Comparing the Effects of Mirror Theraphy and Neuromuscular Electrical Nerve Stimulation (NMES) in Enhancing the Hand Functional Recovery in Patients after Stroke: A Randomized Controlled Study

Authors: Basaran PO, Bolukbasi A and Basaran T*

DOI: 10.23880/aphot-16000166

Volume 3, Issue 3

Abstract

Objective: The purpose of this study was to assess the effectiveness of mirror theraphy and NMES in enhacing the upper extremity and hand motor and functional recovery , spasticity, and hand-related functioning and quality of life of patients after stroke. Design: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. Setting: Rehabilitation education and research hospital. Participants: A total of 60 inpatients with stroke (mean age 61.45) were randomızed into three groups. Mirror (n:20), NMES (n:20) and Control(n:20) groups. Interventions: All patients received a conventional neuro rehabilitation treatment for 5 days a week, 2-4 hours a day for 4 weeks. In mirror group thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements and NMES applied in front of a mirror, in NMES group; the mirror was covered than NMES applied and in control group neither NMES nor mirror was applied. Main Outcome Measures: Brunnstrom motor staging for upper extremity and hand, Modified Ashworth Scale (MAS), Functional Independence Measurement (FIM) self-care items of the FIM instrument), Nottingham Health Profile (NHP), Nine hole peg test (NHPT), superficial sense, deep sense (two point discrimination, steregnosia, graphestesia, joint position sense). Results: After the treatment, Brunnstrom motor stage improved in both mirror and NMES group but after 6 months statistically significant improvement was determinant only in mirror group(p:0.032). FIM was improved in three groups after treatment, but after 6 months improvement detected only in mirror group (p < 0,05). Spasticity ( MAS), was reduced only in the mirror group (p < 0,05). Hand skills ( NHPT) were improved only in mirror group and this improvement continued 6 months after the treatment ( p< 0,05). Quality of life was improved in both groups after treatment, but it was more in the mirror group. Conclusions: Aplication of NMES in front of a mirror is more effective on upper extremity and hand motor and functional development, hand skills and spasticity than NMES and standart theraphies of rehabilitation. This effect continues at 6 months after treatment.

Keywords: Cerebrovascular Accident; Feedback; Imagery (Psychotherapy); Motor Skills; Rehabilitation

View PDF