Comparison of Electrical Stimulation and Mirror Therapy and Conventional Rehabilitation and Combining them for Rehabilitation of Upper Extremity in Stroke Patients: A Meta-Analysis

Document Type : Review Article

Authors

1 PhD Student, Department. of Bioelectrical Engineering, Amirkabir University, Tehran, Iran

2 Assistant Professor, Department of Bioelectrical Engineering, Amirkabir University, Tehran, Iran

Abstract

Background and Aim: The most common functional disorders in stroke patients are disabilities in reaching and manipulation tasks which are associated with many problems for doing daily activities. Despite multiple techniques in rehabilitation, the amount and rate of recovery of upper extremity motor functions are weak, so new strategies have been suggested for combining different therapy methods. With the assumption that further improvement achieved through the use of both cognitive and physical aspects in the reorganization of neural circuits in the brain, in the rehabilitation of affected limb, the combination of mirror therapy and electrical stimulation can be more effective than using each of these methods separately. In the present study, we compared electrical stimulation and mirror therapy and conventional therapy and combination therapy in a pre-test/post-test study.
Materials and Methods: A systematic review with meta-analysis was performed on mirror therapy, electrical stimulation, and their combination from Pedro, Pubmed, and Rehabdata databases. A meta-analysis was performed based on random effect and effect size was obtained with the standard mean difference. The acute or sub-acute and chronic stroke, active/passive stimulation, and also protocol of training exercises in coordinated bilateral movement and other exercises are considered as affecting factors.
Results: In the present study, 35 articles with 903 stroke patients were studied. A significant difference was observed in comparing the efficacy of the two methods of mirror therapy and electrical stimulation and a conventional therapy. Also, a significant difference was confirmed between efficacies of pre-test/post-test in conventional therapy. Therewith, the existence of significant difference was confirmed between treatments of the early and late duration of the stroke. The type of active and passive stimulation, as well as bimanual or bilateral exercise movements in comparison with other exercise movements did not reveal a significant difference between the efficacy of electrical stimulation and mirror therapy, respectively.  
Conclusion: The hypothesis of improving brain reorganization for stroke patients is confirmed by simultaneously applying both cognitive aspects and physical functions. Electrical stimulation and mirror therapy can be more effective during the period early after the stroke. It can be concluded that other factors such as intensity of stimulation, duration, and frequency of excitation or even the active stimulation can be resulted in the lack of confirmation of the efficacy of the active stimulation method versus the passive stimulation. The reliability of the results in the meta-analysis could be increased if more articles are used.

