Posts Tagged physiotherapy

[ARTICLE] Short-term effects of physiotherapy combining repetitive facilitation exercises and orthotic treatment in chronic post-stroke patients – Full Text PDF

Abstract.

[Purpose] This study investigated the short-term effects of a combination therapy consisting of repetitive facilitative exercises and orthotic treatment.

[Subjects and Methods] The subjects were chronic post-stroke patients (n=27; 24 males and 3 females; 59.3 ± 12.4 years old; duration after onset: 35.7 ± 28.9 months) with limited mobility and motor function. Each subject received combination therapy consisting of repetitive facilitative exercises for the hemiplegic lower limb and gait training with an ankle-foot orthosis for 4 weeks. The Fugl-Meyer assessment of the lower extremity, the Stroke Impairment Assessment Set as a measure of motor performance, the Timed Up & Go test, and the 10-m walk test as a measure of functional ambulation were evaluated before and after the combination therapy intervention.

[Results] The findings of the Fugl-Meyer assessment, Stroke Impairment Assessment Set, Timed Up & Go test, and 10-m walk test significantly improved after the intervention. Moreover, the results of the 10-m walk test at a fast speed reached the minimal detectible change threshold (0.13 m/s).

[Conclusion] Short-term physiotherapy combining repetitive facilitative exercises and orthotic treatment may be more effective than the conventional neurofacilitation therapy, to improve the lower-limb motor performance and functional ambulation of chronic post-stroke patients.

 

INTRODUCTION

The mobility of many stroke survivorsislimited, and most identify walking as a top priority for rehabilitation1) . One way to manage ambulatory difficulties is with an ankle-foot orthosis (AFO) or a foot-drop splint, which aims to stabilize the foot and ankle while weight-bearing and lift the toes while stepping1) . In stroke rehabilitation, various approaches, including robotic assistance, strength training, and task-related/virtual reality techniques, have been shown to improve motor function2) . The benefits of a high intensity stroke rehabilitation program are well established, and although no clear guidelines exist regarding the best levels of intensity in practice, the need for its incorporation into a therapy program is widely acknowledged2) . Repetitive facilitative exercises (RFE), which combine a high repetition rate and neurofacilitation, are a recently developed approach to rehabilitation of stroke-related limb impairment2–5) . In the RFE program, therapists use muscle spindle stretching and skin-generated reflexes to assist the patient’s efforts to move an affected joint5) . Previous studies have shown that an RFE program improved lower-limb motor performance (Brunnstrom Recovery Stage, foot tapping, and lower-limb strength) and the 10-m walk test in patients with brain damage3) . An AFO is an assistive device to help stroke patients with hemiplegia walk and stand. A properly prescribed AFO can improve gait performance and control abnormal kinematics arising from coordination deficits6) . Gait training with an AFO has been also reported to improve gait speed and balance in post-stroke patients7, 8) . Therefore, we hypothesized that short-term physiotherapy combining RFE and orthotic treatment would improve both lower-extremity motor performance and functional ambulation. The present study aimed to confirm the efficacy of a combination therapy consisting of RFE for the hemiplegic lower limb and gait training with AFO.

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[Abstract] An observational study of Australian physiotherapy consultations to explore the prescription of strategies.

Abstract

Objective

The aim of the study was to explore the types of self-management strategies prescribed; the number of strategies and the overall length of time allocated to self-management prescription, by consultation type and by injury location, in physiotherapy consultations.

Methods

A cross-sectional, observational study of 113 physiotherapist–patient consultations was undertaken. Regression analyses were used to determine whether consultation type and injury location were associated with the number of strategies prescribed and the length/fraction of time spent on self-management.

Results

A total of 108 patients (96%) were prescribed at least one self-management strategy – commonly exercise and advice. The mean length of time spent on self-management was 5.80 min. Common injury locations were the neck (n = 40) and lower back (n = 39). No statistically significant associations were observed between consultation type or injury location for either outcome (number of strategies and the length/fraction of time allocated to self-management prescription).

