Mirror Therapy After Stroke: A Dosing Study
| Status: | Terminated |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - 99 |
| Updated: | 2/16/2018 |
| Start Date: | January 2017 |
| End Date: | February 13, 2018 |
Self-directed Box (Mirror) Therapy After Stroke: A Dosing Study
It has been suggested that augmenting repetitive task practice with the use of box (mirror)
therapy (BT) can enhance the benefits of task practice and may provide stroke survivors an
opportunity to engage in self-directed practice outside of normally scheduled therapy
sessions. However, the dosage of BT to be used in clinical practice is unclear. In order for
practitioners to begin integrating BT into clinical practice situations more information is
needed to determine what defines a therapeutic dose. The aim of this study is to
differentiate between two dosages of self-directed BT added to treatment as usual for
decreasing arm and hand motor impairments, improving activity level, and increasing
self-directed participation after stroke. Forty-five subjects from the Stroke Rehabilitation
Unit at Helen Hayes Hospital (HHH) will be randomly assigned into three groups: treatment as
usual plus 30 minute dosage of self-directed BT 5x/week; treatment as usual plus 60 minute
dosage of self-directed BT 5x/week; treatment as usual plus 30 minutes of self-directed sham
BT 5x/week.
therapy (BT) can enhance the benefits of task practice and may provide stroke survivors an
opportunity to engage in self-directed practice outside of normally scheduled therapy
sessions. However, the dosage of BT to be used in clinical practice is unclear. In order for
practitioners to begin integrating BT into clinical practice situations more information is
needed to determine what defines a therapeutic dose. The aim of this study is to
differentiate between two dosages of self-directed BT added to treatment as usual for
decreasing arm and hand motor impairments, improving activity level, and increasing
self-directed participation after stroke. Forty-five subjects from the Stroke Rehabilitation
Unit at Helen Hayes Hospital (HHH) will be randomly assigned into three groups: treatment as
usual plus 30 minute dosage of self-directed BT 5x/week; treatment as usual plus 60 minute
dosage of self-directed BT 5x/week; treatment as usual plus 30 minutes of self-directed sham
BT 5x/week.
Approximately 795,000 people in the United States have a stroke each year, and stroke is
considered a leading cause of long-term disability. Impairments in arm and hand function are
common after stroke and limit engagement in daily life activities, which impacts the overall
quality of life of stroke survivors. It has been found that incomplete upper limb recovery
predicted health related quality of life in stroke survivors at one year post-stroke in four
(self-care, usual activities, pain/discomfort, & anxiety/depression) out of five domains
measured on the EuroQol-5D questionnaire. Thus, evidence-based interventions that improve arm
and hand function after stroke are needed. In fact, a recent study identified "treatments for
upper extremity recovery" to be one of the top ten research priorities relating to life after
stroke according to stroke survivors, caregivers, and health professionals. Evidence suggests
task-oriented training interventions such as Repetitive Task Practice (RTP) are effective at
improving upper extremity (UE) function and activity, and therapy participation in stroke
survivors.
Recently, it has been suggested that augmenting RTP with the use of cognitive strategies,
such as Mirror Box Therapy (BT), can enhance the benefits of task practice and may provide
stroke survivors an opportunity to engage in self-directed practice outside of normally
scheduled therapy sessions. During BT, a person engages in motor activities with the
unimpaired limb while watching its mirror reflection superimposed over the (unseen) impaired
limb; this process creates a visual illusion whereby activities performed by the unimpaired
limb are attributed to the impaired limb. While generating this visual illusion is a common
ingredient in published BT effectiveness trials, the actual treatment protocols differ
considerably. One important protocol difference seen across published trials relates to the
dosage of BT. For instance, the minutes of BT provided range from 10 minutes to 60 minutes
per session; session frequencies range from 1 to 7 sessions per week, and the length of the
intervention ranges from 3 to 6 weeks. Thus, the dosage of BT to be used in clinical practice
is unclear. In order for practitioners to begin integrating BT into clinical practice more
information is needed on the effective dosage, as this may vary according to multiple factors
(e.g., stage of recovery, the survivor's current functional limitations, or environment in
which services are rendered).
considered a leading cause of long-term disability. Impairments in arm and hand function are
common after stroke and limit engagement in daily life activities, which impacts the overall
quality of life of stroke survivors. It has been found that incomplete upper limb recovery
predicted health related quality of life in stroke survivors at one year post-stroke in four
(self-care, usual activities, pain/discomfort, & anxiety/depression) out of five domains
measured on the EuroQol-5D questionnaire. Thus, evidence-based interventions that improve arm
and hand function after stroke are needed. In fact, a recent study identified "treatments for
upper extremity recovery" to be one of the top ten research priorities relating to life after
stroke according to stroke survivors, caregivers, and health professionals. Evidence suggests
task-oriented training interventions such as Repetitive Task Practice (RTP) are effective at
improving upper extremity (UE) function and activity, and therapy participation in stroke
survivors.
Recently, it has been suggested that augmenting RTP with the use of cognitive strategies,
such as Mirror Box Therapy (BT), can enhance the benefits of task practice and may provide
stroke survivors an opportunity to engage in self-directed practice outside of normally
scheduled therapy sessions. During BT, a person engages in motor activities with the
unimpaired limb while watching its mirror reflection superimposed over the (unseen) impaired
limb; this process creates a visual illusion whereby activities performed by the unimpaired
limb are attributed to the impaired limb. While generating this visual illusion is a common
ingredient in published BT effectiveness trials, the actual treatment protocols differ
considerably. One important protocol difference seen across published trials relates to the
dosage of BT. For instance, the minutes of BT provided range from 10 minutes to 60 minutes
per session; session frequencies range from 1 to 7 sessions per week, and the length of the
intervention ranges from 3 to 6 weeks. Thus, the dosage of BT to be used in clinical practice
is unclear. In order for practitioners to begin integrating BT into clinical practice more
information is needed on the effective dosage, as this may vary according to multiple factors
(e.g., stage of recovery, the survivor's current functional limitations, or environment in
which services are rendered).
Inclusion Criteria:
- Adults status post ischemic or hemorrhagic stroke between the ages 18-85, receiving
inpatient rehabilitation
- Using the impaired arm, ability to lift and release a wash cloth off a table with any
means of prehension in either the sitting or standing positions
- A score > 21/30 on the Mini-Mental State Exam
- Ability to consent.
Exclusion Criteria:
- Serious visual or visual-perceptual deficits, neuropsychological impairments, or
orthopedic conditions that would prevent participation in the BT protocol as
determined by the treatment team
- Involvement in another study protocol related to motor function after stroke
- Anticipated length of stay less than two weeks
- More than six months post stroke
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