Mirror Therapy After Stroke: A Dosing Study
Mirror Therapy After Stroke: A Dosing Study
It has been suggested that augmenting repetitive task practice with the use of box (mirror)
 therapy (BT) can enhance the benefits of task practice and may provide stroke survivors an
 opportunity to engage in self-directed practice outside of normally scheduled therapy
 sessions. However, the dosage of BT to be used in clinical practice is unclear. In order for
 practitioners to begin integrating BT into clinical practice situations more information is
 needed to determine what defines a therapeutic dose. The aim of this study is to
 differentiate between two dosages of self-directed BT added to treatment as usual for
 decreasing arm and hand motor impairments, improving activity level, and increasing
 self-directed participation after stroke. Forty-five subjects from the Stroke Rehabilitation
 Unit at Helen Hayes Hospital (HHH) will be randomly assigned into three groups: treatment as
 usual plus 30 minute dosage of self-directed BT 5x/week; treatment as usual plus 60 minute
 dosage of self-directed BT 5x/week; treatment as usual plus 30 minutes of self-directed sham
 BT 5x/week.
Approximately 795,000 people in the United States have a stroke each year, and stroke is
 considered a leading cause of long-term disability. Impairments in arm and hand function are
 common after stroke and limit engagement in daily life activities, which impacts the overall
 quality of life of stroke survivors. It has been found that incomplete upper limb recovery
 predicted health related quality of life in stroke survivors at one year post-stroke in four
 (self-care, usual activities, pain/discomfort, & anxiety/depression) out of five domains
 measured on the EuroQol-5D questionnaire. Thus, evidence-based interventions that improve arm
 and hand function after stroke are needed. In fact, a recent study identified "treatments for
 upper extremity recovery" to be one of the top ten research priorities relating to life after
 stroke according to stroke survivors, caregivers, and health professionals. Evidence suggests
 task-oriented training interventions such as Repetitive Task Practice (RTP) are effective at
 improving upper extremity (UE) function and activity, and therapy participation in stroke
 survivors.

 Recently, it has been suggested that augmenting RTP with the use of cognitive strategies,
 such as Mirror Box Therapy (BT), can enhance the benefits of task practice and may provide
 stroke survivors an opportunity to engage in self-directed practice outside of normally
 scheduled therapy sessions. During BT, a person engages in motor activities with the
 unimpaired limb while watching its mirror reflection superimposed over the (unseen) impaired
 limb; this process creates a visual illusion whereby activities performed by the unimpaired
 limb are attributed to the impaired limb. While generating this visual illusion is a common
 ingredient in published BT effectiveness trials, the actual treatment protocols differ
 considerably. One important protocol difference seen across published trials relates to the
 dosage of BT. For instance, the minutes of BT provided range from 10 minutes to 60 minutes
 per session; session frequencies range from 1 to 7 sessions per week, and the length of the
 intervention ranges from 3 to 6 weeks. Thus, the dosage of BT to be used in clinical practice
 is unclear. In order for practitioners to begin integrating BT into clinical practice more
 information is needed on the effective dosage, as this may vary according to multiple factors
 (e.g., stage of recovery, the survivor's current functional limitations, or environment in
 which services are rendered).
Inclusion Criteria:

 -  Adults status post ischemic or hemorrhagic stroke between the ages 18-85, receiving
 inpatient rehabilitation

 -  Using the impaired arm, ability to lift and release a wash cloth off a table with any
 means of prehension in either the sitting or standing positions

 -  A score > 21/30 on the Mini-Mental State Exam

 -  Ability to consent.

 Exclusion Criteria:

 -  Serious visual or visual-perceptual deficits, neuropsychological impairments, or
 orthopedic conditions that would prevent participation in the BT protocol as
 determined by the treatment team

 -  Involvement in another study protocol related to motor function after stroke

 -  Anticipated length of stay less than two weeks

 -  More than six months post stroke