Archive for category Mirror therapy

[Abstract] The Efficacy of Lower Extremity Mirror Therapy for Improving Balance, Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis

Abstract

Background

Mirror therapy is less commonly used to target the lower extremity after stroke to improve outcomes but is simple to perform. This review and meta-analysis aimed to evaluate the efficacy of lower extremity mirror therapy in improving balance, gait, and motor function for individuals with stroke.

Methods

PubMed, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database, and PsychINFO were searched from inception to May 2018 for randomized controlled trials (RCTs) comparing lower extremity mirror therapy to a control intervention for people with stroke. Pooled effects were determined by separate meta-analyses of gait speed, mobility, balance, and motor recovery.

Results

Seventeen RCTs involving 633 participants were included. Thirteen studies reported a significant between-group difference favoring mirror therapy in at least one lower extremity outcome. In a meta-analysis of 6 trials that reported change in gait speed, a large beneficial effect was observed following mirror therapy training (standardized mean differences [SMD] = 1.04 [95% confidence interval [CI] = .43, 1.66], I2 = 73%, and P < .001). Lower extremity mirror therapy also had a positive effect on mobility (5 studies, SMD = .46 [95% CI = .01, .90], I2 = 43%, and P = .05) and motor recovery (7 studies, SMD = .47 [95% CI = .21, .74], I2 = 0%, and P < .001). A significant pooled effect was not found for balance capacity.

Conclusions

Mirror therapy for the lower extremity has a large effect for gait speed improvement. This review also found a small positive effect of mirror therapy for mobility and lower extremity motor recovery after stroke.

 

via The Efficacy of Lower Extremity Mirror Therapy for Improving Balance, Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis – Journal of Stroke and Cerebrovascular Diseases

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[WEB SITE] What we learned about mirror therapy from almost 2000 patients

What we learned about mirror therapy from almost 2000 patients

September 3, 2018
 

Stroke tends to affect one side more than the other. It can leave us feeling off-balance and weaker on one side. Sometimes, people may be unable to stand up straight, or even use their arm or leg on their affected side. Physical therapy and exercises bring you a long way on your recovery path. But is there something else that can help?

A creative way to use a mirror

Sometimes, people try a treatment called mirror therapy. Mirror therapy involves placing a mirror in a particular way so you can see the good side of your body reflected to represent your affected side. The mirror stands in line with the middle of your body. That way, you see the unaffected half reflected in it, as if its the affected side of your body. It creates the optical illusion that your weak hand or leg is moving normally again. Initially, this technique was meant for people suffering from chronic pain. Now, stroke patients can benefit from mirror therapy too. It’s pretty easy to set up, even if you might be severely disabled. You can also do it on your own at home!

Does mirror therapy work?

But, does it even work? German researchers took on the enormous task of looking at the 62 studies out there about mirror therapy and stroke. Compiling all these studies, a total of 1982 patients were included. The data showed that mirror therapy resulted in moderate improvement of motor function and daily activities. Mirror therapy also seemed to work well for people suffering from post-stroke complex regional pain syndrome, which is a chronic pain caused by damage to the nerves. However, authors couldn’t tell if mirror therapy helped with neglect, which is when people have a hard time noticing things in the visual field on their bad side.

Try it today with your regular therapy!

It looks like mirror therapy really can’t hurt you if you want to try it. But don’t think that it could replace the efforts of hard work and physical therapy! We shouldn’t use mirror therapy instead of these other standard therapies but as a supplement. Right now, we just don’t know if it is as good as other treatments. But it wouldn’t hurt to try it along with the training you do with your therapist!

The lead author of this study was Dr. Holm Thieme, the Erste Europäische Schule für Physiotherapie, Ergotherapie und Logopädie, Klinik Bavaria Kreischa, Kreischa,  Saxony, Germany.

 

via What we learned about mirror therapy from almost 2000 patients – Strokemark : Strokemark

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[VIDEO] Post Concussion Syndrome – ReAttach and Mirror therapy – YouTube

This young lady had a contusio cerebri in 2014 and a concussion in 2016. In 2018 she suddenly showed sensorimotor problems after a relative small incident. This video shows the impressive improvement after one session of ReAttach to ( among others) improve the multiple sensory integration processing and to stimulate motor imagery and after the second session by means of mirror therapy.

via Post Concussion Syndrome – ReAttach and Mirror therapy – YouTube

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[Systematic Review] Mirror therapy for improving motor function after stroke – Abstract

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.

