LOWER EXTREMITY MIRROR THEARPY IN STROKE PATIENTS WITH NEGLECT
Alli McCarthy
PT 640 Research Proposal
Spring Semester 2015
Research Question: Can mirror therapy performed on the upper and lower extremity of stroke patients improve unilateral visual neglect more than mirror therapy exclusively performed on the upper extremity?
Abstract
Background and Purpose. Stroke patients with visual neglect can be treated with mirror therapy to improve neglect and function. Previous studies have shown improvement of neglect and function in stroke patients who are given mirror therapy on the upper extremity only. This research will exam whether mirror therapy of both the upper and lower extremity can show greater improvement than if mirror therapy is performed
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Physical therapists working at these large hospitals throughout the Midwest where recruitment will occur will be formally trained how on how to perform MT so that therapists will be consistent within and between patients. Both groups will receive 1 hour of MT of the upper extremity 5 days a week for 4 weeks. In addition to this treatment, the physical therapist will also work with patients in both groups on limb activation for 1 hour 5 days a week for 4 weeks and provide the more traditional physical therapy given to stroke patients, such as doing exercises to improve strength in the upper and lower extremity on the affected side involving neuromuscular re-education, pre-walking functional activities, weight shifts in sitting or standing, or the maintenance of unassisted …show more content…
A pilot study will be performed since no current research looking at the effect of mirror therapy performed on stroke patients with neglect with primary outcome measures of SCT and LBT have provided exact values of means with standard deviations between the groups. An effect size of .50 will be used based on the study performed by Pandian et al. which looked at the effect of mirror therapy performed on stroke patients with neglect and used similar primary outcome measures as this study (Pandian) Therefore, with an effect size of .5, a sample size of 64 participants in each group will be needed. However, it is necessary to account for a predicted attrition rate when recruiting participants. Based on the 12% attrition rate seen in the study performed by Pandian et al., this study will start with an additional 8 participants per group with the hope of maintaining 80% power and reducing the risk of a type II error. (Pandian) Therefore, this study will begin with 72 participants in each group. An intention-to-treat analysis will be performed in order to account for subjects who drop out of the study. A Bonferroni adjustment will be made in order to maintain an overall α2 = 0.05 to protect against type 1
Stroke is a leading health care problem worldwide; ‘living with stroke’ is a real challenge both stroke survivors and their caregivers face.
One of the most rewarding parts of working as a physical therapy technician is both seeing and being partly responsible for the noticeable improvements in both mobility and function that our patients make. To me, there is nothing better than seeing patients who at first were reliant on crutches or a walker progress to the point where they can walk unassisted, or hearing patients who suffer from chronic pain say they woke up pain-free for the first time in weeks. To reach this point of improvement, however, the patients must be engaged and active in their own rehabilitation, which means following their home exercise programs and showing up for their scheduled appointments. In order for patients to buy in and take an active role in their therapy,
Aneesh Singhal, MD, author of Recognition and management of stroke in young adults and adolescents, from the Clinical Journal of the American Academy of Neurology states
Sundin, K., Jansson, L., & Norberg, A. (2000). Communicating with people with stroke and aphasia: understanding through sensation without words. Journal of Clinical Nursing, 9(4), 481-488.
following a stroke the client usually has weakness in the left side of the body so physiotherapist will aim to create a work out plan
Clients suffering from stroke have slow speech loss of memory, speechless one side of their body paralysed which cause restriction to their movement.
Stroke is a leading cause of adult disability and patients face multiple challenges, such as weakness/paralysis on one side of the body, social disability, inability to walk and self-care, the decline in community participation, and the decline in cognitive and emotional functioning. These challenges impede them from independently performing their daily activities related to work, school, parenting, or leisure. Evidence Based Practice shows that the best way to treat individuals with stroke is through the use of the mental practice. Mental practice is a training method during which a person cognitively rehearses a physical skill in the absence of overt, physical movements for the purpose of enhancing motor skill performance. It is a practice
The importance of Occupational Therapy services for induvials after stroke is to assists the pt, to become in depend when preforming their ADL’s.
