Further studies and still NO PROTOCOL for mirror therapy. Hope you like flying blind in your therapy. You'll have to ask your doctor what the difference is between task and movement. Task would seem to be almost impossible since it would move out of the mirror view.
Comparison Between Movement-Based and Task-Based Mirror Therapies on Improving Upper Limb Functions in Patients With Stroke: A Pilot Randomized Controlled Trial
- 1Department of Occupational Therapy, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
- 2Department of Rehabilitation Sciences, Tongji University School of Medicine, Shanghai, China
- 3Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
Objective: The aim of this trial was to
compare the effect of movement-based mirror therapy (MMT) and
task-based mirror therapy (TMT) on improving upper limb functions in
patients with stroke.
Methods: A total of 34 patients with
sub-acute stroke with mildly to moderately impaired upper limb motor
functions. The participants were randomly allocated to one of three
groups: MMT, TMT, and conventional treatment (CT). The MMT group
underwent movement-based mirror therapy for around 30 min/day, 5
days/week, for 4 weeks, whereas the TMT group underwent dose-matched
TMT. The CT group underwent only conventional rehabilitation. The MMT
and TMT groups underwent CT in addition to their mirror therapy. Blinded
assessments were administered at baseline and immediately after the
intervention. Upper limb motor functions, measured using Fugl-Meyer
Assessment-upper extremity (FMA-UE), Wolf Motor Function Test (WMFT),
and hand grip strength; upper limb spasticity, measured using the
modified Ashworth scale (MAS); and activities of daily living, measured
using the modified Barthel index (MBI).
Results: A significant time-by-group interaction effect was noted in FMA-UE. Post-hoc
analysis of change scores showed that MMT yielded a better effect on
improving FMA-UE than the other two therapies, at a marginally
significant level (P = 0.050 and 0.022, respectively). No significant interaction effect was noted in WMFT, hand grip strength, MAS, and MBI.
Conclusion: Both MMT and TMT are
effective in improving the upper limb function of patients with mild to
moderate hemiplegia due to stroke. Nevertheless, MMT seems to be
superior to TMT in improving hemiplegic upper extremity impairment.
Further studies with larger stroke cohorts are expected to be inspired
by this pilot trial.
Trial registration number: No. ChiCTR1800019043 (http://www.chictr.org.cn/index.aspx)
Introduction
Mirror therapy (MT) has been shown to be a useful
intervention for rehabilitation of upper limb functions following
stroke, since the first attempt by Altschuler et al. (1).
The neural correlate of MT remains under investigation. Three main
theories explaining the neural mechanism underlying the clinical
efficacy of MT have been proposed (2).
The first theory hypothesizes that the neural correlate
of MT is the mirror neuron system (MNS), which is defined as a class of
neurons that fire during action observation and action execution (3). It is assumed that the MNS can be triggered when people are observing mirror visual feedback (MVF) generated in MT (4, 5). The affected cortical motor system can be accessed via the MNS owing to their functional connections (6).
The second theory, supported by several studies with transcranial
magnetic stimulation (TMS), suggests that a potential neural mechanism
underlying the effect of MT can be the recruitment of the ipsilesional
corticospinal pathway. Indeed, many TMS studies have demonstrated the
increment of motor-evoked potentials of the ipsilesional primary motor
cortex in participants with stroke when viewing MVF (7),
which indicates a facilitatory effect of MVF on the ipsilesional
corticospinal pathway. The last theory attributes the effect of MT to
the compensation of restricted proprioception input from the affected
limb and the enhancement of attention toward the paretic upper limb (8), which may contribute to the reduction of the learned non-use in patients with stroke (1).
A substantial number of randomized controlled trials
(RCTs) have demonstrated that MT is useful in improving upper limb
functions after stroke (9–12).
A recently published meta-analytic review identified a moderate level
of evidence supporting the effects of MT on improving upper limb motor
functions (Hedges' g = 0.47) and activities of daily living (ADLs) (Hedges' g = 0.48) in patients with stroke (13). In the meta-analysis (13),
the heterogeneity of conducting MT was obvious across studies. One
major category of MT is movement-based MT (MMT), in which participants
practice simple movements such as wrist flexion and extension, or finger
flexion and extension, with their unaffected hands when viewing the MVF
generated by a physical mirror placed at their mid-sagittal plane (14–16).
Another category of MT is task-based MT (TMT), in which participants
perform specific motor tasks with their unaffected hands, such as
squeezing sponges, placing pegs in holes, and flipping a card, while
they are viewing the MVF (12, 17).
In some studies, researchers applied MMT in the first few sessions and
subsequently applied TMT in the following sessions, constituting a
hybrid MT protocol (9, 10, 18). MMT and TMT were also described as intransitive and transitive movements in some studies (9, 10). However, a sub-group meta-analysis comparing MMT and TMT was not carried out in the meta-analysis study (13).
Initially, MMT was used for alleviating phantom pain after amputation and for treating upper limb hemiplegia after stroke (1, 19).
Subsequently, the effect of MMT in stroke upper limb rehabilitation has
been systematically investigated by many clinical trials (14–16, 20).
Arya et al. were the first to compare the effects of TMT with those of
conventional rehabilitation on upper limb motor recovery after stroke,
and they found a superior effect of TMT (12).
The main rationale that Arya et al. mentioned was that the response of
the MNS was better for object-directed actions than for non-object
actions (12, 21).
In a recent study comparing the effects of action observation training
and MT on gait and balance in patients with stroke, the results showed
that action observation training had significantly better effects on the
improvement of balance functions than MT (22),
indicating that action observation may be different from MT in terms of
their neural mechanisms. In other studies in which TMT was introduced
or combined with MMT, the authors did not explain why they employed TMT (9–11).
Thus far, no RCT has systematically investigated the
difference between the effects of MMT and TMT. Therefore, we aimed to
conduct an RCT to directly compare the effect of MMT and TMT, on
improving hemiplegic upper limb motor functions, spasticity, and ADLs,
in a group of patients with stroke.
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