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İnmeli Hastalarda Ayna Tedavisinin Üst Ekstremitede Motor İyileşme ve Fonksiyona Etkisi

Year 2018, Volume: 2 Issue: 2, 173 - 181, 31.08.2018

Nevcivan Bulmuş Demirbaş Şenay Özdolap Selda Sarıkaya Füruzan Köktürk

Abstract

İnmeli hastalarda üst ekstremite motor fonksiyonlarının
iyileştirilmesinde ayna tedavisinin etkinliğini değerlendirmek.
Çalışmaya kliniğimizde yatarak rehabilitasyona alınan 53 inme
hastası dahil edildi. Hastalardan 30’u çalışma grubuna, 23’ü ise
kontrol grubuna alındı. Tüm hastalar 4 hafta boyunca 60 dk süre ile,
haftada beş gün konvansiyonel rehabilitasyon programına alındı.
Çalışma grubunda yer alan hastalar ek olarak haftada beş gün, 4 hafta
boyunca 30 dk ayna tedavisi aldı. Hastalar rehabilitasyon
programının başlangıcında (tedavi öncesi), 4. hafta sonunda (tedavi
sonrası) ve 12 hafta sonra (takip) değerlendirildi. Üst ekstremite ve
el motor iyileşmesi Brunnstrom motor evrelemesi ile değerlendirildi.
El bilek fleksör kas spastisite düzeyini belirlemek için Modifiye
Ashworth Skalası (MAS) kullanıldı. Hastaların engellilik düzeyleri
Fonksiyonel Bağımsızlık Ölçütü (FBÖ) ile değerlendirildi.
Çalışmaya dahil edilen hastaların 30’u kadın, 23’ü erkekti ve yaş
ortalaması 59.91±4.04 (55-66) yıl idi. Grupların zaman içindeki
değişimi incelendiğinde, tedavi sonrası ve takipte hem çalışma
grubunda hem de kontrol grubunda Brunnstrom üst esktremite ve el
motor evresinin ve FBÖ motor ve total skorunun istatistiksel olarak
anlamlı düzeyde arttığı saptandı (tümü için p<0.001). İki grupta
Brunnstrom üst esktremite ve el motor evresinin ve FBÖ motor ve
total skorunun tedavi sonu ve takipte elde edilen artışları birbiriyle
karşılaştırıldığında istatistiksel olarak anlamlı fark saptanmadı
(sırasıyla p=0.607, p=0.790, p=0.146, p=0.123 ). Tedavi sonrası ve
takipte hem çalışma grubunda hem de kontrol grubunda el bilek
fleksör spastisitesinde istatistiksel olarak anlamlı değişiklik
saptanmadı (p=0.240). İki grupta el bilek fleksör kaslarının
spastisitesinde tedavi sonu ve takipte elde edilen değişiklikler
birbiriyle karşılaştırıldığında istatistiksel olarak anlamlı fark
saptanmadı (p=0.731).
Bu araştırmada kronik inme hastalarında konvansiyonel
rehabilitasyona eklenen 4 haftalık ayna tedavisinin motor ve
fonksiyonel iyileşmeye katkısının olmadığı saptanmıştır. Ayna
tedavisinin inme rehabilitasyonunda gelecekte daha etkin olarak
kullanılabilmesi için standardizasyonunu sağlayacak iyi planlanmış
araştırmalara halen ihtiyaç bulunmaktadır.