Conclusion

Physiotherapists regularly spend time prescribing self-management strategies such as exercise, advice, and the use of heat or ice to patients receiving treatment linked to a range of injury locations. This suggests that self-management is considered to be an important adjunct to in-clinic physiotherapy. The practice implications of this are that clinicians should reflect on how self-management strategies can be used to maximize patient outcomes, and whether the allocation of consultation time to self-management is likely to optimize patient adherence to each strategy.

Source: An observational study of Australian private practice physiotherapy consultations to explore the prescription of self-management strategies – Peek – 2017 – Musculoskeletal Care – Wiley Online Library

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[Abstract] Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review

Objective: This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated.

Method: A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials.

Results: In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component.

Discussion: The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.

Source: Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review: Topics in Stroke Rehabilitation: Vol 0, No 0

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[Abstract] Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review

Objective: This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated.

Method: A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials.

Results: In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component.

Discussion: The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.

Source: Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review: Topics in Stroke Rehabilitation: Vol 0, No 0

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[ARTICLE] Effectiveness of robotic-assisted gait training in stroke rehabilitation: A retrospective matched control study – Full Text HTML

Abstract

Objective

This study aimed to evaluate the effectiveness of robotic-assisted gait training (RAGT) in improving functional outcomes among stroke patients.

Design

This was a retrospective matched control study.

Setting

This study was conducted in an extended inpatient rehabilitation centre.

Patients and intervention

There were 14 patients with subacute stroke (4–31 days after stroke) in the RAGT group. Apart from traditional physiotherapy, the RAGT group received RAGT. The number of sessions for RAGT ranged from five to 33, and the frequency was three to five sessions per week, with each session lasting for 15–30 minutes. In the control group, there were 27 subacute stroke patients who were matched with the RAGT group in terms of age, days since stroke, premorbid ambulatory level, functional outcomes at admission, length of training, and number of physiotherapy sessions received. The control group received traditional physiotherapy but not RAGT.

Outcome measures

Modified Functional Ambulation Category (MFAC), Modified Rivermead Mobility Index (MRMI), Berg’s Balance Scale (BBS), and Modified Barthel Index (MBI) to measure ambulation, mobility, balance, and activities of daily living, respectively.

Results

Both RAGT and control groups had significant within-group improvement in MFAC, MRMI, BBS, and MBI. However, the RAGT group had higher gain in MFAC, MRMI, BBS, and MBI than the control group. In addition, there were significant between-group differences in MFAC, MRMI, and BBS gains (p = 0.026, p = 0.010, and p = 0.042, respectively). There was no significant between-group difference (p = 0.597) in MBI gain (p = 0.597).

Conclusion

The results suggested that RAGT can provide stroke patients extra benefits in terms of ambulation, mobility, and balance. However, in the aspect of basic activities of daily living, the effect of RAGT on stroke patients is similar to that of traditional physiotherapy.

Introduction

Stroke, also known as cerebrovascular accident, is an acute disturbance of focal or global cerebral function, with signs and symptoms lasting more than 24 hours or leading to death, presumably of vascular origin [1]. In Hong Kong, around 25,000 stroke patients are admitted to public hospitals under the Hong Kong Hospital Authority annually [2]. Although mortality and morbidity among stroke patients have declined due to medical advances, impacts on stroke survivors and community remain significant. The most widely recognized impairment caused by stroke is motor impairment, which restricts muscle movement or mobility function [3]. Many stroke patients experience difficulties in walking, and improving walking is one of the main goals of rehabilitation [4]. Since it was shown that the process of spontaneous recovery is almost completed within 6–10 weeks [5], early rehabilitation is essential to maximize the function of patients after stroke. Recent evidence suggests that high-intensity repetitive task-specific practice might be the most effective principle when trying to promote motor recovery after stroke [3]. Robotic-assisted gait training (RAGT) is a new global physiotherapy technology that applies the high-intensity repetitive principle to improve mobility of patients with stroke or other neurological disorders. The advantage of RAGT may be the reduction of the effort required by therapists compared with treadmill training with partial bodyweight support, as they no longer need to set the paretic limbs or assist in trunk movements [6]. People who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices [7]. More specifically, people in the first 3 months after stroke and those who are not able to walk seem to benefit most from this type of intervention [7]. Evidence also shows that the use of RAGT in stroke patients has positive effects on their balance [8].

