Clinical trial NCT04887376: Mirror Therapy and Cross-Education of Muscle Strength
Official title: Additive Effect of Mirror Therapy on Effects of Cross-Education of Muscle Strength of Neuromuscular Electrical Stimulation In Hemiplegic Patients
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Cerebrovascular Stroke
Muscle Weakness
Keywords: Cross-education
Neuromuscular electrical stimulation
Mirror Therapy
Lead sponsor: Istanbul Physical Medicine Rehabilitation Training and Research Hospital
Sponsor class: OTHER_GOV
First posted: 2021-05-14
Enrollment: 29
Sex: ALL
Minimum age (years): 18
Maximum age (years): 75
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Randomized controlled trial
Primary purpose: TREATMENT

Brief summary: This study was conducted to determine whether mirror therapy has an additive effect on cross-education of the strength of neuromuscular electrical stimulation (NMES) in patients with hemiplegia. As an outcome measure, the ankle dorsiflexion strength of hemiplegic patients was measured.

Detailed description: A total of 29 patients, 7 women, and 22 men were included according to the inclusion and exclusion criteria. The patients were randomly assigned to the control group (n = 14) and the Mirror group (n = 15). Five sessions of neuromuscular electrical stimulation, unaffected side ankle dorsiflexors were applied to the patients in both groups. In addition to the NMES, mirror therapy was applied to the experimental group simultaneously with NMES. Before and after treatment, both ankle dorsiflexor strength was measured with a force sensor. For force measurements, a force transducer (FC2211-0000-0100-L Compression Load Cell, TE Connectivity company, France) was used. Force transducer signals were received with a data acquisition device (POWERLAB® data acquisition system ADInstruments, Oxford, UK) and evaluated offline on the computer. The measurement values were expressed in kilogram.force (kg.f) and this value was normalized according to body weight.

Eligibility criteria: Inclusion Criteria:

* Cases with stroke duration ≥ 1 month
* Ability to walk at least 10m (functional ambulation scale ≥3)
* Age range 18-75 years
* Hemorrhagic or ischemic stroke
* Brunnstrom stage ≥4 for lower limb
* Unilateral stroke
* Cooperating with the examination and tests

Exclusion Criteria:

* Mini Mental State Assessment score \<21
* Severe spasticity (MAS = 4) in ankle dorsiflexors
* Have a contracture on ankle joint
* The presence of skin lesions in the application area
* Painful pathologies in the lower extremities
* Having visual field defects
* Active inflammatory, rheumatological or infectious disease
* Parent rhythm / conduction block problem in the heart
* Uncontrollable hypertension (Maxima\> 140, Minima\> 90)
* Presence of lower extremity fracture
* Peripheral nerve lesions such as polyneuropathy, radiculopathy
* Finding or suspected active deep vein thrombosis
* History of deep vein thrombosis and pulmonary embolism

Primary outcomes:
measure: Change of ankle dorsiflexor isometric muscle strength
timeFrame: Change from Baseline muscle strength at 6 days
Secondary outcomes:
measure: Change of Lower Extremity Brunnstrom score
timeFrame: Change from Baseline Brunnstrom score at 6 days
measure: Change of Modified Ashworth Scale score
timeFrame: Change from Baseline Modified Ashworth Scale score at 6 days
measure: Change of Functional Ambulation Scale score
timeFrame: Change from Baseline Functional Ambulation Scale score at 6 days
measure: Change of Timed Up and Go Test score
timeFrame: Change from Baseline Timed Up and Go Test score at 6 days
Other outcomes:
Locations:
city: Istanbul
country: Turkey
facility: Istanbul Physical Medicine Rehabilitation Training & Research Hospital
Study officials:
affiliation: Istanbul Physical Medicine Rehabilitation Training & Research Hospital
name: Ilhan Karacan, Assoc Prof
role: PRINCIPAL_INVESTIGATOR
References:
citation: Howatson G, Zult T, Farthing JP, Zijdewind I, Hortobagyi T. Mirror training to augment cross-education during resistance training: a hypothesis. Front Hum Neurosci. 2013 Jul 24;7:396. doi: 10.3389/fnhum.2013.00396. eCollection 2013.
citation: Zult T, Goodall S, Thomas K, Solnik S, Hortobagyi T, Howatson G. Mirror Training Augments the Cross-education of Strength and Affects Inhibitory Paths. Med Sci Sports Exerc. 2016 Jun;48(6):1001-13. doi: 10.1249/MSS.0000000000000871.
citation: Sariyildiz M, Karacan I, Rezvani A, Ergin O, Cidem M. Cross-education of muscle strength: cross-training effects are not confined to untrained contralateral homologous muscle. Scand J Med Sci Sports. 2011 Dec;21(6):e359-64. doi: 10.1111/j.1600-0838.2011.01311.x. Epub 2011 Apr 18.
citation: Lee D, Lee G. Effect of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors: a randomized controlled trial. Eur J Phys Rehabil Med. 2019 Aug;55(4):442-449. doi: 10.23736/S1973-9087.19.05334-6. Epub 2019 Mar 22.
citation: Kim H, Lee G, Song C. Effect of functional electrical stimulation with mirror therapy on upper extremity motor function in poststroke patients. J Stroke Cerebrovasc Dis. 2014 Apr;23(4):655-61. doi: 10.1016/j.jstrokecerebrovasdis.2013.06.017. Epub 2013 Jul 16.
citation: Ji SG, Cha HG, Kim MK, Lee CR. The effect of mirror therapy integrating functional electrical stimulation on the gait of stroke patients. J Phys Ther Sci. 2014 Apr;26(4):497-9. doi: 10.1589/jpts.26.497. Epub 2014 Apr 23.