 

Plain language summary

Review question
Does mirror therapy improve movement, the performance of daily activities, pain, and lack of attention to and awareness of the affected field of vision (visuospatial neglect) after stroke.

Backround
Paralysis of the arm or leg is common after stroke and frequently causes problems with activities of daily living such as walking, dressing, or eating. Mirror therapy (MT) is a rehabilitation therapy in which a mirror is placed between the arms or legs so that the image of a moving non‐affected limb gives the illusion of normal movement in the affected limb. By this setup, different brain regions for movement, sensation, and pain are stimulated. However, the precise working mechanisms of mirror therapy are still unclear. We conducted a search for literature in various databases and extracted the data of relevant studies.

Search date
This review identified studies up to 16 August 2017.

Study characteristics
We found 62 relevant studies, of which 57 randomly allocated participants to receive either MT or a control therapy (randomised controlled trials) and five provided both therapies to all participants, but in random order (cross‐over trials). The studies involved a total of 1982 participants with a mean age of 59 years (30 to 73 years) after stroke. 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).

Key results
At the end of treatment, mirror therapy moderately improved movement of the affected upper and lower limb and the ability to carry out daily activities for people within and also beyond six months after the stroke. Mirror therapy reduced pain after stroke, but mainly in people with a complex regional pain syndrome. We found no clear effect for visuospatial neglect. The beneficial effects on movement were maintained for six months, but not in all study groups. No adverse effects were reported.

Quality of the evidence
The studies provide moderately‐reliable evidence that MT improves movement (motor function, motor impairment) and the performance of daily activities. However, there was only low reliability that MT decreases pain and visuospatial neglect. This may be due to the small number of studies. Further research is needed, with larger methodologically‐sound studies.

 

via Mirror therapy for improving motor function after stroke – Thieme, H – 2018 | Cochrane Library

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[Review Article] Do Robotics and Virtual Reality Add Real Progress to Mirror Therapy Rehabilitation? A Scoping Review – Full Text

Abstract

Background. Mirror therapy has been used in rehabilitation for multiple indications since the 1990s. Current evidence supports some of these indications, particularly for cerebrovascular accidents in adults and cerebral palsy in children. Since 2000s, computerized or robotic mirror therapy has been developed and marketed.Objectives. To map the extent, nature, and rationale of research activity in robotic or computerized mirror therapy and the type of evidence available for any indication. To investigate the relevance of conducting a systematic review and meta-analysis on these therapies. Method. Systematic scoping review. Searches were conducted (up to May 2018) in the Cochrane Library, Google Scholar, IEEE Xplore, Medline, Physiotherapy Evidence Database, and PsycINFO databases. References from identified studies were examined. Results. In sum, 75 articles met the inclusion criteria. Most studies were publicly funded (57% of studies; n = 43), without disclosure of conflict of interest (59% of studies; n = 44). The main outcomes assessed were pain, satisfaction on the device, and body function and activity, mainly for stroke and amputees patients and healthy participants. Most design studies were case reports (67% of studies; n = 50), with only 12 randomized controlled trials with 5 comparing standard mirror therapy versus virtual mirror therapy, 5 comparing second-generation mirror therapy versus conventional rehabilitation, and 2 comparing other interventions. Conclusion. Much of the research on second-generation mirror therapy is of very low quality. Evidence-based rationale to conduct such studies is missing. It is not relevant to recommend investment by rehabilitation professionals and institutions in such devices.

1. Introduction

Mirror therapy was originally described by Ramachandran and Rogers-Ramachandran, who suggested its use in amputees with phantom limb pain [1]. They introduce an inexpensive new device: a mirror was placed vertically on a table so that the mirror reflection of the patient’s intact hand was superimposed on the felt position of the phantom [1]. This standard mirror therapy has been used in rehabilitation for multiple indications since the 1990s [2]. A good level of evidence supports some of these indications, particularly for cerebrovascular accidents in adults [34] and cerebral palsy in children [5]. Cost is very low, because a simple little and not specifically dedicated mirror can be used [1]. Dedicated mirror boxes cost about $65 each [6].