Randomized controlled trials and systemic reviews have demonstrated the effectiveness of RAGT for stroke patients in terms of functional outcomes such as walking ability [9], [10] and [11] and balance [8] and [11]. However, limited published evidence is available on the effectiveness of RAGT in improving other functioning activities such as basic activities of daily living (ADL) [12] and [13]. If RAGT can improve walking ability and balance of stroke patient, can RAGT also improve basic ADL of stroke patients? The hierarchical pattern of progression in basic ADL is in the following order: bathing, dressing, transferring, toileting, controlling continence, and feeding, with bathing being the most complex task and feeding the least [14]; however, walking ability and balance contribute to parts of basic ADL. Moreover, factors that make the greatest contribution to ADL after stroke were found to be balance, upper extremity function, and perceptual and cognitive functions [15]. If RAGT can improve ADL of stroke patients, which of the above factors is/are enhanced by RAGT? Can RAGT also enhance perceptual and cognitive functions of stroke patients? Hence, controlled studies are necessary to address these research questions. A retrospective study conducted by Dundar et al [13] investigated the effect of robotic training in functional independence measure and other functional outcomes of patients with subacute and chronic stroke. However, the study concluded that combining robotic training with conventional physiotherapy produced better improvement than conventional physiotherapy in terms of functional independence measure, but not walking status or balance. The result was opposite to the specificity of training principle [16] that gait training should produce more positive effect for walking and balance than ADL. Hence, this study intends to investigate the effectiveness of RAGT in improving functional mobility and basic ADL for stroke patients, and hopefully can lead to further randomized controlled studies to investigate the impact of RAGT on basic ADL.

Continue —> Effectiveness of robotic-assisted gait training in stroke rehabilitation: A retrospective matched control study

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Figure 1

Figure 1. Flowchart of patient assignment. DAMA = discharged against medical advice; RAGT = robotic-assisted gait training.

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[Abstract] Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review

Objective: This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated.

Method: A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials.

Results: In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component.

Discussion: The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.

Source: Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review: Topics in Stroke Rehabilitation: Vol 0, No 0

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[ARTICLE] Early Post Stroke Rehabilitation Load Correlates With Greater Functional Improvement of Hemiparesis – Full Text

Abstract

Background: Evidences show that generally stroke patients receiving greater amount of physiotherapy obtain better motor function over time, although this has not been investigated in the early post stroke population. The aim of the present observational retrospective study was to investigate the relationship between the amount of physiotherapy provided to early post acute stroke patients and their motor improvement.

Methods: Overall, 846 early stroke patients with hemiparesis, treated with physiotherapy, were retrospectively analyzed. Clinical data at admission as well as functional scales at the first evaluation and at discharge were analyzed. For each patient, a rehabilitation load (resulting from the total number of the 30’ daily consecutive physiotherapy sessions they received) was used as the dose of physiotherapy. Pre and post rehabilitation scales were analyzed and their change (Δ) was correlated with the rehabilitation load.

Results: The mean rehabilitation load was ten sessions (range 2 to 56). The scores of Barthel index, Motor Assessment Score, Motricity index for both lower and upper limb, Functional Ambulation Classification, Berg Balance scale and Trunk control test significantly improved from pre to post rehabilitation, and a significant correlation was found between the rehabilitation load and the improvement in Barthel index (P < 0.05), Motor Assessment Score, Motricity Index for upper and lower limb (P < 0.001), Berg Balance scale (P < 0.05) and Trunk control test (P < 0.001).

 

 

Conclusions: In this study, a significant correlation was found between early post stroke motor rehabilitation dose and greater improvement in functional scales, assessing patient’s independence, balance and paretic limb’s motricity.