Keywords

İnme Rehabilitasyon Ayna tedavis

References

  • 1. Herrington W, Haynes R, Staplin N, Emberson J, Baigent C, Landray M. Evidence for the prevention and treatment of stroke in dialysis patients. Semin Dial 2015;28(1):35-47.
  • 2. Invernizzi M, Negrini S, Carda S, Lanzotti L, Cisari C, Baricich A. The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: a randomized controlled trial. Eur J Phys Rehabil Med 2013;49(3):311-317.
  • 3. Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke 2003;34(9):2181-2186.
  • 4. Masiero S, Celia A, Rosati G, Armani M. Robotic-assisted rehabilitation of the upper limb after acute stroke. Arch Phys Med Rehabil 2007;88(2):142-149.
  • 5. de Kroon JR, van der Lee JH, MJ IJ, Lankhorst GJ. Therapeutic electrical stimulation to improve motor control and functional abilities of the upper extremity after stroke: a systematic review. Clin Rehabil 2002;16(4):350-360.
  • 6. Corbetta D, Sirtori V, Moja L, Gatti R. Constraint-induced movement therapy in stroke patients: systematic review and meta-analysis. Eur J Phys Rehabil Med 2010;46(4):537-544.
  • 7. Funase K, Tabira T, Higashi T, Liang N, Kasai T. Increased corticospinal excitability during direct observation of self-movement and indirect observation with a mirror box. Neurosci Lett 2007;419(2):108-112.
  • 8. Ramachandran VS, Rogers-Ramachandran D, Cobb S. Touching the phantom limb. Nature 1995;377(6549):489-490.
  • 9. Sutbeyaz S, Yavuzer G, Sezer N, Koseoglu BF. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil 2007;88(5):555-559.
  • 10. Park Y, Chang M, Kim KM, An DH. The effects of mirror therapy with tasks on upper extremity function and self-care in stroke patients. J Phys Ther Sci 2015;27(5):1499-1501.
  • 11. Park JY, Chang M, Kim KM, Kim HJ. The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients. J Phys Ther Sci 2015;27(6):1681-1683.
  • 12. Lee MM, Cho HY, Song CH. The mirror therapy program enhances upper-limb motor recovery and motor function in acute stroke patients. Am J Phys Med Rehabil 2012;91(8):689-696, quiz 697-700.
  • 13. Kim K, Lee S, Kim D, Lee K, Kim Y. Effects of mirror therapy combined with motor tasks on upper extremity function and activities daily living of stroke patients. J Phys Ther Sci 2016;28(2):483-487.
  • 14. Amasyali SY, Yaliman A. Comparison of the effects of mirror therapy and electromyographytriggered neuromuscular stimulation on hand functions in stroke patients: a pilot study. Int J Rehabil Res 2016;39(4):302-307.
  • 15. Welmer AK, Holmqvist LW, Sommerfeld DK. Hemiplegic limb synergies in stroke patients. Am J Phys Med Rehabil 2006;85(2):112-119.
  • 16. Gregson JM, Leathley MJ, Moore AP, Smith TL, Sharma AK, Watkins CL. Reliability of measurements of muscle tone and muscle power in stroke patients. Age Ageing 2000;29(3):223-228.
  • 17. Granger CV, Cotter AC, Hamilton BB, Fiedler RC. Functional assessment scales: a study of persons after stroke. Arch Phys Med Rehabil 1993;74(2):133-138.
  • 18. Stevens JA, Stoykov ME. Simulation of bilateral movement training through mirror reflection: a case report demonstrating an occupational therapy technique for hemiparesis. Top Stroke Rehabil 2004;11(1):59-66.
  • 19. Kim YH, Jang SH, Chang Y, Byun WM, Son S, Ahn SH. Bilateral primary sensori-motor cortex activation of post-stroke mirror movements: an fMRI study. Neuroreport 2003;14(10):1329- 1332.
  • 20. Hamzei F, Lappchen CH, Glauche V, Mader I, Rijntjes M, Weiller C. Functional plasticity induced by mirror training: the mirror as the element connecting both hands to one hemisphere. Neurorehabil Neural Repair 2012;26(5):484-496.
  • 21. Franceschini M, Agosti M, Cantagallo A, Sale P, Mancuso M, Buccino G. Mirror neurons: action observation treatment as a tool in stroke rehabilitation. Eur J Phys Rehabil Med 2010;46(4):517-523.
  • 22. Small SL, Buccino G, Solodkin A. The mirror neuron system and treatment of stroke. Dev Psychobiol 2012;54(3):293-310.
  • 23. Yeldan I, Huseyinsinoglu BE, Akinci B, Tarakci E, Baybas S, Ozdincler AR. The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients. J Phys Ther Sci 2015;27(11):3519-3524.
  • 24. Kuzgun S, Özgen M, Armagan O, Tascioglu F, Baydemir C. İnme rehabilitasyon programı ile kombine edilen ayna tedavisinin motor ve fonksiyonel iyileşme üzerine etkinliğinin araştırılması. Turkish Journal of Cerebrovascular Diseases. 2012;18(3):77-82.
  • 25. Colomer C, E NO, Llorens R. Mirror therapy in chronic stroke survivors with severely impaired upper limb function: a randomized controlled trial. Eur J Phys Rehabil Med 2016;52(3):271-278.
  • 26. Arya KN, Pandian S. Effect of task-based mirror therapy on motor recovery of the upper extremity in chronic stroke patients: a pilot study. Top Stroke Rehabil 2013;20(3):210-217.
  • 27. Stevens JA, Stoykov ME. Using motor imagery in the rehabilitation of hemiparesis. Arch Phys Med Rehabil 2003;84(7):1090-1092.
  • 28. Altschuler EL, Wisdom SB, Stone L, Foster C, Galasko D, Llewellyn DM, et al. Rehabilitation of hemiparesis after stroke with a mirror. Lancet 1999;353(9169):2035-2036.
  • 29. Yavuzer G, Selles R, Sezer N, Sutbeyaz S, Bussmann JB, Koseoglu F, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil 2008;89(3):393-398.
  • 30. Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev 2012(3):CD008449.
  • 31. Dohle C, Pullen J, Nakaten A, Kust J, Rietz C, Karbe H. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair 2009;23(3):209-217.
  • 32. Wu CY, Huang PC, Chen YT, Lin KC, Yang HW. Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil 2013;94(6):1023-1030.
  • 33. Samuelkamaleshkumar S, Reethajanetsureka S, Pauljebaraj P, Benshamir B, Padankatti SM, David JA. Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial. Arch Phys Med Rehabil 2014;95(11):2000-2005.
  • 34. Agnew ZK, Wise RJ, Leech R. Dissociating object directed and non-object directed action in the human mirror system; implications for theories of motor simulation. PLoS One 2012;7(4):e32517.
  • 35. 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;26(4):497-499.
  • 36. Arya KN, Pandian S, Kumar D. Task-based mirror therapy enhances ipsilesional motor functions in stroke: A pilot study. J Bodyw Mov Ther 2017;21(2):334-341.
  • 37. 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;23(4):655-661.

