0.001).
|1.||Brewer L, Horgan F, Hickey A, Stroke rehabilitation: recent advances and future therapies. QJM 2013; 106: 11–25. Google Scholar CrossRef, Medline|
|2.||Bethoux F, Rogers HL, Nolan KJ, The effects of peroneal nerve functional electrical stimulation versus ankle-foot orthosis in patients with chronic stroke: a randomized controlled trial. Neurorehabil Neural Repair 2014; 28: 688–697. Google Scholar Link|
|3.||O’Dell MW, Dunning K, Kluding P, Response and prediction of improvement in gait speed from functional electrical stimulation in persons with poststroke drop foot. PM R 2014; 6: 587–601; quiz 601. Google Scholar CrossRef, Medline|
|4.||Michielsen ME, Selles RW, van der Geest JN, Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil Neural Repair 2011; 25: 223–233. Google Scholar Link|
|5.||Samuelkamaleshkumar S, Reethajanetsureka S, Pauljebaraj P, Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial. Arch Phys Med Rehabil 2014; 95: 2000–2005. Google Scholar CrossRef, Medline|
|6.||Sousa Nanji L, Torres Cardoso A, Costa J, Analysis of the Cochrane review: interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014; 11: CD010820; Acta Med Port 2015; 28: 551–553. Google Scholar|
|7.||Thieme H, Mehrholz J, Pohl M, Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev 2012; 3: CD008449. Google Scholar CrossRef|
|8.||Stein C, Fritsch CG, Robinson C, Effects of electrical stimulation in spastic muscles after stroke: systematic review and meta-analysis of randomized controlled trials. Stroke 2015; 46: 2197–2205. Google Scholar CrossRef, Medline|
|9.||Knutson JS, Fu MJ, Sheffler LR, Neuromuscular electrical stimulation for motor restoration in hemiplegia. Phys Med Rehabil Clin N Am 2015; 26: 729–745. Google Scholar CrossRef, Medline|
|10.||Sabut SK, Sikdar C, Kumar R, Functional electrical stimulation of dorsiflexor muscle: effects on dorsiflexor strength, plantarflexor spasticity, and motor recovery in stroke patients. NeuroRehabilitation 2011; 29: 393–400. Google Scholar Medline|
|11.||You G, Liang H, Yan T. Functional electrical stimulation early after stroke improves lower limb motor function and ability in activities of daily living. NeuroRehabilitation 2014; 35: 381–389. Google Scholar Medline|
|12.||Kojima K, Ikuno K, Morii Y, Feasibility study of a combined treatment of electromyography-triggered neuromuscular stimulation and mirror therapy in stroke patients: a randomized crossover trial. NeuroRehabilitation 2014; 34: 235–244. Google Scholar Medline|
|13.||Kim H, Lee G, Song C. Effect of functional electrical stimulation with mirror therapy on upper extremity motor function in poststroke patients. J Stroke Cerebrovasc Dis 2014; 23: 655–661. Google Scholar CrossRef, Medline|
|14.||Yun GJ, Chun MH, Park JY, The synergic effects of mirror therapy and neuromuscular electrical stimulation for hand function in stroke patients. Ann Rehabil Med 2011; 35: 316–321. Google Scholar CrossRef, Medline|
|15.||Lee D, Lee G, Jeong J. Mirror Therapy with Neuromuscular Electrical Stimulation for improving motor function of stroke survivors: a pilot randomized clinical study. Technol Health Care 2016; 24: 503–511. Google Scholar CrossRef, Medline|
|16.||Gregson JM, Leathley M, Moore AP, Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil 1999; 80: 1013–1016. Google Scholar CrossRef, Medline|
|17.||Mehrholz J, Wagner K, Rutte K, Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil 2007; 88: 1314–1319. Google Scholar CrossRef, Medline|
|18.||Lee HJ, Cho KH, Lee WH. The effects of body weight support treadmill training with power-assisted functional electrical stimulation on functional movement and gait in stroke patients. Am J Phys Med Rehabil 2013; 92: 1051–1059. Google Scholar CrossRef, Medline|
