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Unilateral strength training and mirror therapy in chronic stroke patients

A pilot randomised trial

Ehrensberger, Monikaa; Simpson, Daniela; Broderick, Patricka; Blake, Catherineb; Horgan, Francesc; Hickey, Paulad; O’Reilly, Joanned; Monaghan, Kennetha

American Journal of Physical Medicine & Rehabilitation: February 13, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001162
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Objective This study aimed to investigate the feasibility and potential effectiveness of mirror-aided cross-education compared to cross-education alone in post-stroke upper limb recovery.

Design A pilot randomized controlled parallel group study was carried out. Thirty-two chronic stroke patients followed a 4-week isometric strength-training programme performed with the less-affected upper limb 3 times per week. Participants in the mirror and strength training group observed the reflection of the exercising arm in the mirror; Participants in the strength training only group exercised without a mirror entirely. Participant compliance, adverse effects and suitability of outcome measures assessed feasibility. Effectiveness outcomes included maximal isometric strength measured with the Biodex Dynamometer, the Modified Ashworth Scale and the Chedoke Arm and Hand Activity Inventory.

Results Compliance was high with no adverse effects. The use of the Biodex Dynamometer must be reviewed. Mirror therapy did not augment the cross-education effect (p>0.05) in chronic stroke patients when training isometrically.

Conclusion This pilot trial established the feasibility of a randomised controlled trial comparing mirror-aided cross-education to cross-education alone for post-stroke upper limb recovery. Mirror therapy did not augment cross-education when training isometrically. However, results indicate that the combination of interventions should be investigated further applying an altered training protocol.

(Trial Registration Number NCT 03500705)

a Clinical Health & Nutrition Centre (CHANCE), Department of Life Sciences, Institute of Technology, Sligo, Ireland

b Physiotherapy & Population Science, University College Dublin, Dublin, Ireland

c Faculty of Medicine & Health Sciences, Royal College of Surgeons Ireland, Dublin, Ireland

d University Hospital, Sligo, Ireland

Corresponding author: Monika Ehrensberger, Clinical Health & Nutrition Centre (CHANCE), Department of Life Sciences, Institute of Technology, Sligo, Ireland. Email: s00083283@mail.itsligo.ie / Tel: (+353) (0) 7191 55222

Disclosure of Interest Statement: All contributors to this article are independent authors; there are no conflicts of interest.

Funding/ Support Statement

Monika Ehrensberger: Institute of Technology Sligo President’s Bursary Fund and Irish Research Council Postgraduate Scholarship (GOIPG/2016/1662)

Daniel JC Simpson: Institutes of Technology Ireland Postgraduate Research Scholarship and Institute of Technology Sligo Capacity Building Fund

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