Effect of Modified Mirror Therapy in Patients With Upper Limb Hemiparesis After Stroke

The Clinical Effect of Modified Mirror Therapy in Patients With Upper Limb Hemiparesis After Stroke: A Randomized Controlled Study

This was a randomized controlled study in China conducted during Aug. 2022 to Aug. 2023. Totally, patients with upper limb hemiplegia after stroke, who were admitted in the Department of Rehabilitation Medicine of two hospitals, were enrolled. The study lasted 30 days for each participant. The patients enrolled were randomly divided into the experimental group and the control group, all under routine rehabilitation therapy. Additionally, the patients in the experimental group were given modified mirror therapy.

Study Overview

• Status: Terminated
• Conditions: Stroke
• Intervention / Treatment: Behavioral: Routine treatment; Behavioral: Rehabilitation training; Behavioral: Modified mirror therapy

Detailed Description

Upper limb hemiparesis is a motor and sensory disorder that occurs after stroke, with an incidence rate of up to 55% to 75%. Effective upper limb rehabilitation methods help reduce the occurrence of disuse syndrome and complex regional pain syndrome. Therefore, finding active and effective limb rehabilitation methods has important practical significance.This was a randomized controlled study in China conducted during Aug. 2022 to Aug. 2023. Totally, patients with upper limb hemiplegia after stroke, who were admitted in the Department of Rehabilitation Medicine of two hospitals, were enrolled. The study lasted 30 days for each participant. The patients enrolled were randomly divided into the experimental group and the control group, all under routine rehabilitation therapy. Additionally, the patients in the experimental group were given modified mirror therapy. The assessment was conducted respectively on day 1 and day 30.

• Study Type: Interventional
• Enrollment (Actual): 116
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Henan
    • Zhengzhou, Henan, China, 450000
      • Zheng da yi fu yuan hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Meeting the diagnostic criteria of stroke, by CT or MRI.
• The first-onset stroke.
• Presenting with unilateral upper limb dysfunction, within Brunnstrom stage Ⅱ to Ⅳ on the affected side, and Ash-worth score ≤2.
• No obvious cognitive impairment, with Mini-Mental State Examination (MMSE) score >21 points.
• National Institutes of Health Stroke Scale (NIHSS) score >4 points.
• Stable vital signs, no severe diseases such as cancer, liver or kidney disorders.
• Aged 35-70 years.
• Courses of diseases 2-6 weeks.

Exclusion Criteria:

• Presence of aphasia, apraxia, or hemispatial neglect.
• Presence of hearing, vision, or comprehension impairments that hinder diagnosis and treatment.
• Complicate with traumas, fractures, or other progressive neuro-muscular system diseases.
• Severe spasticity in the upper limbs.
• Severe bone, joint, or muscle deformities or lesions.
• History of mental illness.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: modified mirror therapy+Modified mirror therapy; The study lasted 30 days for each participant. The patients enrolled were randomly divided into the experimental group and the control group, all under routine rehabilitation therapy. Additionally, the patients in the experimental group were given modified mirror therapy.	Behavioral: Routine treatment; The routine treatment included intervention for risk factors (such as blood pressure, blood lipids, and blood glucose control, restriction of smoking and alcohol, exercise, etc.); Other Names: Comprehensive routine treatment; Behavioral: Rehabilitation training; The Participants with stable vital signs were scheduled for specialized rehabilitation training upon enrollment, and targeted rehabilitation programs were selected based on the patient's specific limb function impairment, conducted by experienced rehabilitation therapists.; Behavioral: Modified mirror therapy; The patients were instructed to watch the recorded video and imitate the movements of their affected limbs. After the video ended, only the instructions and synchronized music were played. The patient was required to sit in front of a mirror table, with the mirror placed between both arms and facing the healthy side. The patient was required to recall the video based on the verbal instructions while using the healthy side to perform movement training. They were also asked to observe the reflected motion of the healthy limb in the mirror, simultaneously imagining the affected limb moving in sync (the patient focused on the front of the mirror, avoiding direct eye contact with the healthy hand, to create the sensation that it was the affected hand performing the movements).
Active Comparator: routine rehabilitation therapy; The study lasted 30 days for each participant. The patients enrolled were randomly divided into the experimental group and the control group, all under routine rehabilitation therapy.	Behavioral: Routine treatment; The routine treatment included intervention for risk factors (such as blood pressure, blood lipids, and blood glucose control, restriction of smoking and alcohol, exercise, etc.); Other Names: Comprehensive routine treatment; Behavioral: Rehabilitation training; The Participants with stable vital signs were scheduled for specialized rehabilitation training upon enrollment, and targeted rehabilitation programs were selected based on the patient's specific limb function impairment, conducted by experienced rehabilitation therapists.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fugl-Meyer Assessment-Upper Extremity	The Fugl-Meyer Assessment-Upper Extremity was used to evaluate the patient's upper limb function and motor control. It included the assessment of movements in the shoulder, elbow joint, wrist, and fingers. During the assessment, the assessor observed and recorded the patient's abilities and limitations in specific actions. Based on the patient's performance in each sub-item, the assessor assigned a score using a 0-2 scale, a score of 0 indicating inability to perform, 1 indicating partial ability, and 2 indicating full ability. Finally, the scores for each sub-item were summed up to obtain an overall upper limb function score of 0-66, with scores positively correlated with the upper limb function.	day 1 and day 30