Keywords

References

1. de Almeida Oliveira R, Cintia dos Santos Vieira P, Fernanda Rodrigues Martinho Fernandes L, Jorge Patrizzi L, Ferreira de Oliveira S, Aparecida Pascucci Sande de Souza L. Mental practice and mirror therapy associated with conventional physical therapy training on the hemiparetic upper limb in poststroke rehabilitation: a preliminary study. Topics stroke Rehabil. 2014;21(6):484-94.##
2.  Berner YN, Kimchi OL, Spokoiny V, Finkeltov B. The effect of electric stimulation treatment on the functional rehabilitation of acute geriatric patients with stroke—a preliminary study. Arch Gerontol Geriat. 2004;39(2):125-32. ##
3. Quandt F, Hummel FC. The influence of functional electrical stimulation on hand motor recovery in stroke patients: a review. Exp Transl Stroke Med. 2014;6(1):9. ##
4. Gharib NM, Aboumousa AM, Elowishy AA, Rezk-Allah SS, Yousef FS. Efficacy of electrical stimulation as an adjunct to repetitive task practice therapy on skilled hand performance in hemiparetic stroke patients: a randomized controlled trial. Clin Rehabil. 2015;29(4):355-64. ##
5.  Vafadar AK, Côté JN, Archambault PS. Effectiveness of functional electrical stimulation in improving clinical outcomes in the upper arm following stroke: a systematic review and meta-analysis. BioMed Res intern. 2015. ##
6. Boyaci A, Topuz O, Alkan H, Ozgen M, Sarsan A, Yildiz N, et al. Comparison of the effectiveness of active and passive neuromuscular electrical stimulation of hemiplegic upper extremities: a randomized, controlled trial. Intern J Rehabil Res. 2013;36(4):315-22. ##
7.  Cauraugh JH S. J., " Neural plasticity and bilateral movements: a rehabilitation approach for chronic stroke. ," Prog Neurobiol., vol. 75, pp. 309-320, 2005. ##
8. Chan MK-l, Tong RK-y, Chung KY-k. Bilateral upper limb training with functional electric stimulation in patients with chronic stroke. Neurorehabilitation and neural repair. 2009;23(4):357-65. ##
9. Cui B-J, Wang D-Q, Qiu J-Q, Huang L-G, Zeng F-S, Zhang Q, et al. Effects of a 12-hour neuromuscular electrical stimulation treatment program on the recovery of upper extremity function in sub-acute stroke patients: a randomized controlled pilot trial. J Phys Ther Sci. 2015;27(7):2327-31. ##
10. Narayan Arya K, Pandian S. Effect of task-based mirror therapy on motor recovery of the upper extremity in chronic stroke patients: A pilot study. Topics stroke Rehabil. 2013;20(3):210-7. ##
11. Hummelsheim H, Maier-Loth ML, Eickhof C. The functional value of electrical muscle stimulation for the rehabilitation of the hand in stroke patients. Scand J Rehabil Med 1997;29:3-10. ##
12.  Kroon ‌J. De, Van der Lee J, IJzerman M. J, and Lankhorst G, "Therapeutic electrical stimulation to improve motor control and functional abilities of the upper extremity after stroke: a systematic review," Clin Rehabil, vol. 16, pp. 350-360, 2002. ##
13.  Stevens J. A and Stoykov M. E. P, "Using motor imagery in the rehabilitation of hemiparesis," Arch Phys Med Rehabil, vol. 84, pp. 1090-1092, 2003. ##
14. K. Bachman, "Using mental imagery to practice a specific psychomotor skill," J Contin Educ Nurs, vol. 21, pp. 125-128, 1990. ##
15. Yágüez L, Nagel D, Hoffman H, A Canavan, Wist E, and Hömberg V, "A mental route to motor learning: improving trajectorial kinematics through imagery training," Behav Brain Res, vol. 90, pp. 95-106, 1998. ##
16. Meilink A, Hemmen B, Seelen H, Kwakkel G. Impact of EMG-triggered neuromuscular stimulation of the wrist and finger extensors of the paretic hand after stroke: a systematic review of the literature. Clin Rehabil. 2008;22(4):291-305. ##
17. Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseoğlu F, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(3):393-8. ##
18. Dohle C, Püllen J, Nakaten A, Küst J, Rietz C, Karbe H. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair. 2009;23(3):209-17. ##
19. Michielsen ME, Selles RW, van der Geest JN, Eckhardt M, Yavuzer G, Stam HJ, et al. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil Neural Repair. 2011;25(3):223-33. ##
20. Lee MM, Cho H-y, 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):689-700. ##
21. Wu C-Y, Huang P-C, Chen Y-T, Lin K-C, Yang H-W. Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2013;94(6):1023-30. ##
22. Yoon JA, Koo BI, Shin MJ, Shin YB, Ko H-Y, Shin Y-I. Effect of constraint-induced movement therapy and mirror therapy for patients with subacute stroke. Ann Rehabil Med. 2014;38(4):458-66. ##
23. 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):2000-5. ##
24. Cristina LM, Matei D, Ignat B, Popescu CD. Mirror therapy enhances upper extremity motor recovery in stroke patients. Acta Neurologica Belgica. 2015;115(4):597-603. ##
25. Park J-Y, Chang M, Kim K-M, Kim H-J. The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients. J Phys Ther Sci. 2015;27(6):1681-3. ##
26. Arya KN, Pandian S, Kumar D, Puri V. Task-based mirror therapy augmenting motor recovery in poststroke hemiparesis: a randomized controlled trial. J Stroke Cerebrovasc Diseases. 2015;24(8):1738-48. ##
