Mental Practice and Mirror Therapy Associated with Conventional Physical Therapy Training on the Hemiparetic Upper Limb in Poststroke Rehabilitation: A Preliminary Study Rafael de Almeida Oliveira,1 Paula Cintia dos Santos Vieira,2 Luciane Fernanda Rodrigues Martinho Fernandes, PhD,3 Lislei Jorge Patrizzi, PhD,3 Sabrina Ferreira de Oliveira, MSc,3 and Luciane Aparecida Pascucci Sande de Souza, PhD3 Master's program in Physical Education, Federal University of Triângulo Mineiro (UFTM); 2Physiotherapist graduated from UFTM; 3 Department of Physical Therapy, UFTM, Uberaba, Minas Gerais, Brazil
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Background: The presence of sensory and motor deficits is common in patients post stroke. Mental practice (MP) and mirror therapy (MT) can be used as therapeutic techniques for poststroke rehabilitation. Important results have been demonstrated, although they have not established the patients’ functional gain or related results of muscle electromyographic (EMG) data to functionality. Objective: The aim was to investigate EMG activity and sensory, motor, and functional performance in hemiparetic limbs of patients with stroke after intervention with MP and MT associated with conventional physical therapy training (CPTT). Methods: Seven patients were treated twice weekly during 8 weeks with MP and MT associated with CPTT of the affected upper limb. The Fugl-Meyer scale and the Barthel Index (BI) were applied to assess sensorimotor ability and independence of patients. Activation of the upper trapezius, biceps brachii, triceps brachii, flexor carpi ulnaris, and extensor carpi radialis was evaluated by means of EMG symmetry index and muscle co-activation measurements. Results: There were statistically significant differences between pre- and postassessment findings for the motor, sensory, and mobility domains of the Fugl-Meyer scale, as well as for BI evaluation. No statistically significant differences were observed when the pre- and posttest symmetry and co-activation data were compared, although there were qualitative changes. Conclusions: The protocol was effective for improving motor, sensory, and mobility aspects, as well as function involved in activities of daily living. Qualitative changes in symmetry and muscle co-contraction were found, indicating a possible improvement in upper limb rehabilitation of patients with stroke. Key words: electromyography, rehabilitation, stroke, upper limb extremity
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troke is caused by the interruption of blood supply to the central nervous system, typically as a result of the rupture of a blood vessel or a blood clot.1 The most commonly compromised motor functions in individuals who have had a stroke occur in the upper limbs, involving the ability to reach, grip, and manipulate objects. These components form the basis of the motor skills required to successfully perform activities of daily living (ADLs).2,3 One of the deficiencies in the production of movement is caused by muscle weakness, which is attributed to improper recruitment of motor
units, leading to an inability to generate force.4 These deficits in muscle activation occur as a result of low neural conduction and less activation of the units in terms of firing rate and intraand intermuscular synchronization.5,6 Changes in motor units therefore lead to changes in the patterns of muscle activation, such as decreased ability to recruit agonist muscles, delayed onset of muscle activation, co-contraction of agonists and antagonists, and loss of selective activation of sets of muscles needed to perform motor tasks.7 In recent publications, researchers have described the use of mental practice (MP) and mirror therapy (MT)
Corresponding author: Rafael de A. Oliveira, Department of Physical Therapy, Federal University of Triangulo Mineiro, 405 Padre Zeferino Street, Uberaba, Minas Gerais, 38015-160 Brazil; e-mail: fael.
[email protected]
Top Stroke Rehabil 2014;21(6):484–494 © 2014 Thomas Land Publishers, Inc. www.strokejournal.com
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doi: 10.1310/tsr2106-484
