| Objective:The paradigm of bilateral combined functional training based digital mirror therapy(BDMT)was designed.The study was to analyze the possible problems in the clinical application of BDMT,and to explore the clinical efficacy of BDMT on upper limb function in stroke patients,so as to provide ideas for the novel clinical application of the mirror therapy(MT).Methods:1 According to the ratio of 1:2,5 therapists and 10 patients with subacute stroke were recruited to conduct clinical treatment to analyzed potential problems of BDMT.BDMT with the dosage of 30 minutes a day,5 days a week,and 4 weeks was investigated.Fugl-Meyer Assessment upper limb motor impairment subscale(FMA-UL),the Box and Block Test(BBT)and Functional Independence Measure(FIM)were used as clinical efficacy measures.Meanwhile,the study analyzed the problems existing in the application of BDMT according to the subjective feedback of the therapists and patients.2 36 patients with stroke were randomly assigned to the BDMT group and control group.Both groups received the same conventional stroke rehabilitation project.In addition,the BDMT group received bilateral combined functional training(BCFT)under mirror visual feedback(MVF)with 30 minutes per day,5 days per week,for 4 weeks,while the conventional group received same does intervention without MVF.FMA-UL,BBT and FIM were used as outcome indicators before,2-week and 4-weeks intervention.The study aimed at observing the effects of the BDMT on both upper limbs function and activity of daily living(ADL).In addition,the relationship of the recovery of ipsilesiona land contralesional upper limb was investigated.Results:1 In the clinical observational study,all patients completed the experimental study without adverse reactions.In addition,FMA-UL,BBT and FIM scores were improved after intervention(P<0.05).Clinical application analysis showed that both the therapists' and the patients' subjective feedback on the BDMT were good.There was a certain degree of interest,comfort and operability in the application of paradigm.With the assistance of the therapist,the patient could better cooperate with the treatment.It was generally believed by most therapists that BDMT extended the clinical application paradigm of MT and suited to treatment for stroke patients.However,BDMT has its limitations in narrow treatment space,high labor cost and quiet treatment environment.2 The results from the randomized controlled study were as followed:(1)Baseline results showed that no statistically significant differences was found in general information,including age,gender,stroke type,injury side and disease course,Brunnstrom stages of the proximal and distal of arm between both groups(P>0.05).There were no statistically significant differences in FMA-UL,ipsilesional and contralesional BBT and FIM scores between the two groups(P>0.05).Meanwhile,the ipsilesional BBT scores in stroke patients was lower than normal standard.(2)After the intervention,comparative analysis within the group showed that the differences in FMA-UL,ipsilesional BBT and FIM scores in the two groups were both statistically significant(P<0.05).There were statistically significant differences of contralesional BBT scores in BDMT group(P<0.05),while the differences were not statistically significant in the control group after the intervention(P>0.05).After the intervention,comparative analysis between groups showed that the differences in FMA-UL,ipsilesional BBT and FIM scores were statistically significant in BDMT group compared with conventional group(P<0.05).But no significant differences in contralesional BBT scores was found in the two groups.(P>0.05).(3)Before and after the intervention,correlation analysis showed that there was no significant correlation between the ipsilesional BBT scores and contralesional BBT scores in both groups(P>0.05).Conclusion:1 BDMT has operational feasibility in the application for upper limb rehabilitation after stroke and expands the clinical application paradigm of MT.2 BDMT has limitations in treatment space,high labor cost,and the requirement of quiet environment.3 BDMT can promote the recovery of the motor impairment of the contralesional upper limb,the dexterity motor function of the ipsilesional upper limb and ADL after stroke.4 Patients with stroke may have a ipsilesional upper limb coordinated movement disorder,and the recovery of bilateral upper limb function may not be relevant. |
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