The Effect of Mirror Therapy on Upper Extremity Motor Function and Motor Recovery in Stroke Patients

Year 2018, Volume: 2 Issue: 2, 173 - 181, 31.08.2018

Nevcivan Bulmuş Demirbaş Şenay Özdolap Selda Sarıkaya Füruzan Köktürk

Abstract

To evaluate the effectiveness of mirror therapy on improvement of
motor functions of the upper extremity in patients with stroke.
Fifty-three stroke patients were included this study. Patients were
assigned to either an mirror therapy group (n=30) or a control group
(n=20). All patients were enrolled in a conventional rehabilitation
program for 4 weeks, 60 minutes, and 5 days a week. Patients in the
study group received additional 30 minutes of mirror therapy for five
days a week for four weeks. Patients were evaluated at the beginning
of the rehabilitation program (pre-treatment), at the end of the 4th
week (after the treatment) and 12 weeks (follow-up). Brunnstrom
recovery stage of arm and hand, Functional Independence Measure
(FIM) and Modified Ashworht Scale (MAS) were used to evaluate
the patient’s upper extremity motor recovery, function and spasticity.
After one month of treatment and follow-up evaluation patients of
both groups showed statistically significant improvement in all the
variables except spasticity (all for p<0.001). No significant
differences in Brunnstrom stage, FIM were found between groups
(Respectively sırasıyla p=0.607, p=0.790, p=0.146, p=0.123). There
was no statistically significant change in wrist flexor spasticity in
both the study group and the control group after treatment (p =
0.240). There was no statistically significant difference in the
spasticity of the wrist flexor muscles were found between groups (p
= 0.731).
In our study, the superiority of mirror therapy to conventional
therapy was not determined. There is still a need for well-planned
studies to standardize mirror therapy so that it can be used more
effectively in stroke rehabilitation in the future.

