Quantitative Research Article Critique
Effectiveness of Mirror Therapy on Upper Extremity Functioning among Stroke Patients
Rohini T. Chaudhari1, Seeta Devi2, Dipali Dumbre3
1MSc Nursing, 2Asst. Professor, 3Tutor, Symbiosis College of Nursing, Symbiosis International (Deemed University), Pune
ABSTARCT
Background: The prevalence of stroke in the general population varies from 40 to 270 per 1000,000 in India. Approximately 12% of all strokes occur in those older than 40 years. Stroke may require a variety of rehabilitation services. One of them Mirror therapy is a simple, inexpensive and most importantly patient directed treatment that may improve hand function after stroke.
Objective: To assess the effectiveness of mirror therapy on upper extremity functioning among stroke patients at selected neuro- rehabilitation centres
Method: A quantitative research approach was used in this study. Research design was Quasi- experimental: pre-test post-test. Sample size was 50 post stroke patients who receive stroke rehabilitation at Neurorehabilitation centres. The 25 subjects were randomly divided into two groups, experimental group and control group. The experimental group has received mirror therapy with the conventional therapy for 3 days in a week for 4 weeks. Other side the control group has received only conventional therapy for 4 weeks, and 3 days in a week. The effectiveness was evaluated by Modified Brunnstrom’s motor function test
Result: An average hand functioning score in pre-test was 8.2 which increased to 12.6 in post-test and 7.6 which increased to 13.4 in post-test for upper extremity functioning among experimental group, following for the control group as in pre-test an average was 8.3 which increased to 11.2 for hand and 8.1 which increased to 11.7 of upper extremity.
Conclusion: The findings of the study show that there is significant difference between the scores of experimental and control group.
Keywords: Mirror Therapy, Upper Extremity Stroke , Neuro Rehabilitation Centre
INTRODUCTION
As human, we move our bodies to explicit our wants, needs, emotions, thoughts, and ideas. Basically, how well we move- and how much we move- decides how well we engage with the world and make our full purpose in life. Mostly the active movement helps us in function completely, interact with the world, feel well physically and emotionally, connect and build relationship with others, and communicate and express ourselves. Also the movement helps us recover if our brain is injured or inflamed. Body movements are comparable important for smooth and effective day to day activities.1
Nervous system is a one of the system of our body, which perform all the sensory and motor function
of body. The reason a healthy nervous system is so important is because it’s what runs everything in our body. When nervous system is functioning correctly, body is able to perform all the things it needs to do. However, when the nervous system is compromised, or not working efficiently, body begins to break down.2
Stroke is the third biggest killer in India after heart attack and cancer and is a major public health concern.1 Stroke occurs when there is (1) lack of blood flow to a section of brain or (2) haemorrhage into the brain that results in death of brain cells. The predominance of stroke in the population varies from 40 to 270 per 1000,000 in India. Approximately 12% of all strokes occur in those older than 40 years. It was projected that by 2015 the number of cases of stroke would be increase to 1666,372
DOI Number: 10.5958/0973-5674.2019.00026.1
Indian Journal of Physiotherapy and Occupational Therapy, January-March 2019, Vol.13, No. 1 129
in the country. A predicted 5.7 million people died from stroke in 2005 and it is projected that these deaths would rise to 6.5 million by 2015.3
Impact on daily life, 4 out of 10 stroke survivors leave hospital requiring help with daily living activities but almost a third receive no social service visits. Around a third of stroke survivors experience depression after their stroke.4
15 million people suffer from stroke worldwide each year. Of these, 5 million die and another 5 million are permanently DISABLED.5Ischemic stroke 10% in 30 days, 23% in 1 year and 52 % in 5 year. Same as Intra- cerebral haemorrhage 52% in 30 days, 62% in 1 year and 70% in 5 years. The sub-arachnoid haemorrhage was 45% in 30 days, 48% in 1 year and 52 % in 5 years. They also concluded that this prevalence of stroke may increase till 2020. Stroke patient may require a variety of rehabilitation services like physiotherapy, occupational therapy, speech therapy etc. One of them MIRROR THERAPY is an inexpensive, simple and patient directed treatment. The principle of mirror therapy is use of a mirror to create a reflective illusion of an affected limb in order to trick the brain into thinking movement has occurred without pain. 5
METHODOLOGY
A quantitative research approach was used in this study. Research design was Quasi-experimental: pre-test post-test. Content validity was obtained by experts of medical surgical nursing and physiotherapy opinion. Tool reliability (0.8) was calculated by inter rated reliability method. The consent was taken from the subjects for participation in study. Data collection was carried out
from 14/02/2018 to 15/03/2108. Sample size was 50 post stroke patients who receive stroke rehabilitation at Neurorehabilitation centres. The 25 subjects were randomly divided into two groups, experimental group and control group. The experimental group has received mirror therapy with the conventional therapy for 3 days in a week for 4 weeks. Other side the control group has received only conventional therapy for 4 weeks, and 3 days in a week. The effectiveness was evaluated by Modified Brunnstrom’s motor function test before and after intervention. Data was compiled and analysis was done by using inferential and descriptive statistics.
