Article

OBJECTIVE: To evaluate for any clinical effects of home-based mirror therapy and
subsequent cortical reorganization in patients with chronic stroke with moderate
upper extremity paresis. METHODS: A total of 40 chronic stroke patients (mean
time post .onset, 3.9 years) were randomly assigned to the mirror group (n = 20)
or the control group (n = 20) and then joined a 6-week training program. Both
groups trained once a week under supervision of a physiotherapist at the
rehabilitation center and practiced at home 1 hour daily,
5 times a week. The
primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip
force, spasticity, pain, dexterity, hand-use in daily life, and quality of life
at baseline-posttreatment and at 6 months-were all measured by a blinded
assessor. Changes in neural activation patterns were assessed with functional
magnetic resonance imaging (fMRI) at baseline and posttreatment in an available
subgroup (mirror, 12; control, 9). RESULTS: Posttreatment, the FMA improved more
in the mirror than in the control group (3.6 +/- 1.5, P < .05), but this
improvement did not persist at follow-up. No changes were found on the other
outcome measures (all Ps >.05). fMRI results showed a shift in activation balance
within the primary motor cortex toward the affected hemisphere in the mirror
group only (weighted laterality index difference 0.40 +/- 0.39, P < .05).
CONCLUSION: This phase II trial showed some effectiveness for mirror therapy in
chronic stroke patients and is the first to associate mirror therapy with
cortical reorganization. Future research has to determine the optimum practice
intensity and duration for improvements to persist and generalize to other
functional domains.

Langue : ANGLAIS