Home-based mirror therapy for treating hemiparesis in stroke patients

描述(由申请人提供)：在美国，每年有550,000人在中风(偏瘫)后出现上肢运动障碍。镜像疗法(MT)最近的成功值得注意，因为它是一种治疗偏瘫的简单方法，而且在家庭使用可能是可行的。MT使用标准的镜子来创造一种引人注目的错觉，在这种错觉中，未受损的肢体的运动看起来就像是由受损的肢体做出的一样。我们建议完成一项MT的随机安慰剂对照临床试验，目标是招募100名慢性中风患者。该疗法将包括一套标准化的手部、手腕和肘部运动，每天两次，每次30分钟，每周5次，为期4周。被分配给安慰剂治疗的患者(使用不透明隔板而不是镜子进行相同的治疗)将在三个月的随访后被交叉接受MT。这项研究的第一个目标将是确定基于家庭的MT是否是治疗偏瘫的有效方法。提供证据表明镜子疗法可以在家中实施，这将对偏瘫的治疗成本产生巨大影响，特别是相对于需要大量治疗师时间的替代疗法(强制性运动疗法)或昂贵的设备(机器人训练)。试点数据表明，以家庭为基础的镜子疗法可能会在临床上显著改善功能。第二个目标是通过包括每周的改善措施来确定MT的最佳剂量。第三个目标是了解镜面疗法疗效的个体差异。以前的MT研究没有报道，或者缺乏测试的能力，尽管已经报道了显著的个体差异，但为什么一些患者从MT中受益，而另一些患者则不受益。我们对大样本患者的使用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非常创新的，因为这个问题很少在康复研究中得到更广泛的解决，并且对于为个别患者选择治疗的现实世界任务至关重要。

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.