 

1. Background

In western countries, stroke represents the third cause of death, the second cause of dementia and the first cause of severe loss of independence. Although stroke incidence and stroke-related death were reported to have decreased, longitudinal studies show an increase in the absolute number of strokes and of the stroke impact on disability in the world. Approximately 800,000 people in the USA have their first or recurrent stroke each year. The prevalence of chronic stroke in the USA is estimated at about seven million1, with about 80% of patients with stroke being over the age of 65. The prevalence of stroke is likely to increase in the future due to the aging population. Even though acute stroke care has improved, for example by large-scale application of recombinant tissue plasminogen activator (rTPA) (1, 2) and organized interdisciplinary inpatient stroke care (3) (Stroke Units in Italy), a large number of patients still remain disabled regardless of the time that has elapsed post stroke.

Only 12% of the patients with stroke are independent in basic Activities of Daily Living (ADL) at the end of the first post stroke week (4). In the long term, 25 to 74% of patients have to rely on human assistance for basic ADLs, like feeding, self-care and mobility (5). In Italy ischemic stroke was reported in 80% of cases in the whole stroke population, whereas hemorrhagic stroke was diagnosed in 20%. Stroke incidence was 6.5% in the general population, respectively 7.4% in males and 5.9% in females (6).

Multidisciplinary rehabilitation of stroke is recommended as the gold standard by several authors (7, 8) and better outcomes in patients, who underwent more intense motor rehabilitation regimens, than in patients, who received lower intensity ones have been reported, based on data taken from several randomized clinical trials, usually conducted on mixed acute and chronic large post stroke patients’ populations, including patients submitted to several different rehabilitative therapies (9). To the best of our knowledge, the role of different amounts of physiotherapy in specific timeframes after stroke has not been exhaustively investigated till now, although early post stroke rehabilitation is recommended and prescribed worldwide. Pathophysiological mechanisms underlying motor recovery after stroke are supposedly different between acute post stroke and the chronic phase (10), consequently different effects are expected to be obtained by physiotherapy in different post stroke periods.

In Italy, stroke patients, usually admitted to the Stroke Unit for acute care including thrombolysis, are referred to rehabilitation units, as soon as the critical conditions have been managed and the diagnostic procedures are concluded. Afterwards, they are often transferred to Rehabilitation Units until recovery is completed. In nearly all the Italian Stroke Units, early physiotherapy is started for patients, who present motor deficits and then are prosecuted in the rehabilitation units or (in milder cases) in outpatient settings. Their functional evaluation at admission in and at discharge from the Stroke Unit is frequently performed, including several scales measuring, both daily living patient’s abilities and independence, ambulation quality or motor functions. Obviously, only a limited number of these patients appear to be completely recovered at the time of discharge from the Stroke Unit and do not need further rehabilitation, the majority of them need to be treated at specific rehabilitation units.

Although the effects of rehabilitation on motor recovery have been studied in several researches on patients with post stroke time of more than 10 to 30 days (9), to the best of our knowledge, the effect of early post stroke rehabilitation, as offered in the Stroke Unit, on functional independence and motor abilities of patients has not been investigated till now. This has both clinical and cost-effectiveness implications, considering the allocation of rehabilitative resources within acute care hospitals (11).

This real life retrospective study was conducted on patients with hemiparesis/hemiplegia due to stroke admitted to the stroke unit of the Spedali Civili of Brescia from January 2012 to May 2015, to evaluate the correlation between the dose of physiotherapy provided in the early post stroke phase and different functional scales. We also investigated, on the basis of these results, which scales revealed to be the most useful to be used to detect functional motor improvement early after the stroke.

Continue —> Early Post Stroke Rehabilitation Load Correlates With Greater Functional Improvement of Hemiparesis – Archives of Neuroscience – – Tehran University of Medical Sciences

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[Abstract] Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study.