Like the first article above, the purpose of this study was to determine the efficacy of mental practice use on upper-extremity impairment and functional outcomes on stroke patients, but also to see if mental practice plus physical practice would yield better results. This study took place in a licensed university-affiliated rehabilitation hospital. The design of this experiment was a case study, which consisted of only four total participants. Participants were chosen randomly; three men and one woman with moderate upper-limb hemiparesis post-stroke. Two subjects received mental practice and constraint-induced movement therapy (CIMT), one subject received only mental practice, and one received only CIMT. The main outcomes measures were the Wolf Motor Function Test (WMFT) and the Motor Activity Log (MAL). The WMFT is a validated test that measures time (15 tasks) or strength (2 tasks) in completing upper-extremity joint specific or multiple joint movements or functions. The MAL is an upper-extremity disability measure. It is a semi-structured interview during which participants are asked to rate how much and how well (6-point scale; range, 0 worst to 5 best) they use their more affected arm for 30 ADL items in the home environment over a specified period. The participant who received only mental practice showed slight
Hemi spatial neglect is a condition in which patients fail to respond to stimuli on the side of the body opposite the brain injury (Myers & Blake, 2008) Neglect may be caused by injury in either brain hemisphere, however, it is more sever and persistent after a right hemisphere brain injury (Brookshire, 2015). Many deficits exist
Constraint-Induced Physical Therapy is a specialized rehabilition approach used to improve motor ability and the functional use of a limb affected by brain injury or a stroke. After suffering a stroke, a person can lose the function of one of their limbs. These stroke survivors can get frustrated and learn to stop using affected limb and start relying on the unaffected limb. Constraint-Induced Physical Therapy tries to decrease the effects of learned non-use by forcing patients to use the affected side. CIMT uses techniques like placing a mitt on the patient’s unaffected functional hand and forcing them to perform tasks with their stroke-affected limb for a majority of the day. This therapy also has the patient perform repetitive movements to repair the brains pathways. CIMT is a deliberate practice that focuses on relearning previously acquired motor skills. Relearning motor skills is measured by acquisition, retention, and transfer of skills. Acquisition is the performance of a previously learned motor skill. To relearn a motor skill, the skill must be rehearsed repeatedly. The more time a patient devotes to a task the more opportunity they have to improve their movement
cognitive functional independence in stroke patients. Practitioners made treatment plans to check the patients’ response to treatment approach by adapting and grading the activities in order to verify their recovery process. The test result significantly correlate with ADL performance; it was predicted that the level of injury severity and injury location in stroke patients determine the cognition complication. The augment of the research shows the importance of visual perspective and spatial relations on ADL performance. Therefore, any obstacles to it impede ADL performance in the sense that stroke patients find it difficult to distinguish the relationship between an object and a person. For example, patients may not know if either leg is
The suddenly stop in blood flow to the brain from strokes can result in varying degrees of damage to the brain as seen a patient Ellen. Post stroke, Ellen ate only from the right side of her plate and will only dress and put makeup her right side. She completely neglects her left side of her body and external world. This condition is a common neurological syndrome called hemi-neglect seen in post right brain stroke patients like Ellen, especially affecting the right parietal lobe. These patients often manifest sets of odd behaviors. They report not seeing anything on their left side, but are not blind and can receive visual input from both eyes. Sometimes they even notice things in their neglected side when their attention is drawn to it. What is peculiar about a neglect patient is that he was unconsciously recognizing differences in the images, yet verbalized the images were the same. He was given 2 pictures of the houses: one on fire in the left side and the other was intact. He said they were identical, but when forced to choose, he picked the intact house over the one on fire. Another patient would roll her wheel chair in huge circles to the right to see the neglected side rather than simply turning left.
A systematic search was performed using 3 electronic databases: PubMed, ClinicalKey, and Embase. The following MeSH headings were used to conduct this search: Stroke AND Proprioception (OR Balance) AND Exercise. In Embase and ClinicalKey, a simple search was performed using combinations of the following key words: 1) Interventions (rehabilitation, exercises), 2) Stroke (cerebral vascular accident), 3) Balance (postural control). References of identified studies were manually searched.
It is common for patients to create learned non-utilization of their weaker arm. Study shows about demonstrates the serious rehashed undertaking work on utilizing the weaker arm can enhance both the measure of utilization and nature of development prompting enhanced capacity and independence. Limitation induced development treatment depends on learned non-utilize which creates amid beginning times following a stroke as the patients acquaint with adjust for trouble utilizing the impaired extremities by expanding dependence of the in-place