Effects of home-based mirror therapy and cognitive therapeutic exercise on the improvement of the upper extremity functions in patients with severe hemiparesis after a stroke: a protocol for a pilot randomised clinical trial

Abstract

IntroductionNeuroplasticity is defined as the capacity of the brain to reorganise new neuronal pathways. Mirror therapy (MT) and cognitive therapeutic exercise (CTE) are two neurorehabilitation techniques based on neuroplasticity and designed to improve the motor functions of the affected upper extremity in patients with severe hemiparesis after a stroke. Home-based interventions are an appropriate alternative to promote independence and autonomy. The objective of this study is to evaluate which of these techniques, MT and CTE, combined with task-oriented training, is more effective in functional recovery and movement patterns of the upper extremities in patients with severe hemiparesis after a stroke.Methods and analysisThis is a home-based, single-blind, controlled, randomised clinical trial with three parallel arms, including 154 patients who had a stroke aged above 18 years. The primary outcome will be the functionality of the affected upper extremity measured using the Fugl-Meyer Assessment. Secondary variables will include cognitive performance, emotional state, quality of life and activities of daily living. During 6 weeks, one of the intervention groups will receive a treatment based on MT and the other one on CTE, both combined with task-oriented training. No additional interventions will be provided to the control group. To assess the progress of patients who had a stroke in the subacute phase, all variables will be evaluated at different visits: initial (just before starting treatment and 4 weeks post-stroke), post-intervention (6 weeks after initial) and follow-up (6 months).Ethics and disseminationThis protocol has been approved by the Institutional Review Board (CEIm-2.134/2.019) and registered at ClinicalTrials.gov (NCT04163666). The results will be disseminated through open-access peer-reviewed journals, conference presentation, broadcast media and a presentation to stakeholders. These study results will provide relevant and novel information on effective neurorehabilitation strategies and improve the quality of intervention programmes aimed at patients after a stroke.Trial registration numberClinicalTrials.gov (NCT04163666).

Impact of Hand Grip Strength on Functional Independence and Arm Motor Performance in Stroke Survivors

“…The study's assessments were systematically conducted at baseline, during the 3rd week, and at the 6th week. The tools utilized for these evaluations included the Action Research Arm Test, the Fugl-Meyer Assessment for the upper extremity, a Hand-Held Dynamometer, and the Stroke Impact Scale (19). These instruments were chosen for their reliability and validity in measuring the aspects of upper limb functionality, muscle strength, and the overall impact of stroke on the participants' quality of life.…”

Efek Mirror Therapy Pada Fungsi Motorik Ekstremitas Atas Pada Pasien Pasca Stroke

“…(Oliveira e Castro et al, 2018) Berbagai uji klinis telah menetapkan bahwa Mirror therapy berguna dalam meningkatkan fungsi Mirror therapy melibatkan superimposisi dari refleksi gerakan ekstremitas yang sehat pada ekstremitas yang terkena agar pasien dapat mengamatinya seolah-olah ekstremitasnya bergerak (Gurbuz et al, 2016). Sebuah cermin ditempatkan pada bidang midsagital pasien sehingga gambar samping yang sehat akan dilapiskan pada proyeksi ekstremitas yang terkena (Gonzalez-Santos et al, 2020). Dengan demikian, terdapat ilusi visual peningkatan kemampuan gerak pada ekstremitas paretik (Simpson et al, 2019).…”

Move Bit: um Jogo Sério que melhora a função motora do membro superior de hemiparéticos

“…Destaca-se que a hemiparesia é o quadro mais frequente, sendo caracterizada por uma perda parcial da força muscular (FM) no hemicorpo contralateral à lesão encefálica 5 . Esse quadro limita a capacidade funcional, refletindo em dificuldades para realização de atividades de vida diárias (AVD's) 6 , especialmente pelo fato de muitas dessas atividades envolverem os membros superiores 7 .…”

“…A fisioterapia possui inúmeros recursos convencionais que podem ser utilizados, como técnicas de posicionamento, cinesioterapia passiva e ativa para mobilização precoce, exercícios resistidos, estimulação sensorial, uso de órteses, eletroestimulação, terapia do espelho, exercícios terapêuticos cognitivos, entre outros 6,9 . Embora estas abordagens já tenham demonstrado efeitos terapêuticos positivos, de forma frequente, são consideradas pelos pacientes como tarefas repetitivas, monótonas e entediantes 4,9,10 .…”