Since 2000s, virtual reality or robot has been developed and marketed to treat various diseases as a more technologically sophisticated version of the standard mirror therapy introduced in 1996 [78]. Robotic devices and virtual reality are increasingly used and assessed in rehabilitation and research [910]. This second-generation devices are probably much more expensive than standard mirror therapy: they often present a technological complexity that requires investment, constant maintenance, and highly qualified operators [11]. Low cost virtual reality device costs about $252 to purchase [12]. Low cost robotic device for robotic gait rehabilitation was estimated to cost $25,000, which is less than 10% of the price of device currently available in Brazil for the same indication [13]. For some indications, virtual reality such as robotics has no greater effectiveness than more conventional techniques [1415]. Studies evaluating the impact on various outcomes of these mirror therapy devices exist [81617], but no review summarizes the available data.

The purpose of this review was as follows: (1) to map the extent, nature, and rationale of research activity in robotic or computerized mirror therapy; (2) to summarize the main sources and types of evidence available about the effectiveness of these therapies for any indication; (3) to investigate the relevance of conducting a systematic review and meta-analysis on these therapies.[…]

Continue —>  Do Robotics and Virtual Reality Add Real Progress to Mirror Therapy Rehabilitation? A Scoping Review

 

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[WEB SITE] Effects of Mirror Therapy on Walking Ability, Balance and Lower Limb Motor Recovery After Stroke

Leanne Loranger, PT, Manager Policy and Practice    August 2, 2018

Full Citation

Li Y, Wei Q, Gou W, He C. Effects of mirror therapy on walking ability, balance and lower limb recovery after stroke: A systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation 2018; DOI: 10.1177/0269215518766642.1

Background

“Stroke is the leading cause of death and disability in Canada.”2 Up to half of people with stroke-related hemiplegia cannot walk independently after rehabilitation;1 however, independent mobility is often a priority for people following stroke.

Mirror therapy involves the use of a mirror placed in the mid-sagittal plane to create the illusion that the affected limb is performing the movements that the unaffected limb is performing. It has been theorized that the visual feedback can help to prevent or reduce learned non-use of the affected limb. Mirror therapy first became common in the rehabilitation of stroke-related upper extremity dysfunction, but more recently has been used in the rehabilitation of lower limbs.

The authors conducted a systematic review and meta-analysis of randomized controlled trials of the use of mirror therapy in the rehabilitation of stroke-related lower-limb impairments.

Methods

  • Systematic search of MEDLINE, EMBASE, Web of Science, CENTRAL, Physiotherapy Evidence Database, CNKI, VIP, Wan Fang, ClinicalTrials.gov, and Current Controlled Trials, conducted according to PRISMA guidelines.
  • Study Inclusion Criteria:
    • Randomized Controlled Trials
    • Patients > 18 years of age with stroke
    • More than five subjects in the study
    • Compared mirror to no intervention, a different intervention, or a control group with the same therapeutic intervention minus mirror therapy
    • Provided original data or sufficient information about at least one outcome to allow inclusion in Meta-analysis
    • Published in English or Chinese
  • The PEDro Scale was used to assess quality of included studies.
    • Scores ranged from five to eight points
    • Six studies were rated “good quality” while seven were rated “fair quality”
  • Meta-analysis was conducted using RevMan 5.3.
  • Subgroup analysis was conducted to establish the effectiveness of treatment depending on recovery stage (acute, subacute, or chronic) and nature of the treatment intervention (movement of unaffected limb only, or bilateral movement).
  • A total of 13 studies, representing 572 patients were included in the meta-analysis.
  • Timing of interventions ranged from six days to 16 months post-stroke.
  • Six studies involved bilateral movements, while in seven only the unaffected side was moved.
  • Frequency ranged from three to six days per week.
  • Duration of treatment ranged from two weeks to three months.

Findings

  • Significant improvement in walking speed compared with control group, measured by 10-meter walk test.
    • Both bilateral and unilateral movements led to improved walking speed.
  • No significant improvement in mobility, measured by Timed Up and Go or Functional Ambulatory Category.
  • Significant treatment effect for balance, measured by the Berg Balance Scale or Brunnel Balance Assessment.
  • Significant effect on lower limb motor recovery, measured by the Fugl-Meyer or Brunnstrom Scale.
  • No significant effect on spasticity of ankle muscles.
  • Significant improvement in PROM of ankle dorsiflexion.

Discussion

The main finding of this systematic review and meta-analysis was that “patients with stroke who received mirror therapy had significant improvements in walking speed, balance, lower limb motor recovery and passive range of motion of ankle dorsiflexion.”1 However, although the findings were statistically significant, they “seemed to have little clinical significance.” For example, the average improvement in walking speed after mirror therapy treatment would not lead to a change in patient categorization from “house-hold ambulator” to “limited community ambulator.”

