Strokes in Older People Research Paper

Strokes are more common in older people than in any other age groups. A significant number of stroke incidences occur in people under the age bracket of 65 and above. However, stroke is now common in other age groups. Each stroke is different depending on the part of the brain injured, how severe the injury is, and the person's general health. Weakness or paralysis on one side of the body is some of the effects of stroke. They also have trouble with balance and coordination, as well as fine motor function and motor control. The purpose of this study is to investigate the efficacy of mirror therapy compare to constraint-induced movement therapy in treating stroke patients with fine motor and motor control impairments.

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Introduction

Motor deficits are one of the widespread effects of stroke. The disorder is more common among the elderly as compared to other age groups. Almost three-quarters of all strokes happen in people of age 65 and above. However, recent statistics indicate that stroke can also affect anyone regardless of age. Strokes are of different types, and it depends which part of the brain is injured, the extent of the injury, and the person's overall health condition. Some of the effects of stroke include paralysis on one side of the body, difficulties with balance and coordination, and lack of fine motor function and control.

Problem Statement

Stroke has been identified as one of the most common conditions that are affecting a large population of people in the world. Stroke not only affects the old but has expanded to other age groups. According to Nookala and Vadlamudi (2011), stroke is the third leading cause of death globally. It causes various side effects in the body such as difficulties in motor function. Therapists have recommended different therapies in an attempt to cure the diseases; thus, prompting the essence of evaluating the effectiveness of two primary treatments, which are mirror-therapy and constraint-induced approach.

Literature Review

Scholars have conducted various studies to assess the effectiveness of multiple interventions in the treatment of stroke. Gillen, Geller, Hreha, and Saleem (2015) performed an evidence-based review on some of the various approaches used in the treatment of stroke. The methodologies include repetitive task practice, CIMT and mCIMT, mental rehearsal, virtual reality, mirror therapy, action observation, and strengthening and exercise. The authors defined repetitive task practice as an approach that entails performance in goal-directed activities with frequent repetitions and movements. CIMT (constraint-induced movement therapy) was defined as the method that involves straining of the unaffected limb for extended hours during the day. mCIMT is a shortened version of CIMT where all the activities of the approach are compressed over time. Mental practice is training where a person engages in cognitive operations in the absence of actual movements. In virtual reality, participants take part in computer-based treatment sessions in a simulated environment similar to the real world. In mirror therapy, a patient is encouraged to focus on the mirror reflection of the uninvolved extremity while the involved extremity remains hidden. Strengthening and exercise method involves activities such as yoga and tai chi.

Kim and Hee Lee (2015) conducted a study to establish the effectiveness of mirror therapy combined with biofeedback functional electrical simulation (BF-FES) in twenty-nine patients suffering from a stroke. The authors found that when BF-FES was conducted together with mirror therapy, motor therapy and the quality of life of the patients improved. Other studies have also been conducted to determine the effectiveness of mirror therapy in the treatment of cerebral palsy among children (Park, Baek & Park, 2016). Their study showed positive effects of the mirror therapy with improvement in various functions such as hand strength, muscle activity, and movement speed. In a randomized controlled experimental study with 30 respondents, Nookala and Vadlamudi (2011), identified that mirror therapy when combined with congruent visual feedback recorded significant improvement in motor recovery of hand functions among sub-acute stroke subjects. Mirror therapy is also known for the immediate treatment of pain and decreased the range of motion. Louw, Puentedura, Reese, Parker, Miller, and Mintken (2017) assessed the effectiveness of mirror therapy in the treatment of pain in three outpatient physical therapy clinics among patients with shoulder pain and limited active range of motion (AROM). The therapeutic approach in the results section showed significant statistical results in the treatment of pain catastrophization, shoulder flexion AROM in patients, and fear avoidance. The therapeutic approach portrayed immediate effects, but the researchers proposed further studies to be conducted to ascertain long-term effects of the method.

Motor and sensory recovery in chronic stroke can also be treated using mirror therapy. In a study to measure the effectiveness of mirror therapy and control treatment on movement performance and other daily activities, Wu, Huang, Chen, Lin, and Yang (2013), identified that the group that underwent through mirror therapy performed better in the overall and distal part of the Fugl-Meyer Assessment scores. The group also demonstrated shorter reaction time and higher maximum shoulder-elbow cross-correlation. Additionally, temperature scores from the Revised Nottingham Sensory Assessment improved in the mirror therapy group than the control treatment group. Equally important, laboratory studies have indicated that CIMT improves upper extremity function after a patient suffers from a stroke. Therefore, CIMT has become slow to be adapted as a rehabilitation practice because of its strict patient criteria and the required intensive resources. Ploughman, Shears, Hutchings, and Osmond (2017) conducted a study within an outpatient clinical setting to determine the feasibility and effectiveness of CIMT in the treatment of upper extremity impairment after stroke. After undergoing two weeks of CIMT session, AJ, a 16-year-old male improved grip and lateral pinch strength among other measures. The researchers recorded that significant gains were recorded after six months in the ARAT and Box and Block Test.

