Erasmus MC, University Medical Center, Rotterdam, Netherlands.
Neurorehabil Neural Repair. 2011 Mar-Apr;25(3):223-33. doi: 10.1177/1545968310385127. Epub 2010 Nov 4.
To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis.
A total of 40 chronic stroke patients (mean time post .onset, 3.9 years) were randomly assigned to the mirror group (n = 20) or the control group (n = 20) and then joined a 6-week training program. Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practiced at home 1 hour daily, 5 times a week. The primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip force, spasticity, pain, dexterity, hand-use in daily life, and quality of life at baseline-posttreatment and at 6 months-were all measured by a blinded assessor. Changes in neural activation patterns were assessed with functional magnetic resonance imaging (fMRI) at baseline and posttreatment in an available subgroup (mirror, 12; control, 9).
Posttreatment, the FMA improved more in the mirror than in the control group (3.6 ± 1.5, P < .05), but this improvement did not persist at follow-up. No changes were found on the other outcome measures (all Ps >.05). fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only (weighted laterality index difference 0.40 ± 0.39, P < .05).
This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization. Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains.
评估家庭镜像治疗对慢性脑卒中伴中度上肢瘫痪患者的临床疗效及随后的皮质重组作用。
共纳入 40 例慢性脑卒中患者（发病后平均时间为 3.9 年），随机分为镜像组（n=20）和对照组（n=20），然后参加为期 6 周的训练计划。两组患者均每周在康复中心接受 1 次物理治疗师监督下的训练，每周在家练习 5 次，每天 1 小时。主要结局指标为 Fugl-Meyer 运动评估量表（FMA）。在基线-治疗后和 6 个月时，由盲法评估者测量握力、痉挛、疼痛、灵巧性、日常生活中的手功能和生活质量。在可行的亚组中（镜像组 12 例，对照组 9 例），采用功能磁共振成像（fMRI）评估基线和治疗后神经激活模式的变化。
治疗后，镜像组的 FMA 改善优于对照组（3.6±1.5，P<.05），但这种改善在随访时并未持续。其他结局指标均无变化（均 P>.05）。fMRI 结果显示，仅在镜像组中，初级运动皮层的激活平衡向患侧转移（加权偏侧性指数差值 0.40±0.39，P<.05）。
这项 II 期试验显示，慢性脑卒中患者的镜像治疗具有一定疗效，且首次将镜像治疗与皮质重组相关联。未来的研究需要确定最佳的练习强度和持续时间，以维持和推广到其他功能领域的改善。
