Effect of Mirror Therapy on Unilateral Neglect for Patients After Stroke

Study Overview
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Brief Summary
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This is a single-blinded randomized controlled trial to investigate the effects of mirror therapy (MT), with reference to sham mirror (a glass wall) and control (a covered mirror), in reducing unilateral neglect for patients with stroke in 2 centres.

Detailed Description
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Twenty-one subacute inpatients with left unilateral neglect after right-hemispheric stroke, recruited from 2 hospitals - Hong Kong and Guangzhou, in 1 and a half years, were randomly assigned to three groups; mirror therapy, sham therapy (in the form of a transparent glass wall), and control (covered mirror). The treatment programme for all groups consisted of 12 sessions (4 per week for 3 weeks) movement practice for the hemiplegic arm involved 5 table-top tasks graded according to the severity of patients' arm impairments. Blinded assessments were administered at baseline, 3-week postintervention, and 3-week follow-up upon completion of training.

Official Title
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Effect of Mirror Therapy on Unilateral Neglect for Patients After Stroke

Conditions
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The Effects of Mirror Therapy on Patients With Unilateral Neglect After Stroke

Intervention / Treatment
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* Behavioral: Mirror therapy
* Behavioral: Sham mirror
* Behavioral: Covered mirror


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ischemic or hemorrhagic stroke, confirmed by medical diagnoses compatible with a unilateral right lesion involvement (i.e. left hemiplegic), exhibited left visual field inattention or unilateral neglect by obtaining a total score of star cancellation subtest in the conventional battery of the Behavioural Inattention Test ≤ 51 (out of 54); stroke with onset of neurological condition ≤ 6 months previously; have normal or corrected-to-normal visual acuity better than 20/60 (6/18) in the better eye; with hemiplegic upper extremity functional levels 3-7 as rated by Functional Test for the Hemiplegic Upper Extremity and is able to move against gravity; ability to understand and follow simple verbal instructions, with Mini-mental State Examination ≥ 21; ability to participate in a therapy session lasting at least 30 minutes; consent to participant in the study Exclusion Criteria: prior neurological or psychiatric disorders; severe spasticity (Modified Ashworth Scale >3) over paretic arm; history of recent Botox injection or acupuncture to the paretic arm within the past three months; participation in another clinical study elsewhere apart from the study site during recruitment

Ages Eligible for Study
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Minimum Age: 18 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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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mirror therapy<br> | Behavioral: Mirror therapy<br>* A mirror is placed at the midsagittal plane of the patient. The patients in the mirror therapy group watched the mirror illusion of the non-affected arm in the mirror and moved together with the affected arm. The treatment programme for all groups consisted of 12 sessions (4 per week for 3 weeks), each lasting for 30 minutes. The movement practice involved 5 table-top tasks and the patient was instructed to perform as many trials as possible in each session with a maximum of 30 trials per task, giving a total of 150 trials per session. Treatment activities are graded according to the severity of the patient's upper extremity impairment.<br>|
| Sham Comparator: Sham mirror<br> | Behavioral: Sham mirror<br>* A transparent glass wall is placed at the midsagittal plane of the patient. The patients in the sham mirror group watched the movements of the affected arm through the transparent glass wall and moved together with the non-affected arm. The treatment programme for all groups consisted of 12 sessions (4 per week for 3 weeks), each lasting for 30 minutes. The movement practice involved 5 table-top tasks and the patient was instructed to perform as many trials as possible in each session with a maximum of 30 trials per task, giving a total of 150 trials per session. Treatment activities are graded according to the severity of the patient's upper extremity impairment.<br>|
| Active Comparator: Covered mirror<br> | Behavioral: Covered mirror<br>* A covered mirror is placed at the midsagittal plane of the patient. The patients in the control group watched the movements of the non-affected arm and moved together with the affected arm behind the covered mirror. The treatment programme for all groups consisted of 12 sessions (4 per week for 3 weeks), each lasting for 30 minutes. The movement practice involved 5 table-top tasks and the patient was instructed to perform as many trials as possible in each session with a maximum of 30 trials per task, giving a total of 150 trials per session. Treatment activities are graded according to the severity of the patient's upper extremity impairment.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unilateral neglect | Behavioural Inattention Test | Change of baseline to 3-week and to follow-up at 6-week | 
| Allocentric and egocentric neglect | Gap Detection Test | Change of baseline to 3-week and to follow-up at 6-week | 
| Functional performance related to unilateral neglect | Catherine Bergego Scale | Change of baseline to 3-week and to follow-up at 6-week | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Upper limb functions | Fugl-Meyer assessment | Change of baseline to 3-week and to follow-up at 6-week | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stroke; unilateral neglect; mirror therapy; mirror visual feedback