Limitations

  • Considerable study heterogeneity regarding treatment frequency and duration may have impacted on the strength of the study findings.
  • Relatively small number of studies and total patients included.

Relevance to physiotherapy practice in Alberta

Mirror therapy shows some promise for lower limb rehabilitation of people who have experienced a stroke, leading to statistically significant changes in gait speed, balance, motor recovery and range of motion. However, current research findings show that effects may have limited clinically significance. More research is needed to determine the frequency, duration, timing and parameters of mirror therapy that may result in clinically significant effects, and the patient populations that derive greatest benefit from the intervention, if any.

Disclaimer

The purpose of this summary is to highlight recently published research findings that are not openly accessible. Every effort is made to ensure accuracy and clarity of the summary. Readers are encouraged to review the published article in full for further information.


Sources

  1. Li Y, Wei Q, Gou W, He C. Effects of mirror therapy on walking ability, balance and lower limb recovery after stroke: A systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation 2018; DOI: 10.1177/0269215518766642
  2. Physiotherapy Alberta – College + Association. Physiotherapy Works for Stroke. Available at https://www.physiotherapyalberta.ca/files/physioworks_stroke.pdf. Accessed July 13, 2018.

via Physiotherapy Alberta College + Association : The Movement Specialists: Research in Focus: Effects of Mirror Therapy on Walking Ability, Balance and Lower Limb Motor Recovery After Stroke

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[Abstract] Combining functional electrical stimulation and mirror therapy for upper limb motor recovery following stroke: a randomised trial

Introduction: There is a growing need to develop effective rehabilitation interventions for people presenting with stroke as healthcare services experience ever-increasing pressures on staff and resources. The primary objective of this research is to examine the effect that mirror therapy combined with functional electrical stimulation has on upper limb motor recovery and functional outcome for a sample of people admitted to an inpatient stroke unit.

Methods: A total of 50 participants were randomised to one of three treatment arms; Functional Electrical Stimulation, Mirror therapy or a combined intervention of Functional Electrical Stimulation with Mirror therapy. Socio-demographic and health information was collected at recruitment together with admission dates, medical diagnoses and baseline measures. Blinded assessments were undertaken at baseline and at discharge post-stroke by a registered physiotherapist and a clinical nurse specialist.

Results: The Action Research Arm Test and the Fugl–Meyer Upper Extremity assessment revealed statistically superior results for Functional Electrical Stimulation compared with Mirror therapy alone (p = 0.03). There were no other significant differences between the three groups.

Conclusion: The theory of combining interventions requires further investigation and warrants further research. Combining current interventions may have the potential to enhance stroke rehabilitation, improve functional outcomes and help reduce the overall burden of stroke.

 

via Combining functional electrical stimulation and mirror therapy for upper limb motor recovery following stroke: a randomised trial: European Journal of Physiotherapy: Vol 0, No 0

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[Abstract] Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial

Abstract

Objective

We investigated the treatment effects of a home-based rehabilitation program compared with clinic-based rehabilitation in patients with stroke.

Design

A single-blinded, 2-sequence, 2-period, crossover-designed study.

Setting

Rehabilitation clinics and participant’s home environment.

Participants

Individuals with disabilities poststroke.

Interventions

During each intervention period, each participant received 12 training sessions, with a 4-week washout phase between the 2 periods. Participants were randomly allocated to home-based rehabilitation first or clinic-based rehabilitation first. Intervention protocols included mirror therapy and task-specific training.

Main Outcome Measures

Outcome measures were selected based on the International Classification of Functioning, Disability and Health. Outcomes of impairment level were the Fugl-Meyer Assessment, Box and Block Test, and Revised Nottingham Sensory Assessment. Outcomes of activity and participation levels included the Motor Activity Log, 10-meter walk test, sit-to-stand test, Canadian Occupational Performance Measure, and EuroQoL-5D Questionnaire.

Results

Pretest analyses showed no significant evidence of carryover effect. Home-based rehabilitation resulted in significantly greater improvements on the Motor Activity Log amount of use subscale (P=.01) and the sit-to-stand test (P=.03) than clinic-based rehabilitation. The clinic-based rehabilitation group had better benefits on the health index measured by the EuroQoL-5D Questionnaire (P=.02) than the home-based rehabilitation group. Differences between the 2 groups on the other outcomes were not statistically significant.

