Intensive Mirror Therapy in older adults
The present work was carried out to determine the effectiveness of neuromuscular stimulation triggered by mirror therapy in older patients with post-stroke hemiplegia by two different intervention protocols, either intensively or spaced over time. Main outcome measures: Muscle strength and activity was measured at baseline and at the end of treatment. Functional ability was also evaluated.
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A prospective randomized study was carried out. To evaluate the impact of mirror therapy on patients with post-stroke hemiplegia, a pilot-study was designed. The present trial was planned to follow a double-blind (de facto masking) design; neither the participants nor the researcher who carried out the mirror therapy knew the purpose of the study. The subjects that took part in the study were unconscious of the protocols and possible assignments between the groups. The trial was registered on clinicaltrials.gov (NCT04668963). Participants Selection criteria included voluntary aging patients (75-85 years-old) with ischaemic stroke diagnosed by imaging (CT or MR), to be included into physiotherapy therapy between two and six weeks after the stroke (mean of 20 ± 2 days), with brain damage and a significant limitation of hand extension and foot dorsiflexion stroke-derived without spasticity (Ashworth scale 1 or 1+). All patients were right-handed and hemiparetic left-sided, without previous experience in isometric evaluations. Exclusion criteria included patients with haemorrhagic stroke, with a surface EMG signal <0.5 μV, those with previous neurologic comorbidity which comprise muscle strength, patients with medical treatment which may affect muscle strength, patients with pacemaker and those with severe psychiatric conditions cognitive decline or dementia (beyond the aging-related degenerative progression). All evaluations of cognitive and sensory states were performed in the same Neurological Service. Conventional physiotherapy All patients perform the same routine for 60 minutes, which included: hand stretching, wrist extension and flexion, strength grip with a therapeutic ball, and rolling a ball on the table. Mirror therapy In addition to the physiotherapy, both groups received several mirror therapy (MT) sessions depending on the random allocation. The intensive therapy group participants received 5 MT session/week for 6 weeks, which makes a total of 30 sessions. The conventional therapy group received the same number of sessions but more spaced in time, consisting in 3 MT session/week for 10 weeks. To carry out the MT, patients were seated on a chair, with the mirror positioned between the upper limbs perpendicular to the subject’s midline and with the unaffected upper limb facing the reflective surface. Measures The mean activity of the extensor and dorsiflexor muscles during all activity stages of each EMG session was analysed. The isometric strength (Nw) of the hand was assessed with a hand-held digital dynamometer (Smedley digital hand dynamometer, RMS Ltd., UK) c. The evaluation of the physical performance was conducted through the Fugl-Meyer (FM) evaluation test. Finally, the ability of the patients to perform basic daily living activities was determined through the Barthel index.