Abstract

Purpose: The goal of this study was to examine which motor learning options are applied by experienced physiotherapists in neurological rehabilitation, and how they choose between the different options.
Methods: A descriptive qualitative approach was used. A purposive sample of five expert physiotherapists from the neurological ward of a rehabilitation center participated. Data were collected using nine videotaped therapy situations. During retrospective think-aloud interviews, the physiotherapists were instructed to constantly “think aloud” while they were watching their own videos.
Results: Five “operators” were identified: “act”, “know”, “observe”, “assess” and “argue”. The “act” operator consisted of 34 motor learning options, which were clustered into “instruction”, “feedback” and “organization”. The “know”, “observe”, “assess” and “argue” operators explained how therapists chose one of these options. The four operators seem to be interrelated and together lead to a decision to apply a particular motor learning option.
Conclusions: Results show that the participating physiotherapists used a great variety of motor learning options in their treatment sessions. Further, the decision-making process with regard to these motor learning options was identified. Results may support future intervention studies that match the content and process of therapy in daily practice. The study should be repeated with other physiotherapists.

  • Implications for Rehabilitation

  • The study provided insight into the way experienced therapist handle the great variety of possible motor learning options, including concrete ideas on how to operationalize these options in specific situations.

  • Despite differences in patients’ abilities, it seems that therapists use the same underlying clinical reasoning process when choosing a particular motor learning option.

  • Participating physiotherapists used more than the in guidelines suggested motor learning options and considered more than the suggested factors, hence adding practice based options of motor learning to the recommended ones in the guidelines.

  • A think-aloud approach can be considered for peer-to-peer and student coaching to enhance discussion on the motor learning options applied and the underlying choices and to encourage research by practicing clinicians.

 

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Source: Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study – Disability and Rehabilitation –

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[Abstract] Action research in rehabilitation with chronic stroke recovery: A case report with a focus on neural plasticity – IOS Press

Abstract

BACKGROUND: Chronic stroke patients are primarily referred to general rehabilitation, rather than to specific neurorehabilitation. Currently, there are no Danish clinical guidelines for chronic stroke, but recent research in neuroplasticity has contributed to possible rehabilitation interventions for these patients.

OBJECTIVE: The purpose of this project is to describe the use of a specialized neuroplastic approach in combination with an already existing training program.

METHODS: The project is designed as an action research project concerning four participants with chronic stroke. Through ten intervention, a neuroplastic focus has been added to their group training program including daily home training. Participants were tested before and after the intervention with MAS, DGI, 6MWT, SSQLS.

RESULTS: All four participants improved their functional levels and their quality of life following the intervention.

CONCLUSIONS: This report indicates that a specific neuroplastic focus in combination with action research has an impact on the participants with chronic stroke. However, there is still no clarity regarding what type of rehabilitation methods can be considered the most efficacious in promoting neuroplasticity. This case report serves as a pilot project for further studies of how to implement neuroplasticity in physical therapy.

Source: Action research in rehabilitation with chronic stroke recovery: A case report with a focus on neural plasticity – IOS Press

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[ARTICLE] Mirror therapy for upper limb rehabilitation in chronic patients after stroke – Full Text PDF

Abstract

Introduction: Individuals with stroke sequelae present changes in the postural alignment and muscle strength associated with hemiplegia or hemiparesis. Mirror therapy is a technique that aims to improve the motor function of the paretic limb.

Objective: The aim of this study was to evaluate the effect of mirror therapy, associated with conventional physiotherapy, for range of motion (ROM), degree of spasticity of the affected upper limb, and the level of independence in the activities of daily living (ADL) of chronic patients after stroke.

Methods: This was a quasi-experimental (before and after) study. The study included ten stroke survivors undertaking physiotherapy and presenting with upper limb paresis. The following gauges were used for the present study: goniometry, the Modiϐied Ashworth Scale, Fugl-Meyer and Barthel Index. Fifteen sessions were performed, each lasting 30 minutes, consisting of stretching of the ϐlexor and extensor muscles of the wrist and elbow, pronators and supinators, followed by mirror therapy with gradual functional exercises.

Results: Improvement was observed in all aspects studied, however with signiϐicant differences for ROM wrist extension (p = 0.04) and forearm supination (p = 0.03).

Conclusion: It can be concluded that mirror therapy contributed to the participants’ good performance in the aspects studied, mainly in relation to ROM of the affected upper limb.

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