“TO COMPARE THE EFFECT OF MIRROR THERAPY AND MOTOR RELEARNING PROGRAMME ON BALANCE AND GAIT SPEED IN CHRONIC STROKE PATIENTS”: AN EXPERIMENTAL STUDYSahil rathod,Megha soni |
- Dr. Megha Soni Assistant Professor, Pioneer Physiotherapy College, Vadodara
- Dr. Sahil S Rathod PhD Scholar, Gujarat University, Ahmedabad, Assistant . Professor Pioneer Physiotherapy College, Vadodara
Stroke is rapidly developing clinical sign of focal disturbance of cerebral function. Mirror therapy is a form of mental practice, and it excites the primary motor cortex and evokes movement of the paralyzed side as mirror therapy allows an individual to have an experience of normal movement, also helps in improving balance and gait. The Motor Relearning approach was developed based on motor learning theory and in promoting physical function for stroke patients. The MRP was found to be effective for enhancing functional recovery as this drive neural plasticity for retraining functional skills useful for balanced sitting, sitting and standing, gait.
OBJECTIVE: To compare the effect Mirror Therapy and Motor Relearning Programme on balance and gait speed by BBS, TUG and 10MWT in chronic stroke patients.
METHOD: 22 Subjects according to inclusion criteria were recruited into two groups. Group A was given MT while Group B was given MRP for 4 weeks. Outcome measures such as BBS, TUG and 10MWT were assessed before and after intervention.
RESULT: Paired t-test was used for within group analysis for BBS and Mann Whitney test was used for TUG and 10MWT which showed significant difference in Mirror Therapy group, while BBS and TUG were significant and 10MWT was not significant in Motor Relearning Programme. Independent sample t-test was used for between group analysis for BBS which showed significant difference while Wilcoxon test was used for TUG and 10MWT with significant difference.
CONCLUSION: This study shows that Mirror Therapy is more effective in improving balance and gait speed then Motor Relearning Programme.
KEY WORDS: Mirror Therapy, Motor Relearning Programme, Balance, Gait speed, Chronic stroke.
Study Design- An experimental study
Sampling Design- Convenience sampling
Study Population- Patient with Chronic Stroke patients more than 6 months
Study Setting- OPD based Study Duration- 5days/week, for 4 weeks
Study Period- 1 year (2021-2022)
Sample Size- The sample size was calculated using G power software version 3.1.9.4 The main outcome variable taken into consideration for sample size collection is rated of perceived exertion. From the previous study conducted by Dora YL Chan and Ranjeet Singha et al. Physiological responses to mirror therapy and motor relearning Programme. The TUG values were (mean=36.4, SD=15.5) (mean= 37.26, SD= 5.65). Keeping value of α error as 0.1 (since 95% confidence interval) and β error as 0.2 (power of the study 80%) the calculated sample size is 22.
SAMPLING CRITERIA
Inclusion Criteria-
➢ Both male and female
➢ 40-60 years
➢ First episode of Ischemic and Hemorrhagic unilateral stroke with hemiparesis (onset > 6 months) ➢ Able to walk 10 meters with or without assistance
➢ Spasticity grade < 3(according to modified Ashworth scale)
➢ ≥24 score in Mini Mental Scale
➢ Brunnstorm grade ≥ 3
➢ Willing to participate
• Exclusion Criteria-
➢ Transient Ischemic Attack
➢ Neurological disorder other than stroke such as (Parkinson, tremors, etc)
➢ Musculoskeletal disorder affecting locomotion
➢ Uncontrolled hypertension and peripheral arterial occlusion disease.
➢ Surgery of lower limb
➢ Gross visual spatial and visual deficit
➢ Diabetic retinopathy
➢ Apraxia
➢ Congenital deformity
Paired t-test was used for within group analysis for BBS and Mann Whitney test was used for TUG and 10MWT which showed significant difference in Mirror Therapy group, while BBS and TUG were significant and 10MWT was not significant in Motor Relearning Programme. Independent sample t-test was used for between group analysis for BBS which showed significant difference while Wilcoxon test was used for TUG and 10MWT with significant difference.
In the present study subjects were recruited according to Age, Gender, Modified Ashworth Scale, Voluntary Control Grading (VCG), Mini Mental Scale (MMSE) and Manual Muscle Testing (MMT). Mean age of the Group 1 and Group 2 was 55 years, Mean MMSE score of Group 1 was 29.27 and Group 2 was 29.09, Mean Voluntary Control Grading (VCG) score of Group 1 was 3.73 and Group 2 was 3.45, Mean MMT score of Group 1 was 3.73 and Group 2 was 3.45. Males were more compared to Females in both the groups and data are equally distributed in both the groups.
