Hemiplegia, Upper Extremity Dysfunction
Conditions
Keywords
hemiplegia, mirror theraphy, NMES
Brief summary
In this study, it was aimed to evaluate whether or not NMES in front of the mirror brings an additional benefit to mirror therapy alone or NMES alone on upper extremity motor and functional development, spasticity, anxiety, depression, cognitive function and activities of daily living, and neuropathic pain.
Detailed description
Cerebrovascular diseases are the general name given to clinical neurological pictures that occur as a result of pathological changes in the blood vessels of the primary lesion and / or in the properties of the blood passing through them. Many complications develop in the acute and chronic periods in patients with stroke, and the rate of complication development has been reported to vary between 40-96% in different studies. The aim of hemiplegic upper extremity rehabilitation is to prevent complications and improve lost motor-sensory control. Upper limb rehabilitation is less successful than lower limb rehabilitation because the upper limb is more functional and more complex. For muscle reeducation, NMES is used to strengthen inhibited muscle groups, facilitate voluntary isolated muscle contraction, prevent muscle atrophy, increase metabolism and enzyme activity, change the contractile properties of the muscle, maintain or increase the normal range of motion of the joint, develop voluntary movement and functional gains. NMES has been used in hemiplegia rehabilitation since 1960 for the purpose of functional retraining of muscles. The purpose of this treatment is to enable the muscles with impaired neural function of the electrical current to perform a functional and useful movement. Applications in front of the mirror are thought to trigger the neuronal connections in the motor cortex associated with the imagined movement. Findings obtained from studies with functional magnetic resonance support this theory. Compared to conventional PR, applications in front of the mirror are thought to have more and longer-lasting effects.
Interventions
OTHERGroup Mirror
For 30 minutes, ROM exercises will be applied to the solid upper extremity in all directions in front of a real mirror by the practitioner. (3 weeks, 5 days a week, 15 sessions in total)
DEVICEGroup NMES
NMES will be applied to the hemiplegic arm(deltoid, elbow extensors and forearm) for 30 minutes by the practitioner (3 weeks, 5 days a week, 15 sessions in total)
OTHERGroup Mirror+NMES
The practitioner will be synchronized with visual or auditory stimuli, and ROM exercises in all directions in front of the real mirror for 30 minutes, and NMES therapy for 30 minutes on the paretic upper extremity will be applied together. (3 weeks, 5 days a week, 15 sessions in total)
Sponsors
Bursa Yuksek Ihtisas Training and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Prospective, Randomized, Controlled, Single-Blinded Study
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Subacute hemiplegia * Patients who can communicate well, are motivated enough and are willing to participate in the study * Patients' medical conditions are stable * Initiation of voluntary extension movement in the wrist (lower limit)
Exclusion criteria
* The presence of more than one previous cerebrovascular disease (except transient ischemic attack). * Presence of flaccid hemiplegia. * Presence of a previous neurological disease causing a decrease in strength in the affected extremity. * Presence of deformity due to a previous fracture, inflammatory arthropathy, etc. in the affected extremity. * Presence of more than grade 3 spasticity in upper extremity according to Modified Ashworth Scale * Use of cardiac pace maker * Presence of fatal cardiac arrhythmia * Presence of seizure history within 2 years.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fugl-Meyer Upper Extremity Motor Rating Scale | Change from Baseline Fugl-Meyer Upper Extremity Motor Rating Scale at 3rd week | To analysis the increase in upper limb motor function Motor score: ranges from 0 (hemiplegia) to 100 points (normal motor performance). Divided into 66 points for upper extremity and 34 points for the lower extremity. Sensation: ranges from 0 to 24 points. Divided into 8 points for light touch and 16 points for position sense. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mini-Mental Test | Change from Baseline Mini-Mental Test at 3rd week | for cognitive functions |
| Numeric Rating Scale | Change from Baseline Numeric Rating Scale at 3rd week | for pain |
| Pain Detect Questionnaire | Change from Baseline Pain Detect Questionnaire at 3rd week | for neuropathic pain |
| Functional Independence Scale (FIM) | Change from Baseline Functional Independence Scale (FIM) at 3rd week | for daily life activities |
| Modified Tardieu Scale | Change from Baseline Modified Tardieu Scale at 3rd week | Score, Description 0, No resistance during movement. 1. There is very slight resistance during movement, but no noticeable "catch". 2. There is a noticeable "catch" at a certain angle, followed by relaxation. 3. Clonus occurring at a certain angle and lasting for seconds (ending with fatigue). 4. Uninterrupted clonus occurring at a certain angle and lasting for more than 10 seconds. 5, The joint is too stiff to move (petrified). |
| Brunnstrom stages | Change from Baseline Brunnstrom stages at 3rd week | For improvement of upper limb motor function |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORBurcu Metin Ökmen, M.D. Assoc. Prof
Bursa Yuksek Ihtisas Training and Research Hospital
STUDY_CHAIRBüşra Yeşil, M.D.
Bursa Yuksek Ihtisas Training and Research Hospital
Outcome results
None listed