27. Lim K-B, Lee H-J, Yoo J, Yun H-J, Hwang H-J. Efficacy of Mirror Therapy Containing Functional Tasks in Poststroke Patients. Ann Rehabil Med. 2016;40(4):629-36. ##
28. 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):483-7. ##
29. Gurbuz N, Afsar SI, Ayaş S, Cosar SNS. Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial. J Phys Ther Sci. 2016;28(9):2501-6. ##
30. Rodrigues LC, Farias NC, Gomes RP, Michaelsen SM. Feasibility and effectiveness of adding object-related bilateral symmetrical training to mirror therapy in chronic stroke: A randomized controlled pilot study. Physiother Theory Pract. 2016;32(2):83-91. ##
31. Colomer C, NOé E, Llorens R. Mirror therapy in chronic stroke survivors with severely impaired upper limb function: a randomized controlled trial. Eur J Phys Rehabil Med. 2016:1-29. ##
32. Alon G, Levitt AF, McCarthy PA. Functional electrical stimulation enhancement of upper extremity functional recovery during stroke rehabilitation: a pilot study. Neurorehabil Neural Repair. 2007;21(3):207-15. ##
33. Alon G, Levitt AF, McCarthy PA. Functional electrical stimulation (FES) may modify the poor prognosis of stroke survivors with severe motor loss of the upper extremity: a preliminary study. Am J Phys Med Rehabil. 2008;87(8):627-36. ##
34. Chan MK-l, Tong RK-y, Chung KY-k. Bilateral upper limb training with functional electric stimulation in patients with chronic stroke. Neurorehabil Neural Repair. 2009;23(4):357-65. ##
35. Hsu S-S, Hu M-H, Wang Y-H, Yip P-K, Chiu J-W, Hsieh C-L. Dose-response relation between neuromuscular electrical stimulation and upper-extremity function in patients with stroke. Stroke. 2010;41(4):821-4. ##
36. Wu F-C, Lin Y-T, Kuo T-S, Luh J-J, Lai J-S, editors. Clinical effects of combined bilateral arm training with functional electrical stimulation in patients with stroke. Rehabil Robotics (ICORR), 2011 IEEE International Conference on; 2011: IEEE. ##
37. Lin Z, Yan T. Long-term effectiveness of neuromuscular electrical stimulation for promoting motor recovery of the upper extremity after stroke. J Rehabil Med. 2011;43(6):506-10. ##
38. Shimodozono M, Noma T, Matsumoto S, Miyata R, Etoh S, Kawahira K. Repetitive facilitative exercise under continuous electrical stimulation for severe arm impai##rment after sub-acute stroke: a randomized controlled pilot study. Brain injury. 2014;28(2):203-10.
39. Chae J, Bethoux F, Bohinc T, Dobos L, Davis T, Friedl A. Neuromuscular stimulation for upper extremity motor and functional recovery in acute hemiplegia. Stroke. 1998;29(5):975-9. ##
40. McCabe J, Monkiewicz M, Holcomb J, Pundik S, Daly JJ. Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2015;96(6):981-90. ##
41. Sullivan JE, Hurley D, Hedman LD. Afferent stimulation provided by glove electrode during task-specific arm exercise following stroke. Clin rehabil. 2012;26(11):1010-20. ##
42. Kim TH, In TS, Cho H-y. Task-Related Training Combined with Transcutaneous Electrical Nerve Stimulation Promotes Upper Limb Functions in Patients with Chronic Stroke. Tohoku J Exp Med. 2013;231(2):93-100. ##
43. 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 Diseases. 2014;23(4):655-61. ##
44. Yun GJ, Chun MH, Park JY, Kim BR. The synergic effects of mirror therapy and neuromuscular electrical stimulation for hand function in stroke patients. Ann Rehabil Med. 2011;35(3):316-21. ##
45. Lin K-C, Chen Y-T, Huang P-C, Wu C-Y, Huang W-L, Yang H-W, et al. Effect of mirror therapy combined with somatosensory stimulation on motor recovery and daily function in stroke patients: A pilot study. JFMA. 2014;113(7):422-8. ##
46. Lee Y-y, Lin K-c, Wu C-y, Liao C-h, Lin J-c, Chen C-l. Combining afferent stimulation and mirror therapy for improving muscular, sensorimotor, and daily functions after chronic stroke: A randomized, placebo-controlled study. Am J Phys Med Rehabil. 2015;94(10):859-68. ##
47. Kojima K, Ikuno K, Morii Y, Tokuhisa K, Morimoto S, Shomoto K. Feasibility study of a combined treatment of electromyography-triggered neuromuscular stimulation and mirror therapy in stroke patients: a randomized crossover trial. Neurorehabil. 2014;34(2):235-44. ##
48. Kim JH, Lee BH. Mirror therapy combined with biofeedback functional electrical stimulation for motor recovery of upper extremities after stroke: a pilot randomized controlled trial. Occup Ther intern. 2015;22(2):51-60. ##
49. Lin K-c, Huang P-c, Chen Y-t, Wu C-y, Huang W-l. Combining afferent stimulation and mirror therapy for rehabilitating motor function, motor control, ambulation, and daily functions after stroke. Neurorehabil Neural Repair. 2014;28(2):153-62. ##
50. Howlett OA, Lannin NA, Ada L, McKinstry C. Functional electrical stimulation improves activity after stroke: a systematic review with meta-analysis. Arch Phys Med Rehabil. 2015;96(5).934-43. ##
The Scientific Journal of Rehabilitation Medicine
Volume 7, Issue 4
January and February 2019
Pages 278-299

Files

History

  • Receive Date: 01 November 2017
  • Revise Date: 02 December 2017
  • Accept Date: 10 January 2018
  • First Publish Date: 22 December 2018

Share

How to cite

Statistics