Keywords

Stroke Rehabilitation Mirror therapy

References

  • 1. Herrington W, Haynes R, Staplin N, Emberson J, Baigent C, Landray M. Evidence for the prevention and treatment of stroke in dialysis patients. Semin Dial 2015;28(1):35-47.
  • 2. Invernizzi M, Negrini S, Carda S, Lanzotti L, Cisari C, Baricich A. The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: a randomized controlled trial. Eur J Phys Rehabil Med 2013;49(3):311-317.
  • 3. Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke 2003;34(9):2181-2186.
  • 4. Masiero S, Celia A, Rosati G, Armani M. Robotic-assisted rehabilitation of the upper limb after acute stroke. Arch Phys Med Rehabil 2007;88(2):142-149.
  • 5. de Kroon JR, van der Lee JH, MJ IJ, Lankhorst GJ. Therapeutic electrical stimulation to improve motor control and functional abilities of the upper extremity after stroke: a systematic review. Clin Rehabil 2002;16(4):350-360.
  • 6. Corbetta D, Sirtori V, Moja L, Gatti R. Constraint-induced movement therapy in stroke patients: systematic review and meta-analysis. Eur J Phys Rehabil Med 2010;46(4):537-544.
  • 7. Funase K, Tabira T, Higashi T, Liang N, Kasai T. Increased corticospinal excitability during direct observation of self-movement and indirect observation with a mirror box. Neurosci Lett 2007;419(2):108-112.
  • 8. Ramachandran VS, Rogers-Ramachandran D, Cobb S. Touching the phantom limb. Nature 1995;377(6549):489-490.
  • 9. Sutbeyaz S, Yavuzer G, Sezer N, Koseoglu BF. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil 2007;88(5):555-559.
  • 10. Park Y, Chang M, Kim KM, An DH. The effects of mirror therapy with tasks on upper extremity function and self-care in stroke patients. J Phys Ther Sci 2015;27(5):1499-1501.
  • 11. Park JY, Chang M, Kim KM, Kim HJ. The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients. J Phys Ther Sci 2015;27(6):1681-1683.
  • 12. Lee MM, Cho HY, Song CH. The mirror therapy program enhances upper-limb motor recovery and motor function in acute stroke patients. Am J Phys Med Rehabil 2012;91(8):689-696, quiz 697-700.
  • 13. Kim K, Lee S, Kim D, Lee K, Kim Y. Effects of mirror therapy combined with motor tasks on upper extremity function and activities daily living of stroke patients. J Phys Ther Sci 2016;28(2):483-487.
  • 14. Amasyali SY, Yaliman A. Comparison of the effects of mirror therapy and electromyographytriggered neuromuscular stimulation on hand functions in stroke patients: a pilot study. Int J Rehabil Res 2016;39(4):302-307.
  • 15. Welmer AK, Holmqvist LW, Sommerfeld DK. Hemiplegic limb synergies in stroke patients. Am J Phys Med Rehabil 2006;85(2):112-119.
  • 16. Gregson JM, Leathley MJ, Moore AP, Smith TL, Sharma AK, Watkins CL. Reliability of measurements of muscle tone and muscle power in stroke patients. Age Ageing 2000;29(3):223-228.
  • 17. Granger CV, Cotter AC, Hamilton BB, Fiedler RC. Functional assessment scales: a study of persons after stroke. Arch Phys Med Rehabil 1993;74(2):133-138.
  • 18. Stevens JA, Stoykov ME. Simulation of bilateral movement training through mirror reflection: a case report demonstrating an occupational therapy technique for hemiparesis. Top Stroke Rehabil 2004;11(1):59-66.
  • 19. Kim YH, Jang SH, Chang Y, Byun WM, Son S, Ahn SH. Bilateral primary sensori-motor cortex activation of post-stroke mirror movements: an fMRI study. Neuroreport 2003;14(10):1329- 1332.
  • 20. Hamzei F, Lappchen CH, Glauche V, Mader I, Rijntjes M, Weiller C. Functional plasticity induced by mirror training: the mirror as the element connecting both hands to one hemisphere. Neurorehabil Neural Repair 2012;26(5):484-496.
