Home-based mirror therapy for treating hemiparesis in stroke patients

描述（由申请人提供）：在美国，每年有55万人在中风后出现上肢运动缺陷（轻偏瘫）。最近成功的镜像疗法（MT）是值得注意的，因为它是一种简单的治疗轻偏瘫，并可能是可行的家庭使用。机器翻译使用一面标准的镜子来创造一种引人注目的错觉，在这种错觉中，未受损肢体的运动看起来就像是由受损肢体做出的。我们计划完成一项MT的随机安慰剂对照临床试验，目标招募100例慢性卒中患者。治疗将包括一套标准化的手，手腕和肘部运动，每天两次，每次30分钟，每周5次，持续4周。被分配到安慰剂治疗组（使用不透明分隔器而不是镜子进行相同治疗）的患者将在3个月随访后交叉接受MT治疗。这项研究的第一个目标将是确定是否以家庭为基础的MT形式是一种有效的治疗轻偏瘫。提供镜像疗法可以在家中进行的证据将对治疗轻偏瘫的成本产生巨大影响，特别是相对于需要大量治疗师时间（约束诱导运动疗法）或昂贵设备（机器人训练）的替代治疗。试点数据表明，以家庭为基础的镜子治疗可能会导致临床上显着改善功能。第二个目标将是通过包括每周改善措施来确定MT的最佳剂量。第三个目标是了解镜像疗法疗效的个体差异。以前的MT研究没有报告，或缺乏能力来测试，为什么有些患者受益于MT和其他人没有，即使显着的个体差异已被报道。我们使用大样本的患者将使我们能够评估治疗益处的预测因素。能够预测有益的临床结果将是相当创新的，因为这个问题很少在康复研究中得到更普遍的解决，并且对于个体患者治疗选择的真实的任务至关重要。 公共卫生相关性：该项目将确定一种新的运动问题治疗方法（“镜像疗法”）的家庭形式是否对中风患者有用。该项目还将确定最有效的治疗量，并使我们能够预测哪些患者将或不会从治疗中受益。

DESCRIPTION (provided by applicant): Each year in the United States 550,000 people develop upper-extremity movement deficits after stroke (hemiparesis). The recent success of mirror therapy (MT) is notable because it is a simple treatment for hemiparesis, and may be feasible for home use. MT uses a standard mirror to create a compelling illusion in which movements of the unimpaired limb appear as if they are being made by the impaired limb. We propose to complete a randomized placebo-controlled clinical trial of MT with a target enrollment of 100 chronic stroke patients. The therapy will consist of a standardized set of hand, wrist, and elbow movements completed in two daily 30-minute sessions, 5 times per week for 4 weeks. Patients assigned to the placebo treatment (identical therapy with an opaque divider rather than a mirror) will be crossed over to receive MT after a three month follow-up. The first goal of the study will be to determine whether a home-based form of MT is an effective treatment of hemiparesis. Providing evidence that mirror therapy could be administered at home would have enormous implications for the cost of treating hemiparesis, especially relative to alternative treatments that require a significant amount of therapist time (constraint-induced movement therapy) or expensive equipment (robotic training). Pilot data suggest that home-based mirror therapy could lead to clinically significant improvements in functioning. The second goal will be to determine the optimal dosing of MT by including weekly measures of improvement. The third goal will be to understand individual differences in the efficacy of mirror therapy. Previous MT studies have not reported, or lacked the power to test, why some patients benefit from MT and others do not, even though significant individual differences have been reported. Our use of a large sample of patients will allow us to assess predictors of therapeutic benefit. Being able to predict beneficial clinical outcomes would be quite innovative because this issue is rarely addressed in rehabilitation research more generally and is crucial to the real world task of treatment selection for individual patients. PUBLIC HEALTH RELEVANCE: This project will determine whether a home-based form of a new treatment for movement problems ("mirror therapy") is useful for stroke patients. The project will also determine the most effective amount of therapy and allow us to predict which patients will or will not benefit from the treatment.