Research Question

Is mirror therapy more effective than constraint-induced movement therapy after stroke?

Proposed Methods and Procedures

Sample

The study will be conducted in a short-term rehabilitation facility. The target population for the research will be males or females between the ages of 55-65 diagnosed with stroke.

Instrument

The study will utilize a Quasi-Experimental pretest-posttest, experimental trial. The Fugl-Meyer Assessment scores and stroke impact scale will be used to determine the effectiveness of mirror therapy and CIMT.

Data Collection

The participants will be selected based on the inclusion criteria from the rehabilitation department. Twelve sub-acute stroke subjects 6 males and 6 females (n=12) will participate in the research study. The selected participants will be required to meet particular inclusion criteria. The category for selection include first episode of unilateral stroke with hemiparesis greater than 6 months' post-stroke, have an age limit of 55-65 years, be able to understand simple instructions. Furthermore, the exclusion criteria for the study will be cognitive deficits, neglect one side of the body, perceptual deficits, impaired vision, and dementia.

Interventions

The intervention of the study will be conducted within the scheduled therapy sessions. All the subjects will receive 20 therapy sessions for 1 hour each for 4 weeks (5 days per week). Each period will consist of mirror therapy for 1hour and constraint-induced movement therapy for 1 hour. All the participants will be trained according to the various treatment methods selected for the study.

Outcome Measures

The Fugl-Meyer Assessment utilizes a 3-point ordinal scale to assess the level of sensorimotor function in the affected body area. The highest motor score is 66; and, the higher the score, the higher the recovery. The scores will be divided into the proximal and distal part. The stroke impact scale is a questionnaire that respondents will use to record how stroke has affected their lives. Questions will be divided into various sections depending on the researcher. The scale has zero to 100-frequency rate. The 100 represents full recovery.

Data Analysis and Discussion

The results obtained from the therapy sessions through the stress impact scale and the Fugl-Meyer Assessment will be recorded then presented statistically. Upper limb paresis is one of the severe impairments that affect individuals after stroke. The study will be conducted using various motor therapies. It is expected that participants who will receive mirror therapy in collaboration with CIMT will demonstrate a significant increase in motor function/motor control.

References

Gillen, G., Geller, D., Hreha, K., Osei, E., & Saleem, G. T. (2015). Effectiveness of interventions to improve occupational performance of people with motor impairments after stroke: an evidence-based review. American Journal of Occupational Therapy, 69(1), 6901180030p1-6901180030p9.

Louw, A., Puentedura, E. J., Reese, D., Parker, P., Miller, T., & Mintken, P. E. (2017). Immediate effects of mirror therapy in patients with shoulder pain and decreased range of motion. Archives of physical medicine and rehabilitation, 98(10), 1941-1947.

Kim, J. H., & Lee, B. H. (2015). Mirror therapy combined with biofeedback functional electrical stimulation for motor recovery of upper extremities after stroke: a pilot randomized controlled trial. Occupational therapy international, 22(2), 51-60.

Nookala, K., & Vadlamudi, S. (2011). Efficacy of Mirror Therapy on Motor Recovery of Hand Functions in Sub Acute Stroke Individuals-a Randomized Controlled Trial. Journal of Physiotherapy and Occupational Therapy, 5, 95-100.

Park, E. J., Baek, S. H., & Park, S. (2016). Systematic review of the effects of mirror therapy in children with cerebral palsy. Journal of physical therapy science, 28(11), 3227-3231.

Ploughman, M., Shears, J., Hutchings, L., & Osmond, M. (2008). Constraint-induced movement therapy for severe upper-extremity impairment after stroke in an outpatient rehabilitation setting: a case report. Physiotherapy Canada, 60(2), 161-170.

Wu, C. Y., Huang, P. C., Chen, Y. T., Lin, K. C., & Yang, H. W. (2013). Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial. Archives of physical medicine and rehabilitation, 94(6), 1023-1030.