Unilateral strength training and mirror therapy for enhancing upper limb motor function post stroke /

Abstract

Cross-education of strength appears to be beneficial in the rehabilitation of injuries and illnesses causing bilateral asymmetry. Furthermore, evidence for the effectiveness of mirror therapy to enhance cross-education in the healthy population exists. This thesis firstly aimed to investigate the clinical benefits of cross-education in post-stroke recovery, and secondly aimed to establish if the combination of cross-education and mirror therapy can further enhance positive effects on the upper-limb. Chapter 2 revealed moderate evidence for the successful application of cross-education in stroke patients. It has a positive impact on muscle strength, which potentially translates into improved functional ability. Additionally, healthcare professionals recognised unilateral strength training as a beneficial adjunct therapy. Chapter 3 established excellent protocol reliability for maximal isometric elbow extension measured with the Biodex System 3 Isokinetic Dynamometer, thus ensuring dependable procedures when assessing the effects of the subsequently applied unilateral strength training programme. Chapter 4 investigated the feasibility and potential efficacy of mirror-aided cross-education training compared to cross-education training only on upper limb motor function post stroke. Compliance was high without adverse effects. Information regarding other important aspects of a randomised controlled trial could also be provided. The additional use of a mirror did not augment the cross-education effect when chronic stroke patients trained isometrically. Nevertheless, the combination of results warrants further investigation of the combination treatment with an altered training protocol. These findings suggest a positive impact of (mirror-aided) cross-education training on post-stroke recovery. Considering the low risk for adverse effects and the by clinicians identified benefits, the rehabilitation method may have potential as an adjunct therapy to standard rehabilitation. However, to provide conclusive evidence a fully powered trial investigating the beneficial effects of mirror-aided cross-education training has to be conducted.