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
the coordinated contraction rate-Surface electromyography-The biceps brachii	The surface electromyography (sEMG) was used to assess the coordinated contraction rates of the biceps brachii on the affected upper limb. The surface electromyography device was used for detection, with the most prominent part of muscle belly of the biceps brachii serving as the monitoring points. During the maximum isometric voluntary contraction (MIVC) state of elbow flexion or extension, two channels were used to separately record the integrated electromyographic values (iEMG) of the biceps brachii, and the antagonists. Measurements were taken three times to obtain the maximum value, and the coordinated contraction rate (CR) during elbow flexion or extension under MIVC conditions was calculated using the formula: CR (%) = Antagonist muscle iEMG / (Agonist muscle iEMG + Antagonist muscle iEMG).	day 1 and day 30
the coordinated contraction rate-Surface electromyography-The triceps brachii	The surface electromyography (sEMG) was used to assess the coordinated contraction rates of the triceps brachii on the affected upper limb. The surface electromyography device was used for detection, with the most prominent part of muscle belly of triceps brachii serving as the monitoring points. During the maximum isometric voluntary contraction (MIVC) state of elbow flexion or extension, two channels were used to separately record the integrated electromyographic values (iEMG) of the triceps brachii, and the antagonists. Measurements were taken three times to obtain the maximum value, and the coordinated contraction rate (CR) during elbow flexion or extension under MIVC conditions was calculated using the formula: CR (%) = Antagonist muscle iEMG / (Agonist muscle iEMG + Antagonist muscle iEMG).	day 1 and day 30
Visual Analog Scale	the pain level of the affected shoulder was measured using the Visual Analog Scale (VAS), with 0 indicating no pain and 10 indicating unbearable severe pain. The lower score indicated the lighter pain.	day 1 and day 30
Anxiety	The anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7), including items related to fear, worry, attention, etc. The total score ranged from 0 to 21, which was positively correlated with potential anxiety. In the previous study, the GAD-7 scale demonstrated a Cronbach's α-coefficient of 0.879. The scores range from 0 to 21. The higher scores mean a worse outcome.	day 1 and day 30
Depression	The depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with aspects including mood swings, optimism, sleep quality, appetite, etc. The total score of PHQ-9 ranged from 0 to 27, which was positively correlated with potential depression. In the previous study, the PHQ-9 scale demonstrated a Cronbach's α-coefficient of 0.913.The scores range from 0 to 27.The higher scores mean a worse outcome.	day 1 and day 30

Collaborators and Investigators

• Sponsor: Zeng Changhao
• Investigators: Principal Investigator: Nieto Luis, Doctor, Site Coordinator of United Medical Group located in Miami

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2022
• Primary Completion (Actual): July 12, 2023
• Study Completion (Actual): August 31, 2023

Study Registration Dates

• First Submitted: December 24, 2023
• First Submitted That Met QC Criteria: December 28, 2023
• First Posted (Actual): January 10, 2024

Study Record Updates

• Last Update Posted (Estimated): March 5, 2024
• Last Update Submitted That Met QC Criteria: March 2, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Stroke; Paresis
• Other Study ID Numbers: 2022-KY-0523-012

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No