RESULTS
Fig. 1: Effectiveness of mirror therapy in stroke patients on the functioning of hand
In pre-test, all the experimental and control group stroke patients had poor functioning of hand. In post-test, 48% of the experimental group samples had poor functioning of hand and 52% of them had average functioning of hand. In control group, 68% of the samples had poor functioning of hand and 32% of them had average functioning of hand. This shows that the mirror therapy remarkably improved the hand functioning of stroke patients.
Table 1: Paired t-test for effectiveness of mirror therapy in stroke patients on the functioning of hand N = 25, 25
Group Day Mean SD T Df p-value
Experimental Pre-test 8.2 1.37
12.8 24 0.000 Post-test 12.6 1.71
Control Pre-test 8.3 1.41
10.6 24 0.000 Post-test 11.2 1.72
Researcher applied paired t-test for effectiveness of mirror therapy in stroke patients on the functioning of hand. In experimental group, average hand functioning score in pre-test was 8.2 which increased to 12.6 in post-
test. T-value for this test was 12.8 with 24 degrees of freedom. Corresponding p-value was of the order of 0.000, which is small (less than 0.05), the null hypothesis is rejected.
130 Indian Journal of Physiotherapy and Occupational Therapy, January-March 2019, Vol.13, No. 1
In control group, average hand functioning score in pre-test was 8.3 which increased to 11.2 in post-test. T-value for this test was 10.6 with 24 degrees of freedom. Corresponding p-value was of the order of 0.000, which is small (less than 0.05), the null hypothesis is rejected. Average for experimental group in post-test is higher as compared to that for control group. Mirror therapy is proved to be significantly effective in improving the hand functioning of stroke patients.
Fig. 2: Effectiveness of mirror therapy in stroke patients on the functioning of upper extremity
In pre-test, all the experimental and control group stroke patients had poor functioning of upper extremity. In post-test, 56% of the experimental group samples had poor functioning of upper extremity and 44% of them had average functioning of upper extremity. In control group, 92% of the samples had poor functioning of upper extremity and 8% of them had average functioning of upper extremity. This shows that the mirror therapy remarkably improved the upper extremity functioning of stroke patients.
Table 2: Paired t-test for effectiveness of mirror therapy in stroke patients on the functioning of
upper extremity N = 25, 25
Group Day Mean SD t Df p-value
Experimental
Pre- test
7.6 1.15 14.6 24 0.000
Post- test
13.4 1.80
Control
Pre- test
8.1 1.17 11.0 24 0.000
Post- test
11.7 1.51
Researcher applied paired t-test for effectiveness of mirror therapy in stroke patients on the functioning of upper extremity. In experimental group, average upper extremity functioning score in pre-test was 7.6 which increased to 13.4 in post-test. T-value for this test was 14.6 with 24 degrees of freedom. Corresponding p-value was of the order of 0.000, which is small (less than 0.05), the null hypothesis is rejected. In control group, average upper extremity functioning score in pre-test was 8.1 which increased to 11.7 in post-test. T-value for this test was 11 with 24 degrees of freedom. Corresponding p-value was of the order of 0.000, which is small (less than 0.05), the null hypothesis is rejected. Average post test score for experimental group is higher as compared to that of control group. Mirror therapy is proved to be significantly effective in improving the upper extremity functioning of stroke patients.
Table 3: Two sample t-test for comparison of experimental and control group for hand
functioning N = 25, 25
Group Mean SD T df p-value Experimental 4.4 2.8
4.3 48 0.000 Control 1.7 1.3
Researcher applied two sample t-test for comparison of average change in hand functioning score of experimental and control group. Average change in hand functioning score of experimental group was 4.4 which was 1.7 for control group. T-value for this comparison was 4.3 with 48 degrees of freedom. Corresponding p-value was 0.000, which is small (less than 0.05). This indicates that the mirror therapy has significantly improved the functioning score of hand as compared to that of control group.
