Unilateral strength training and mirror therapy for enhancing lower limb motor function after stroke /

Abstract

Stroke is the leading cause of adult disability. Hemiparesis and spasticity are common impairments, resulting in ankle dorsiflexion dysfunction and gait asymmetry. Often the most-affected side is too weak to engage in rehabilitation programmes. Cross-education and mirror therapy (MT) are novel treatments that unilaterally train the less-affected limb, showing promising therapeutic effects in the more-affected limb. The inclusion of mirror visual feedback during cross-education training can further augment the cross-education effect in healthy populations. However, little is known about the application of a combination of these therapies in a clinical setting. Therefore, a gap remains in the literature regarding whether mirror visual feedback of the training limb can further augment cross-education and motor function recovery post-stroke. The first objective of this thesis was to assess existing evidence for the application of cross-education post-stroke. The systematic review (Chapter 2.0) suggests that there is moderate to strong evidence for applying cross-education after stroke. The second objective was to establish a reliable protocol for assessing strength. The reliability study (Chapter 3.0) established a reliable protocol for assessing three important strength parameters; Peak Torque, Rate of Torque Development and the novel parameter Average Torque of a single isometric contraction. The third objective was to investigate the therapeutic effects of applying a combination of cross-education and MT post-stroke. A combination of ankle dorsiflexion cross-education and MT was applied to one stroke patient (Chapter 4.0), with meaningful outcomes in strength, spasticity, motor function and self-perceived participation. Subsequently, cross-education and cross-education with MT were applied to stroke patients (Chapter 5.0). Both therapies resulted in a significant improvement in spasticity, with the combination therapy showing a trend for improving motor function. These findings present the first evidence that cross-education with MT can be applied post-stroke and may achieve lower limb rehabilitative outcomes.