Comparing Unimanual and Bimanual Mirror Therapy for Upper Limb Recovery Post Stroke

Study Overview
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Brief Summary
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The purpose of this randomized controlled study is to Examine the feasibility of a home Mirror therapy (MT) program in the NYC metropolitan area; Evaluate the effectiveness of home MT versus traditional home exercise program; and Evaluate the superiority of unimanual or bimanual MT intervention protocols for chronic stroke subjects with moderate hand deficits. Subjects from occupational therapy at the Ambulatory Care Center of NYU Langone Center with a diagnosis of cerebral vascular accident (CVA) or stroke will be divided into three (3) groups: Control Group subjects will participate in standard occupational therapy rehabilitation protocol plus a traditional home based exercise program. Experimental group 1 subjects will participate in standard rehabilitation protocol plus unimanual home based mirror therapy program Experimental group 2 subjects will participate in standard rehabilitation protocol plus bimanual home based mirror therapy program.

Official Title
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Home Mirror Therapy: A Randomized Control Study Comparing Unimanual and Bimanual Mirror Therapy for Improved Hand Function Post-stroke

Conditions
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Cerebral Vascular Accident (CVA), Stroke

Intervention / Treatment
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* Behavioral: Traditional Home Based Exercise Program
* Behavioral: Unimanual Home Based Mirror Therapy Program
* Behavioral: Bimanual Home Based Mirror Therapy Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: First time unilateral stroke > 3 months post stroke. Cognitively be able to follow direction Cognitively be able to consent to participation in research study Moderate/severe deficits as per the Fugl-Meyer assessment score from 10-50 and the ability to grasp and release a small towel or washcloth. Exclusion Criteria: Complex medical problems, that would render the subject unable to participate in an extensive home program History of pre-existing neurological or psychiatric diseases, orthopedic conditions of the upper limbs, or peripheral nerve injuries that render the subject unable to sit or to move either upper limb Hearing and vision impairments which may impede subjects participation in the home program Perceptual deficits such as apraxia, neglect, or agnosias as per clinical evaluation which may impede subjects participation in the home program Botox injection in affected arm/hand within 3 months Global aphasia that may interfere with understanding instruction for testing or home exercise program.

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Control Group<br>Subjects will participate in standard occupational therapy rehabilitation protocol plus a traditional home based exercise program. | Behavioral: Traditional Home Based Exercise Program<br>* Subjects in the control group will receive a traditional home Occupational Training exercise program as per conventional OT guidelines with the same home program duration.<br>|
| Experimental Group 1<br>Subjects will participate in standard rehabilitation protocol plus unimanual home based mirror therapy program | Behavioral: Unimanual Home Based Mirror Therapy Program<br>* The affected hand will remain still in the mirror box, the unaffected hand will perform the exercises while the subject watches the mirror reflection.<br>|
| Experimental Group 2<br>Subjects will participate in standard rehabilitation protocol plus bimanual home based mirror therapy program. | Behavioral: Bimanual Home Based Mirror Therapy Program<br>* The affected hand in the mirror box will best mimic the unaffected hand, while also watching the mirror reflection.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fugl-Meyer Assessment (FMA) | Gold Standard to evaluate and measure recovery in patients with hemiplegia post stroke. | Baseline to Six (6) Weeks | 
| Grip strength | Grip strength is important to measure as it is correlated with stroke recovery. | Baseline to Six (6) Weeks | 
| Action Research Arm Test (ARAT) | An interview based tool that measures a subject's perceived difficulty with the use of their arm/hands with activities of daily living post-stroke. | Baseline to Six (6) Weeks | 
| Stroke Impact Scale Version 3.0 | A subjective standardized 59-items 8 domain questionnaire assessing health status post-stroke. | Baseline to Six (6) Weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Post Stroke Recovery, Mirror Therapy, Unimanual mirror therapy, Bimanual mirror therapy, Stroke