Table 4: Two sample t-test for comparison of experimental and control group for upper extremity
functioning N = 25, 25
Group Mean SD t df p-value Experimental 5.8 3.6
4.9 48 0.000 Control 2.0 1.6
Researcher applied two sample t-test for comparison of average change in upper extremity functioning score
Indian Journal of Physiotherapy and Occupational Therapy, January-March 2019, Vol.13, No. 1 131
of experimental and control group. Average change in upper extremity functioning score of experimental group was 5.8 which was 2 for control group. T-value for this comparison was 4.9 with 48 degrees of freedom. Corresponding p-value was 0.000, which is small (less than 0.05). This indicates that the mirror therapy has significantly improved the functioning score of upper extremity as compared to that of control group.
This shows that mirror therapy was effective on upper extremity function among stroke patients.
DISCUSSION
The literature includes some studies that support the use of Mirror Therapy in post-stroke rehabilitation. However, researches involving MT have evolved over the past years, acquiring better methodological quality.
The studies found in this review assessed individuals in the post-stroke and showed similar effects concerning the effectiveness of MT on recovery of the motor function.
The above findings of the study are supported by a study conducted by, Pournima Pawar, vijaykumar biradar to evaluate the effectiveness of the constraint induced movement therapy (CIMT) and combined mirror therapy for patient’s rehabilitation of the patients with subacute and chronic stroke patients.Twenty patients were enrolled and divided into two groups CIMT group, CIMT with Mirror therapy group. CIMT group 6 hours a day for 4 days per week for 4 weeks ,and CIMT with Mirror therapy group 30 minutes of mirror with CIMT for 4 days per week for 4 weeks . The fugl-meyer motor function assessment (FMS) and Brunnstrom Voluntary control grading were evaluated 4weeks after the treatment. The score of the Brunnstrom Voluntary control grading p value (P value 0.0001) and Fugl-meyer scale P value (0.0001), mirror therapy combined with CIMT showed more improvement than the CIMT after 4 weeks of treatment.6
Kil-Byung Lim, Hong-Jae Lee, Jeehyun Yoo, Hyun-Ju Yun, Hye-Jung Hwang conducted study on efficacy of mirror therapy containing tasks in post stroke patients to investigate the effect of mirror therapy on upper extremity function and activities of daily living. The samples were randomly divided into two groups that were mirror therapy group and sham therapy group, each group contains 30 samples. The mirror
therapy group has undergone a mirror therapy with conventional therapy for 20 minutes per day on 5 days per 4 weeks. The Fugl Meyer assessment, Brunnstrom motor recovery stage and modified barthel index were evaluated 4 weeks after the treatment. After 4 weeks of intervention, improvements in the FMA (p=0.027) and MBI (p=0.041) were significantly greater in the mirror therapy group than the sham therapy group. The mirror therapy containing functional task was effective in terms of improving the upper extremity functions.7
CONCLUSION
The findings of the study show that there is significant difference between the scores of experimental and control group. The finding shows that the mirror therapy brought a significantly effect in pre-test and post-test on upper extremity functioning.
Conflict of Interest: Nil declared
Source Funding: Self
Ethical Clearance: This study is ethically approved by Symbiosis College of nursing, Symbiosis International (Deemed University)
REFERENCES
1. Krista Scott-Dixon, The Real reasons healthy movement matters [Internet], Available From: www.precisionnutrition.com/healthy-movement.
2. Lewis, Medical Surgical Nursing, Second South Asia edition, ELSEVIER publication, volume- II, 2015, pg no- 1445.
3. Snehal Narsinha Waghavkar and Suvarna Shyam Ganvir, Effectiveness of Mirror Therapy to improve hand functions in acute and sub-acute stroke patients, International journal of Neuro- rehabilitation., 2015 2(4), 1-3. doi:10.4172/2376- 0281.1000184.
4. Rothgangel, S, Braun,S, Beurskens,A, Seitz,R, Wade,D, The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature, Journal of Rehabilitation Research, 2011, 34(1); 1-13, doi: 10.1097/MRR.0b013e3283441e98.
5. Fiona c Taylor, Suresh Kumar, Stroke in India – factsheet (updated 2015), Available From : https:// www.researchgate.net/publication/264116605.
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6. Pournima pawar, Vijaykumar biradar, Compare the effect of cimt versus mirror therapy on hand function in sub-acute and chronic stroke, European journal of pharmaceutical and medical research, ejpmr, 2017,4(1), 535-540, ISSN 2394-3211.
7. Kil-Byung Lim, Hong-Jae Lee, JeehyunYoo, Hyun-Ju Yun, Hye-Jung Hwan, efficacy of mirror therapy containing tasks in post stroke patients, Ann Rehabil Med 2016;40(4):629-636, pISSN: 2234-0645 • eISSN: 2234-0653.
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