Mirror Therapy Versus Repetitive Facilitation Exercise on Upper Limb Function
Condition: Stroke Patient
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The objective of the study is to determine the effects of Mirror therapy on upper limb
      function in a post-stroke patient, To determine the effects of Repetitive Facilitation
      Exercise on upper limb function in a post-stroke patient and To compare the effects of Mirror
      therapy versus Repetitive Facilitation Exercise on upper limb function in the post-stroke
      patient. Study Design is Randomized control trial with a sample size of 50 participants.
      Sampling Technique used is Non-probability purposive assessor-blinded sampling technique and
      randomization through sealed envelope method Duration of study was 6 months.Study Setting of
      Railway general hospital. Inclusion criteria had Hemiparetic patient, Sub-acute and chronic
      stroke patients, First-ever stroke patient, Age: 40-60, Gender: both male and female, MMSE
      >24, Modified Ashworth scale <3, Stable patient (Good sitting balance ) and No visual-spatial
      hemineglect. Exclusion criteria of Unstable patient, Uncooperative patient, Orthopedic
      deformity, Aphasia, Visual infection and joint pain (shoulder, elbow, wrist, hip, knee,
      ankle)
    

Detailed description: 
      Stroke is classically characterized as a neurological deficit attributed to an acute focal
      injury of the central nervous system by a vascular cause, including cerebral infarction,
      intracerebral haemorrhage, and subarachnoid haemorrhage, and is a major cause of disability
      and death worldwide. Stroke is the second leading cause of death and the third leading cause
      of disability. Stroke, the sudden death of some brain cells due to lack of oxygen when the
      blood flow to the brain is lost by blockage or rupture of an artery to the brain, is also a
      leading cause of dementia and depression. Stroke kills about 140,000 Americans each year
      that's 1 out of every 20 deaths. In Pakistan, the stroke incidence of 95 per 100,000 persons
      per year for the following Years 2000 to 2016, with the highest incidence being 584,000 of
      650,000, noted among individuals aged 75 to 85. The paretic upper limb is a common and
      undesirable consequence of stroke that increases activity limitation. A number of
      interventions have been published evaluating the effect of various rehabilitation methods
      improving upper extremity control and functioning. Mirror therapy is a relatively new
      therapeutic intervention which is simple, inexpensive and most importantly patient-directed
      treatment that focuses on moving the unimpaired limb. It was first introduced by Ramachandran
      and Roger Ramachandran to treat phantom limb pain after amputation.The principle of mirror
      therapy (MT) is use of a mirror to create reflective illusion of an affected limb in order to
      trick the brain into thinking movement has occurred without pain. It involves placing the
      affected limb behind a mirror, which is sited to the reflection of the opposing limb appears
      in placing of the hidden limb. During performing the tasks with the unaffected hand, the
      participants were instructed to move their affected arm synchronically in the same way while
      viewing the mirror during the practices with the unaffected arm, the participants were
      instructed to move their affected arm synchronically while viewing the mirror. Repetitive
      facilitative exercise (RFE), a combination of high repetition rate and neuro facilitation, is
      a recently developed approach to the rehabilitation of stroke-related limb impairment. The
      RFE sessions used a novel facilitation technique to elicit movements of the shoulder, elbow
      and each finger isolated from synergy and give sufficient physical stimulation, such as by
      the stretch reflex or skin-muscle reflex that is elicited immediately before or at the same
      time as when the patient makes an effort to move his hemiplegic hand or finger. Functional
      recovery of the hemiplegic upper limb and hand might depend on the repetition of voluntary
      movements elicited by the RFEs, especially when they are influenced by a synergistic pattern.
      Principles for selection and treatment included the following: (1) an emphasis on the
      proximal musculature, given its role in stabilizing distal movements, gradual increases in
      movement difficulty with a goal of maintaining movement purity and avoiding synergy; and
      consideration of the importance/nature of the movement (eg, the first and second fingers were
      trained separately and the third and fourth together to facilitate the acquisition of pinch.
      This aim of the study is to improve the function of the upper limb in post-stroke hemiparesis
      patient. Repetitive Facilitation exercise has proved beneficial effects for improving upper
      limb function on stroke patients. There is also different opinion about the effectiveness of
      Mirror therapy on upper limb function. So the purpose of my study is to investigate whether
      Mirror Therapy or Repetitive Facilitation exercise is more effective in improving upper limb
      function in Stroke patients.
    

Intervention name(s): mirror box therapy; Repetitive Facilitation Exercise
Intervention type(s): Other; Other
Intervention description(s): Patients in Task-specific mirror box therapy group will receive therapy for 30 min/day, 3 times/week for 6 weeks.
The patient is seated close to a table a mirror (33*35 cm) was placed vertically. The involved hand was placed behind the mirror and uninvolved in front of the mirror.
The subject is asked to transfer small cubes from the middle position to the lateral side, placing pegs in holes and taking them out, turning over paper cards, placing steel needles in holes, stacking blocks, and putting glass on a shelf.
During the sessions, subjects will be asked to try and do the activity on the unaffected side and asked to do some movement with the paretic hand simultaneously.; The patients in the control group will receive Repetitive Facilitation Exercise for 30 min/day, 3 times/week for 6 weeks.
Repetitive facilitative techniques were used to elicit movement of the shoulder, elbow, wrist, and fingers in a manner designed to minimize synergistic movements.
Participants were directed to concentrate on generating movement on the joint being treated while avoiding contraction of non-targeted muscles.
Therapists provided verbal directions with commands such as "bend/straighten" or "one, two, three.
Participant efforts were supplemented as necessary to achieve a full range of motion (ROM)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Mirror therapy; Repetitive Facilitation Exercise; stroke; Upper limb