Brunnstrom Movement Therapy Versus Mirror Therapy on Hand Function in Stroke

NCT ID: NCT05392543

Last Updated: 2023-04-19

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 26 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-05-30
• Study Completion Date: 2023-01-30

Brief Summary

This study will be randomized clinical trial. Non Probability consecutive sampling technique will be used. Data will be collected from patients having stroke by using tools i.e Fugl-Meyer assessment: wrist and hand (FMA- WH) and Brunnstrom Hand Manipulation (BRS-H). Those who will meet inclusion criteria will be recruited. An informed consent will be taken from all patients. The recruited subjects will be assessed according to outcome measures. Patients will be divided into 2 groups. Group A will be treated with Brunnstrom Movement Therapy plus Conventional therapy for 1 hour, 3 sessions per week (4 weeks) and Group B will be treated with Mirror Therapy plus Conventional therapy for 45 min, 3 sessions per week ( 4 weeks) 5 movements, 10 repetitions. Outcome measures will be measured at baseline, 2 weeks and after 4 weeks. Data analysis will be done by Statistical Package for the Social Sciences version 25.

Detailed Description

Stroke commonly known as Cerebro-Vascular Accident (CVA), is stated as a sudden commencement of neurological discrepancy which is attributable to a pivotal vascular basis. In modest words, it is a "brain attack", which occurs when the brain fails to get adequate blood circulation, as a result, brain cells do not get a sufficient amount of oxygen, and cells start dying ultimately. Brunnstrom movement therapy uses reflexes to develop movement behavior through sensory stimulation, in order to inhibit spasticity and movement retraining to enhance recovery. Mirror therapy (MT) in stroke patients involves performing unimpaired limb movements while observing there reflection of the mirror overlapping the impaired limb, creating a visual illusion of increased movement capacity in the impaired limb.

In previous researches, various conventional and contemporary approaches such as Brunnstrom, and Mirror therapy have been used to rehabilitate the hand after stroke in clinical settings. Previous literature was focus on digital and other conventional methods. However, despite a revolution in the number of therapeutic protocols, evidence of efficacy remains limited. Both BHM and MT have been studied separately to evaluate their respective effectiveness. However, no study has been found comparing the two protocols exclusively for hand motor recovery.

Conditions

Stroke

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: SINGLE

Study Groups

Group A

Brunnstrom movement therapy

Group Type: EXPERIMENTAL

Brunnstrom movement therapy.

Intervention Type: OTHER

Group A: Will be treated with Brunnstrom movement therapy for three days in a week for four weeks (1 h) approximately 12 sessions to every subject.

Subjects received Brunnstrom hand manipulation (BHM) and conventional occupational therapy for the upper extremity and lower extremities. The detailed BHM is applied on hand. The major goal of the BHM was the acquisition of mass grasp and mass release of objects. Once the goal was achieved, more prehensile activities were focused. Reflexive, passive, synergistic and active movements were used sequentially to enhance the hand recovery.

Group B

Mirror therapy

Group Type: EXPERIMENTAL

Mirror Therapy

Intervention Type: OTHER

Group B: Will be treated with Mirror therapy 45 minutes, for three days in a week for four weeks approximately 12 sessions to every subjects.

First 30 minutes therapy consists of conventional therapy as given conventional tasks only with the affected upper extremity. 15 minutes were continued with mirror. Mirror is placed in front of the midline of the patient so that the affected limb is fully covered by the mirror and the reflection of the unaffected limb is fully visible. The affected limb positioned in a safe and comfortable position behind the mirror. The non-affected limb should be positioned in a similar position as the affected limb, as this facilitates the intensity of the mirror illusion. Patients in the experimental group received 45 minutes of consecutive session.

Interventions

Brunnstrom movement therapy.

Group A: Will be treated with Brunnstrom movement therapy for three days in a week for four weeks (1 h) approximately 12 sessions to every subject.

Subjects received Brunnstrom hand manipulation (BHM) and conventional occupational therapy for the upper extremity and lower extremities. The detailed BHM is applied on hand. The major goal of the BHM was the acquisition of mass grasp and mass release of objects. Once the goal was achieved, more prehensile activities were focused. Reflexive, passive, synergistic and active movements were used sequentially to enhance the hand recovery.

Intervention Type: OTHER

Mirror Therapy

Group B: Will be treated with Mirror therapy 45 minutes, for three days in a week for four weeks approximately 12 sessions to every subjects.

