Miryutova N F, Samoylova I M, Minchenko N N, Tsekhmeystruk E A
Siberian Federal Research and Clinical Center of the Federal Medical and Biological Agency, Seversk, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2021;98(5):14-23. doi: 10.17116/kurort20219805114.
Impaired function of the upper extremity after a stroke is a common cause of persistent disability and decreased social activity. Mirror therapy is an effective method for correcting hand function after a stroke. This method triggers neuroplasticity and can accelerate the recovery of functions after a wide range of neurological disorders.
To evaluate the effect of mirror therapy on the regression of motor disorders in the paretic arm, functional and psychological disorders, the patient's functioning and quality of life, risk factors for recurrent stroke in the early recovery period of stroke.
We examined 219 patients after stroke, including 154 patients after ischemic stroke (IS) and 65 patients after hemorrhagic stroke (HS) in the early recovery period (21 days to 6 months). All patients received a standard medical rehabilitation course including medications, physical rehabilitation, and physiotherapeutic treatment. Patients were divided into four groups depending on the stroke type and the medical rehabilitation course received: two study treatment groups (post-IS and post-HS groups), which consisted of patients receiving the standard medical rehabilitation course and mirror therapy, and two comparison groups (post-IS and post-HS), in which patients received only the standard medical rehabilitation course. All patients before and after the medical rehabilitation course were evaluated for neurological disorders (NIHSS, Ashworth scale of muscle spasticity, Medical Research Council (MRC) Scale and handgrip test), functional limitations (Frenchay Arm Test, Hauser Ambulation Index, Rivermead Mobility Index, Functional Independence Measure (FIM), ICF), mental status («Visual Memory» and «10 Word Memory» methods, Schulte-Platonoff tables, Lüscher color test, Hospital Anxiety and Depression Scale (HADS), Locus of Control Recovery Questionnaire), quality of life (EQ-5D), arterial hypertension (Arterial Hypertension in Adults. Clinical Guidelines, 2020).
Addition of the mirror therapy to the standard course provided additional therapeutic effects: in patients with IS, the high tone of the paretic muscles of the arm significantly decreased (by 46%); the target blood pressure was achieved in 96% of patients; severe disorders of functional independence and depression regressed; significant changes of mental functions parameters (visual memory, shifting attention); improvement of activity and participation parameters (carrying in the hands, self-care, housekeeping). In patients with HS, the muscle strength of the paretic arm significantly increased (by 35%); the target blood pressure was achieved in all patients; improvement of mental functions (motivation, shifting attention, visual memory), activity and participation parameters (objects moving and manipulation, self-care), and decreased level of depression were observed.
The addition of mirror therapy to the standard of care for patients after stroke resulted in regression of neurological deficit, motor disorders in the paretic arm, improvement of emotions and motivation, mitigation of recurrent stroke risk factors, as well as significant impact on the cognitive functions and enhancement of patients' capabilities of self-care.
中风后上肢功能受损是导致持续残疾和社交活动减少的常见原因。镜像疗法是纠正中风后手部功能的有效方法。该方法可触发神经可塑性，并能加速多种神经系统疾病后功能的恢复。
评估镜像疗法对中风早期恢复阶段患侧手臂运动障碍的消退、功能和心理障碍、患者功能及生活质量、复发性中风危险因素的影响。
我们对219例中风后患者进行了检查，其中包括154例缺血性中风（IS）患者和65例出血性中风（HS）患者，处于早期恢复阶段（21天至6个月）。所有患者均接受了包括药物治疗、物理康复和物理治疗的标准医疗康复疗程。根据中风类型和所接受的医疗康复疗程，将患者分为四组：两个研究治疗组（IS后组和HS后组），由接受标准医疗康复疗程和镜像疗法的患者组成；两个对照组（IS后组和HS后组），其中患者仅接受标准医疗康复疗程。在医疗康复疗程前后，对所有患者进行了神经系统疾病评估（美国国立卫生研究院卒中量表、肌肉痉挛Ashworth量表、医学研究委员会（MRC）量表和握力测试）、功能受限评估（Frenchay上肢测试、Hauser步行指数、Rivermead活动指数、功能独立性测量（FIM）、国际功能、残疾和健康分类（ICF））、精神状态评估（“视觉记忆”和“10词记忆”方法、舒尔特 - 普拉托诺夫表、吕舍尔颜色测试、医院焦虑抑郁量表（HADS）、控制源恢复问卷）、生活质量评估（EQ - 5D）、动脉高血压评估（《成人动脉高血压临床指南，2020》）。
在标准疗程基础上增加镜像疗法可带来额外治疗效果：在IS患者中，患侧手臂肌肉高张力显著降低（降低46%）；96%的患者达到目标血压；严重的功能独立性障碍和抑郁得到缓解；精神功能参数（视觉记忆、注意力转移）有显著变化；活动和参与参数（手持物品、自我护理、家务）得到改善。在HS患者中，患侧手臂肌肉力量显著增加（增加35%）；所有患者均达到目标血压；观察到精神功能（动机、注意力转移、视觉记忆）、活动和参与参数（物体移动和操作、自我护理）得到改善，抑郁水平降低。
在中风患者的标准护理中增加镜像疗法可使神经功能缺损消退、患侧手臂运动障碍改善、情绪和动机得到改善、复发性中风危险因素减轻，同时对认知功能有显著影响并增强患者的自我护理能力。
