Monday, July 8, 2013

Mirror therapy for improving motor function after stroke

I couldn't tell if this was for acute or chronic, so off to your therapist you go.
http://stroke.ahajournals.org/content/44/1/e1.full

Mirror Therapy for Improving Motor Function After Stroke

  1. Christian Dohle, MD, MPhil
+ Author Affiliations
  1. From Erste Europäische Schule für Physiotherapie (H.T.), Ergotherapie und Logopädie, Klinik Bavaria Kreischa, Kreischa, Sachsen, Germany; Medizinische Fakultät (H.T., J.B.), Institut für Gesundheits und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany; Wissenschaftliches Institut (J.M.), Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, Kreischa, Germany; Sektion Therapiewissenschaften (J.M.), SRH Fachhochschule für Gesundheit Gera GmbH, Gera, Germany; Abteilung Neurologie und Fachübergreifende Rehabilitation (M.P.), Klinik Bavaria Kreischa, Kreischa, Germany; Abteilung für Neurologische Rehabilitation (C.D.), MEDIAN Klinik Berlin-Kladow, Berlin, Germany; Center for Stroke Research Berlin (C.D.), Charité, University Medicine Berlin, Berlin, Germany; Department of Rehabilitation Science (C.D.), University of Potsdam, Potsdam, Germany.
  1. Correspondence to Holm Thieme, DrPH, Erste Europäische Schule für Physiotherapie, Ergotherapie und Logopädie, Klinik Bavaria Kreischa Dresdner Straße, 12 D–01705 Kreischa, Germany. E-mail holm.thieme@physiotherapie-schule-kreischa.de
Key Words:

Introduction

Mirror therapy is used to improve motor function after stroke. During mirror therapy, a mirror is placed in the patient’s midsagittal plane, thus reflecting movements of the nonparetic side as if it were the affected side.

Objectives

This systematic review summarizes the effectiveness of mirror therapy for improving motor function, activities of daily living, pain, and visuospatial neglect in patients after stroke.

Methods

We searched the Cochrane Stroke Group’s Trials Register (June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to June 2011), EMBASE (1980 to June 2011), CINAHL (1982 to June 2011), AMED (1985 to June 2011), PsycINFO (1806 to June 2011), and PEDro (June 2011). We also handsearched relevant conference proceedings, trials, and research registers; checked reference lists; and contacted trialists, researchers, and experts in our field of study. We included randomized controlled trials and randomized crossover trials comparing mirror therapy with any control intervention for patients after stroke. Two review authors independently selected trials based on the inclusion criteria, documented the methodological quality of studies, and extracted data. The primary outcome was motor function. We analyzed the results as standardized mean differences (SMDs) for continuous variables.

Results

We included 14 studies with a total of 567 participants, which compared mirror therapy with other interventions. When compared with all other interventions, mirror therapy was found to have a significant effect on motor function (postintervention data: SMD 0.61; 95% CI 0.22 to 1.0; P=0.002; change scores: SMD 1.04; 95% CI 0.57 to 1.51; P<0.0001); Figure). However, effects on motor function are influenced by the type of control intervention. Additionally, mirror therapy was found to improve activities of daily living (SMD 0.33; 95% CI 0.05 to 0.60; P=0.02). We found a significant positive effect on pain (SMD −1.10; 95% CI −2.10 to −0.09; P=0.03), which is influenced by patient population. We found limited evidence for improving visuospatial neglect (SMD 1.22; 95% CI 0.24 to 2.19; P=0.01). The effects on motor function were stable at follow-up assessment after 6 months.

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