First 30 minutes therapy consists of conventional therapy as given conventional tasks only with the affected upper extremity. 15 minutes were continued with mirror. Mirror is placed in front of the midline of the patient so that the affected limb is fully covered by the mirror and the reflection of the unaffected limb is fully visible. The affected limb positioned in a safe and comfortable position behind the mirror. The non-affected limb should be positioned in a similar position as the affected limb, as this facilitates the intensity of the mirror illusion. Patients in the experimental group received 45 minutes of consecutive session.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Both genders

• Patient population of adults 40-70 years old
• Any type of stroke (ischemic or hemorrhage)
• upper extremity, hand impairment
• (include stage here) on brunnstorm scale

Exclusion Criteria

• inability to follow commands

• inability to sit more than 2 h (self-report)
• Botox injection/chemo-denervation within the last 6 months
• presence of cardiac pacemaker
• current participation in other interventions/studies

• Minimum Eligible Age: 40 Years
• Maximum Eligible Age: 60 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Riphah International University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Mehwish Ikram

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

Sargodha Rafiqa Medical Center

Lahore, Punjab Province, Pakistan

Countries

Pakistan

References

Farooq A, Venketasubramanian N, Wasay M. Stroke Care in Pakistan. Cerebrovasc Dis Extra. 2021;11(3):118-121. doi: 10.1159/000519554. Epub 2021 Oct 25.

Reference Type: BACKGROUND

PMID: 34695824 (View on PubMed)

Dzhalagoniya I, Biryukova E, Bushkova Y, Kurganskaia M, Bobrov P, Frolov A. Biomechanical assessment of Fugl-Meyer score: the case of one post stroke patient who has undergone the rehabilitation using hand exoskeleton controlled by brain-computer interface. Int J Phys Med Rehabil. 2018;6(468):10.4172

Reference Type: BACKGROUND

Pathan UHA, Thayyil AR, Juturu T, Kamath S, Pathan UHA. Pathophysiology, complications and management of stroke

Reference Type: BACKGROUND

Pandian S, Arya KN, Davidson EWR. Comparison of Brunnstrom movement therapy and Motor Relearning Program in rehabilitation of post-stroke hemiparetic hand: a randomized trial. J Bodyw Mov Ther. 2012 Jul;16(3):330-337. doi: 10.1016/j.jbmt.2011.11.002. Epub 2011 Dec 6.

Reference Type: BACKGROUND

PMID: 22703742 (View on PubMed)

Chinnavan E, Ragupathy R, Wah YC. Effectiveness of mirror therapy on upper limb motor functions among hemiplegic patients. Bangladesh Journal of Medical Science. 2020;19(2): 208-13.

Reference Type: BACKGROUND

Geller D, Nilsen DM, Quinn L, Van Lew S, Bayona C, Gillen G. Home mirror therapy: a randomized controlled pilot study comparing unimanual and bimanual mirror therapy for improved arm and hand function post-stroke. Disabil Rehabil. 2022 Nov;44(22):6766-6774. doi: 10.1080/09638288.2021.1973121. Epub 2021 Sep 19.

Reference Type: BACKGROUND

PMID: 34538193 (View on PubMed)

Shahmoradi L, Almasi S, Ahmadi H, Bashiri A, Azadi T, Mirbagherie A, Ansari NN, Honarpishe R. Virtual reality games for rehabilitation of upper extremities in stroke patients. J Bodyw Mov Ther. 2021 Apr;26:113-122. doi: 10.1016/j.jbmt.2020.10.006. Epub 2020 Oct 11.

Reference Type: BACKGROUND

PMID: 33992230 (View on PubMed)

Sharma N, Kumar N, Uniyal K. Intermittent Pneumatic Compression and Mirror Therapy Improve Hand Functions after Stroke. Physiotherapy and Occupational Therapy Journal. 2018;11(4):141-53

Reference Type: BACKGROUND

Özkeskin M, Öztürk V, Çakmur R, Bilge K, Küçük F. The Effects of Navigated Repetitive Transcranial Magnetic Simulation and Brunnstrom Movement Therapy on Upper Extremity Proprioceptive Sense and Spasticity in Stroke Patients: A Double-Blind Randomized Trial. Journal of Basic and Clinical Health Sciences. 2017;1(2):29-35. .

Reference Type: BACKGROUND

Other Identifiers

REC/RCR &AHS/22/0205

Identifier Type: -

Identifier Source: org_study_id