Conclusions

The home-based and clinic-based rehabilitation groups had comparable benefits in the outcomes of impairment level but showed differential effects in the outcomes of activity and participation levels.

via Effects of Home-Based Versus Clinic-Based Rehabilitation Combining Mirror Therapy and Task-Specific Training for Patients With Stroke: A Randomized Crossover Trial – Archives of Physical Medicine and Rehabilitation

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[Abstract] Combining tDCS and computerized mirror therapy in upper limb rehabilitation in stroke patients. A feasibility study

Introduction/Background

Mirror therapy (MT) relies on a mirror and movements of the healthy limb to generate visual illusions of movement of the paralyzed limb. MT has proven to be effective for the motor rehabilitation of the upper limb of stroke patients, but suffers several limitations for patients. To overcome these difficulties, a computerized mirror therapy device was developed (IVS3™, Dessintey). MT effects could also be enhanced by applying simultaneous neuromodulation with tDCS. This small sample trial was conducted to evaluate the feasibility and tolerance of an IVS3 motor training combined with simultaneous bi-hemispheric tDCS.

Material and method

Four patients with right or left hemiparesis following stroke were included in this trial. They received 20 sessions of computerized MT (IVS3 ™, Dessintey; 5 sessions/week; 1 hour and 200 movements/session) combined with bi-hemispheric tDCS over the hand motor cortex (2 mA, 20 minutes). The primary endpoint was adherence to the therapeutic program. The secondary judgment criteria were the safety assessmentand the evolution of the tolerance of repeated tDCS stimulation coupled with IVS3.

Results

The synergy of these two therapies is well tolerated by patients with a compliance rate of 99% ± 0.025. There have been no serious adverse reactions or unknown side effects. The upper limb motor function of the 4 patients improved, but this small sample non-controlled trial do not allow to conclude on a significant effect.

Conclusion

In this feasibility small sample study, the 4 patients well tolerated and perfectly complied with the computerized mirror therapy associated with bi-hemispheric tDCS. This finding calls for clinical controlled study to evaluate the efficacy of this combined IVS3-tDCS program in stroke patients.

via Combining tDCS and computerized mirror therapy in upper limb rehabilitation in stroke patients. A feasibility study – ScienceDirect

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[Abstract] Comparative hybrid effects of combining botulinum toxin A injection with bilateral robot-assisted, mirror or task-oriented therapy for upper extremity spasticity in patients with chronic stroke

Introduction/Background

Spasticity, a common impairment after stroke, has profound negative impact on outcomes in patients with stroke. Botulinum toxin type A (BoNT-A) injection combined with rehabilitation training is suggested for spasticity treatment. However, there is no recommendation about what kind of rehabilitation training is more appropriate than others following BoNT-A injection. The purpose of this study was to compare the effects of combining BoNT-A injection with bilateral robot-assisted (RT) or mirror (MT) or task-oriented (TT) therapy for upper extremity (UE) spasticity in patients with chronic stroke.

Material and method

Participants were randomly assigned to RT, or MT, or TT group after BoNT-A injection. The participants received 45 minutes of intervention per day, 3 days/week, for 8 weeks according the allocated results. In addition, all participants received 30 minutes of functional practice training. At pre-intervention, post-intervention and 3-month follow-up a blinded research assistant did outcome measures, including body function and structures by Fugl-Meyer Assessment (FMA), and Modified Ashworth Scale (MAS); activity and participation measures by Motor Activity Log (MAL), and Nottingham Extended Activities of Daily Living Scale (EADLS).

Results

Thirty-seven subjects met the inclusion criteria and underwent randomization, 13 were assigned to the RT; 12 to MT; and 12 to TT group. The 3 groups were well matched with regard to baseline characteristics and functional status. All groups had significant improvement in FMA, MAS and MAL post-intervention. There were no group differences in FMA, MAS, EADLs either post-intervention or at follow-up. There was a trend that TT group had higher quality of movement (QOM) in MAL post intervention than the other 2 groups (P = 0.07), at follow-up TT group had significantly higher QOM in MAL than the other 2 groups (P = 0.03).

Conclusion

Combining BoNT-A injection with TT resulted in better quality of UE movement in patients with spastic stroke than with RT or MT.

 

via Comparative hybrid effects of combining botulinum toxin A injection with bilateral robot-assisted, mirror or task-oriented therapy for upper extremity spasticity in patients with chronic stroke – ScienceDirect 

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