Mirror Therapy and Cross-Education of Muscle Strength

Additive Effect of Mirror Therapy on Effects of Cross-Education of Muscle Strength of Neuromuscular Electrical Stimulation In Hemiplegic Patients

This study was conducted to determine whether mirror therapy has an additive effect on cross-education of the strength of neuromuscular electrical stimulation (NMES) in patients with hemiplegia. As an outcome measure, the ankle dorsiflexion strength of hemiplegic patients was measured.

A total of 29 patients, 7 women, and 22 men were included according to the inclusion and exclusion criteria. The patients were randomly assigned to the control group (n = 14) and the Mirror group (n = 15). Five sessions of neuromuscular electrical stimulation, unaffected side ankle dorsiflexors were applied to the patients in both groups. In addition to the NMES, mirror therapy was applied to the experimental group simultaneously with NMES. Before and after treatment, both ankle dorsiflexor strength was measured with a force sensor. For force measurements, a force transducer (FC2211-0000-0100-L Compression Load Cell, TE Connectivity company, France) was used. Force transducer signals were received with a data acquisition device (POWERLAB® data acquisition system ADInstruments, Oxford, UK) and evaluated offline on the computer. The measurement values were expressed in kilogram.force (kg.f) and this value was normalized according to body weight.

Inclusion Criteria:

• Cases with stroke duration ≥ 1 month
• Ability to walk at least 10m (functional ambulation scale ≥3)
• Age range 18-75 years
• Hemorrhagic or ischemic stroke
• Brunnstrom stage ≥4 for lower limb
• Unilateral stroke
• Cooperating with the examination and tests

Exclusion Criteria:

• Mini Mental State Assessment score <21
• Severe spasticity (MAS = 4) in ankle dorsiflexors
• Have a contracture on ankle joint
• The presence of skin lesions in the application area
• Painful pathologies in the lower extremities
• Having visual field defects
• Active inflammatory, rheumatological or infectious disease
• Parent rhythm / conduction block problem in the heart
• Uncontrollable hypertension (Maxima> 140, Minima> 90)
• Presence of lower extremity fracture
• Peripheral nerve lesions such as polyneuropathy, radiculopathy
• Finding or suspected active deep vein thrombosis
• History of deep vein thrombosis and pulmonary embolism