The synergic effects of mirror therapy and neuromuscular electrical stimulation for hand function in stroke patients

Abstract

Objective: To investigate the synergic effects of mirror therapy and neuromuscular electrical stimulation (NMES) for hand function in stroke patients.

Method: Sixty patients with hemiparesis after stroke were included (41 males and 19 females, average age 63.3 years). Twenty patients had NMES applied and simultaneously underwent mirror therapy. Twenty patients had NMES applied only, and twenty patients underwent mirror therapy only. Each treatment was done five days per week, 30 minutes per day, for three weeks. NMES was applied on the surface of the extensor digitorum communis and extensor pollicis brevis for open-hand motion. Muscle tone, Fugl-Meyer assessment, and power of wrist and hand were evaluated before and after treatment.

Results: There were significant improvements in the Fugl-Meyer assessment score in the wrist, hand and coordination, as well as power of wrist and hand in all groups after treatment. The mirror and NMES group showed significant improvements in the Fugl-Meyer scores of hand, wrist, coordination and power of hand extension compared to the other groups. However, the power of hand flexion, wrist flexion, and wrist extension showed no significant differences among the three groups. Muscle tone also showed no significant differences in the three groups.

Conclusion: Our results showed that there is a synergic effect of mirror therapy and NMES on hand function. Therefore, a hand rehabilitation strategy combined with NMES and mirror therapy may be more helpful for improving hand function in stroke patients than NMES or mirror therapy only.

Keywords: Mirror therapy; Neuromuscular electrical stimulation; Stroke.

Fig. 1

(A) Mirror and NMES therapy: A patient with right hemiparesis was treated with NMES on the right wrist and hand extensor muscle and simultaneously underwent flexion and extension of the finger and wrist while looking at the reflection of her left hand on the mirror. (B) Mirror therapy only: A patient with right hemiparesis underwent flexion and extension of the finger and wrist while looking at the reflection on the mirror. (C) NMES therapy only: A patient with right hemiparesis was treated with NMES on the right wrist and hand extensor muscle and simultaneously underwent flexion and extension of the finger and wrist while looking at a wooden board.