  • 21. Franceschini M, Agosti M, Cantagallo A, Sale P, Mancuso M, Buccino G. Mirror neurons: action observation treatment as a tool in stroke rehabilitation. Eur J Phys Rehabil Med 2010;46(4):517-523.
  • 22. Small SL, Buccino G, Solodkin A. The mirror neuron system and treatment of stroke. Dev Psychobiol 2012;54(3):293-310.
  • 23. Yeldan I, Huseyinsinoglu BE, Akinci B, Tarakci E, Baybas S, Ozdincler AR. The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients. J Phys Ther Sci 2015;27(11):3519-3524.
  • 24. Kuzgun S, Özgen M, Armagan O, Tascioglu F, Baydemir C. İnme rehabilitasyon programı ile kombine edilen ayna tedavisinin motor ve fonksiyonel iyileşme üzerine etkinliğinin araştırılması. Turkish Journal of Cerebrovascular Diseases. 2012;18(3):77-82.
  • 25. Colomer C, E NO, Llorens R. Mirror therapy in chronic stroke survivors with severely impaired upper limb function: a randomized controlled trial. Eur J Phys Rehabil Med 2016;52(3):271-278.
  • 26. Arya KN, Pandian S. Effect of task-based mirror therapy on motor recovery of the upper extremity in chronic stroke patients: a pilot study. Top Stroke Rehabil 2013;20(3):210-217.
  • 27. Stevens JA, Stoykov ME. Using motor imagery in the rehabilitation of hemiparesis. Arch Phys Med Rehabil 2003;84(7):1090-1092.
  • 28. Altschuler EL, Wisdom SB, Stone L, Foster C, Galasko D, Llewellyn DM, et al. Rehabilitation of hemiparesis after stroke with a mirror. Lancet 1999;353(9169):2035-2036.
  • 29. Yavuzer G, Selles R, Sezer N, Sutbeyaz S, Bussmann JB, Koseoglu F, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil 2008;89(3):393-398.
  • 30. Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev 2012(3):CD008449.
  • 31. Dohle C, Pullen J, Nakaten A, Kust J, Rietz C, Karbe H. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair 2009;23(3):209-217.
  • 32. Wu CY, Huang PC, Chen YT, Lin KC, Yang HW. Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil 2013;94(6):1023-1030.
  • 33. Samuelkamaleshkumar S, Reethajanetsureka S, Pauljebaraj P, Benshamir B, Padankatti SM, David JA. Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial. Arch Phys Med Rehabil 2014;95(11):2000-2005.
  • 34. Agnew ZK, Wise RJ, Leech R. Dissociating object directed and non-object directed action in the human mirror system; implications for theories of motor simulation. PLoS One 2012;7(4):e32517.
  • 35. 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;26(4):497-499.
  • 36. Arya KN, Pandian S, Kumar D. Task-based mirror therapy enhances ipsilesional motor functions in stroke: A pilot study. J Bodyw Mov Ther 2017;21(2):334-341.
  • 37. 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;23(4):655-661.
There are 37 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Makaleler
Authors

Nevcivan Bulmuş Demirbaş This is me

Şenay Özdolap This is me

Selda Sarıkaya

Füruzan Köktürk

Publication Date August 31, 2018
Published in Issue Year 2018 Volume: 2 Issue: 2

Cite

Vancouver Bulmuş Demirbaş N, Özdolap Ş, Sarıkaya S, Köktürk F. İnmeli Hastalarda Ayna Tedavisinin Üst Ekstremitede Motor İyileşme ve Fonksiyona Etkisi. Med J West Black Sea. 2018;2(2):173-81.

Medical Journal of Western Black Sea is a scientific publication of Zonguldak Bulent Ecevit University Faculty of Medicine.

This is a refereed journal, which aims at achieving free knowledge to the national and international organizations and individuals related to medical sciences in publishedand electronic forms.

This journal is published three annually in April, August and December.
The publication language of the journal is Turkish and English.