|19.||Flansbjer UB, Holmback AM, Downham D, Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med 2005; 37: 75–82. Google Scholar CrossRef, Medline|
|20.||Sawner KA, LaVigne JM, Brunnstrom S. Brunnstrom’s movement therapy in hemiplegia: a neurophysiological approach. 2nd ed. Philadelphia, PA: Lippincott, 1992. Google Scholar|
|21.||Cho KH, Lee JY, Lee KJ, Factors related to gait function in post-stroke patients. J Phys Ther Sci 2014; 26: 1941–1944. Google Scholar CrossRef, Medline|
|22.||Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67: 206–207. Google Scholar CrossRef, Medline|
|23.||Jung IG, Yu IY, Kim SY, Reliability of ankle dorsiflexion passive range of motion measurements obtained using a hand-held goniometer and Biodex dynamometer in stroke patients. J Phys Ther Sci 2015; 27: 1899–1901. Google Scholar CrossRef, Medline|
|24.||Bakhtiary AH, Fatemy E. Does electrical stimulation reduce spasticity after stroke? A randomized controlled study. Clin Rehabil 2008; 22: 418–425. Google Scholar Link|
|25.||Sütbeyaz S, Yavuzer G, Sezer N, Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil 2007; 88: 555–559. Google Scholar CrossRef, Medline|
|26.||Arya KN. Underlying neural mechanisms of mirror therapy: implications for motor rehabilitation in stroke. Neurol India 2016; 64: 38–44. Google Scholar CrossRef, Medline|
|27.||Guo F, Xu Q, Abo Salem HM, The neuronal correlates of mirror therapy: a functional magnetic resonance imaging study on mirror-induced visual illusions of ankle movements. Brain Res 2016; 1639: 186–193. Google Scholar CrossRef, Medline|
|28.||Gondin J, Brocca L, Bellinzona E, Neuromuscular electrical stimulation training induces atypical adaptations of the human skeletal muscle phenotype: a functional and proteomic analysis. J Appl Physiol 2011; 110: 433–450. Google Scholar CrossRef, Medline|
|29.||Jones S, Man WD, Gao W, Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev 2016; 10: CD009419. Google Scholar CrossRef|
|30.||Shin HK, Cho SH, Jeon HS, Cortical effect and functional recovery by the electromyography-triggered neuromuscular stimulation in chronic stroke patients. Neurosci Lett 2008; 442: 174–179. Google Scholar CrossRef, Medline|
|31.||Sheffler LR, Chae J. Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve 2007; 35: 562–590. Google Scholar CrossRef, Medline|
|32.||Weerdesteyn V, de Niet M, van Duijnhoven HJ, Falls in individuals with stroke. J Rehabil Res Dev 2008; 45: 1195–1213. Google Scholar CrossRef, Medline|
|33.||Yavuzer G, Selles R, Sezer N, Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil 2008; 89: 393–398. Google Scholar CrossRef, Medline|
|34.||Alfieri V. Electrical treatment of spasticity. Reflex tonic activity in hemiplegic patients and selected specific electrostimulation. Scand J Rehabil Med 1982; 14: 177–182. Google Scholar Medline|
|35.||King TIII. The effect of neuromuscular electrical stimulation in reducing tone. Am J Occup Ther 1996; 50: 62–64. Google Scholar CrossRef, Medline|
|36.||Rushton DN. Functional electrical stimulation and rehabilitation—an hypothesis. Med Eng Phys 2003; 25: 75–78. Google Scholar CrossRef, Medline|
|37.||Touzalin-Chretien P, Dufour A. Motor cortex activation induced by a mirror: evidence from lateralized readiness potentials. J Neurophysiol 2008; 100: 19–23. Google Scholar CrossRef, Medline|
Source: Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled studyClinical Rehabilitation – Qun Xu, Feng Guo, Hassan M Abo Salem, Hong Chen, Xiaolin Huang, 2017