Additional Effects of Mirror Therapy on Shoulder Mobility and Function in Post-stroke Adhesive Capsulitis Patients

The estimated annual incidence of stroke in Pakistan is 250/100, 000. Upper limb impairments and post-stroke musculoskeletal complications such as pain, subluxation and restricted joint range of motion are commonly reported. Among many other shoulder impairments, adhesive capsulitis is a leading cause of limited mobility, reduced range of motion, and pain in stroke patients.

The aim of the current study will benefit the clinicians and physiotherapists as it provide an insight to treat post stroke adhesive capsulitis. Effects of mirror therapy have been established but the literature does not provide best treatment approaches or modalities for different types of Hemiplegic shoulder pain. This study will address the limitations in treatment approaches concerning the shoulder joint and its mobility in post-stroke adhesive capsulitis.

The study will be non-blinded randomized control trial, consisting of two groups. Study will be conducted over a period of 1 year. Subjects will be selected via non-probability purposive sampling technique using coin toss method followed by randomization into two groups (A and B).Ethical approval will be obtained from ERC FUMC.

One group will receive mirror therapy while other will receive conventional exercises treatment for period of 6 weeks. Baseline tests will be performed before and after the intervention of mirror therapy \& outcome measure assessments will be done after every 3 weeks for a total period of 6 weeks intervention period. Data will be entered and analyzed on SPSS version 22.

OBJECTIVES OF STUDY

1. To determine the effects of mirror therapy along with conventional therapy on improving shoulder joint range of motion in post-stroke adhesive capsulitis patients.
2. To determine the effects of mirror therapy along with conventional therapy on improving shoulder joint function in post-stroke adhesive capsulitis patients.
3. To compare the difference between the effects of mirror therapy with conventional therapy alone for improving shoulder mobility and function in post stroke adhesive capsulitis patients.

HYPOTHESIS ALTERNATE HYPOTHESIS

1. There is a statistically significant effect of mirror therapy in improving the shoulder joint Range Of Motion in post-stroke adhesive capsulitis patients. (p \> 0.05).
2. There is a statistically significant effect of mirror therapy in improving the shoulder joint function in post-stroke adhesive capsulitis patients. (p \> 0.05).

NULL HYPOTHESIS

1. There is a statistically significant effect of mirror therapy in improving the shoulder joint Range Of Motion in post-stroke adhesive capsulitis patients. (p \> 0.05).
2. There is a statistically significant effect of mirror therapy in improving the shoulder joint function in post-stroke adhesive capsulitis patients. (p \> 0.05).

Eligibility Criteria:
Inclusion Criteria:

* Both genders male and female
* Age 40-70 years
* Ability to understand and follow simple verbal instructions
* Patients able to stand for at least 10-15 mins.
* Ability to participate in a therapy session by coming to hospital.
* Chronic Stroke (ischemic) patients (6 months-1year) with adhesive capsulitis (capsular pattern :external rotation\> abduction \> internal rotation)
* Scores of \>24 on Montreal Cognitive assessment scale.

Exclusion Criteria:

* Upper limb fractures or cervical spine pathology or radiculopathy
* History of upper limb surgery or trauma
* Rotator cuff pathology or prolonged immobilization of upper limb
* Rheumatic disease, fibromyalgia or any other musculoskeletal disorder that is altering upper extremity movement
* Any other neurological condition