Total 22 subjects were included in the study, which were divided into two groups. Group A was given Mirror Therapy for 30 minutes and conventional therapy for 30 minutes, while Group B was given Motor Relearning Programme for 30 minutes and conventional therapy for 30 minutes for 5days/week for 4 weeks.
The first objective of the study was to check the effect of Mirror therapy on balance and gait speed by BBS, TUG and 10MWT in chronic stroke patients.
Table no. 5 showed within group comparison of BBS, TUG and 10MWT in Mirror Therapy, the p value for BBS was <0.001, p value for TUG was 0.003 and p value for 10MWT was 0.003 which showed significant difference in Mirror Therapy group.
The present study showed that there was a significant improvement in BBS, TUG and 10MWT after 4 weeks of Mirror therapy programme.
The possible reason for the increase in gait speed could be that the normal hemisphere of the brain showed mirror neurons and it is thought that the recovery of motor function was accelerated by increasing the excitability of the motor pathway corresponding to the paralyzed limb. 48 Also, it is thought that the walking speed increased as the posture control ability was improved through visual feedback. 49
As a cognitive intervention method, mirror therapy causes activation of the frontal or parietal lobe in the corresponding motor region, an area known as the mirror neurons, through only observing the behaviour of others.43
Therefore, mirror therapy could play an important role in learning a new skill or understanding the behaviour of others, which can be used to motivate stroke patients.39
The Second objective of the study was to check the effect of Motor Relearning Programme on balance and gait speed by BBS, TUG and 10MWT in chronic stroke patients.
Table no. 6 showed that within group comparison of BBS, TUG and 10MWT in Motor Relearning Programme, the p value for BBS was <0.001, p value for TUG was 0.003 and p value for 10MWT was 0.050.
The present study showed that there was a significant improvement in BBS and TUG, while no significant improvement in 10MWT after 4 weeks of Mirror therapy programme.
The possible reason to improve balance in the study could be that Task specific training (i.e., specific training of functional actions, such as walking, reaching, standing up) stimulates the regaining of motor control by training muscles to generate and time force at the necessary length and the appropriate relationship to each other for specific actions or task.36
Neurophysiological and neuroanatomical studies and other non-invasive mapping studies in humans, are providing sufficient evidence that the adult cerebral cortex is capable of significant functional reorganization. These studies have shown plasticity in the functional topography and anatomy of intact cortical tissue adjacent to the injury and of more remote cortical areas.13
The study showed no improvement in gait speed after 4 weeks of MRP programme in chronic stroke patients. Only a few clinically controlled trial studies on the effectiveness of the MRP approach on gait speed. So, further investigation is required to check effect of MRP on gait speed.
The Third objective of the study was to check the effect of Mirror therapy and Motor Relearning Programme on balance and gait speed by BBS, TUG and 10MWT in chronic stroke patients.
Table no. 7 shows that between group comparison of BBS, TUG and 10MWT in Mirror Therapy and Motor Relearning Programme, the p value for BBS was 0.385, p value for TUG was 0.034 and p value for 10MWT was 0.028
In the current study Mirror Therapy found to be more effective than Motor Relearning Programme in TUG and 10MWT on chronic stroke patients. This could be done as patient during Mirror Therapy sees motion in the mirror and then practice this motion, promoting the formation of kinaesthetic memories the relevant mirror nerve cells will respond and the area of the brain will use when actual movements are conducted.44 In doing so, the person learns to understand the form of certain behaviours and selectively imitate the part necessary to learn movement, this helps in increasing stride length during walking, the ratio of the entire swing phase would also increase, hence this are the reasons we see improvement in Mirror therapy in TUG and 10MWT in chronic stroke patients.
As there are paucity of studies about comparison of Mirror Therapy and Motor Relearning Programme, so this present study can be helpful in fulfilling he gap in this literature.
Mirror Therapy and Motor Relearning Programme both were individually effective in improving BBS (static balance) and TUG (dynamic balance) whereas in Mirror Therapy improvement was found in 10MWT (gait speed).
In inter group comparison both Mirror Therapy and Motor Relearning Programme was equally effective in improving BBS whereas Mirror Therapy was found to be effective in TUG and 10MWT than Motor Relearning Programme. Still further investigation is needed.
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