RESEARCH REPORT POSTER DISPLAY

THE IMMEDIATE EXERCISE EFFECT OF VOLUNTARY FACILITATION AT LOWER LIMB BY MIRROR THERAPY. Saito K¹, Sugawara K², Fukui Y³, Yamamoto M³, Abiko T³, Fukumura K⁴, Tomita Y⁴, Maruyama H⁵; ¹Department of Physical Therapy, Waseda College of Medical Arts and Sciences, 354-3, Sinsyoujikuruwa, Ootaaza, Iwatuki-ku, Saitama, Saitama, 339-8555, Japan. ²Division of Physical Therapy, School of Rehabilitation, Faculty of Health and Social Work, Kanagawa University of Human Services, 1-10-1 Heisei-cho, Yokosuka, Kanagawa, 238-8522, Japan. ³Department of Physical Therapy, Tokyo Metoropolitan Rehabilitation Hospital, 2-14-4, Tsutsumi dori, Sumida, Tokyo, 131-0034, Japan. ⁴Department of Biosciences and Informatics, Faculty of Science and Technology, Keio University, 3-14-1, Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, 223-8522, Japan. ⁵Department of Physical Therapy, Faculty of Health Science, International University of Health and Welfare, 2600-1, Kitakanemaru, Ootawara, Tochigi, 324-8501, Japan

PURPOSE: In mirror therapy, the patient recalls movement of the paralyzed side by visual illusion using a mirror, and actively or passively moves the paralyzed side. Its effectiveness in treatment of phantom pain of an amputee and upper limb motor paralysis after cerebral stroke has been reported. Although the therapy has been applied to clinical cases, there has been no report concerning the lower limbs. Further improvement of lower limb function increases gait ability, and leads to improvement of ADL and QOL. RELEVANCE: In this study, we performed mirror therapy using a mirror in patients with cerebral stroke-associated hemiplegia with difficulty in voluntary plantar dorsiflexion of the ankle joint, and investigated its effect on the improvement of voluntary facilitation of the lower limb on the paralyzed side by measuring the time required for plantar dorsiflexion and dorsal angle of the ankle joint. PARTICIPANTS: The subjects were 6 patients with cerebral stroke-associated hemiplegia(the mean time after onset: 130.6±90.5 days, mean age: 54.3±3.8 years). The study was adequately explained to all subjects, and performed after obtaining informed consent. METHODS: In the mirror therapy, a mirror was placed so as to reflect the leg on the non-paralyzed side when the patient looked at the paralyzed leg in the mirror. The patient voluntarily performed plantar dorsiflexion (foot tap) of the bilateral ankles for 20 minutes while looking at the non-paralyzed leg in the mirror. The patient also tapped the feet, wearing a foot switch on the sole, 20 times as fast as he/she could without looking at the mirror before and after foot tap with looking at the mirror. The mean and standard deviation of the intervals of 20 foot taps at the maximum speed were calculated using MATLAB (Math Work), and this mean value was regarded as the maximum foot tap. An electric angle system was attached to the paralyzed ankle joint, and the dorsiflexion angle was measured. ANALYSIS: For statistical analysis, t-test was used, and the significance level was set to lower than 5%. RESULTS: Regarding the time required for plantar dorsiflexion, the maximum foot tap was 503.9±90.0 ms before mirror therapy and 477.9±92.2 ms after mirror therapy, showing a significant difference The dorsiflexion angle of the ankle joint was 15.8±0.2 degrees before and after mirror therapy. The mean tap interval was shortened after mirror therapy, suggesting that the repulsive muscular coordination involved in plantar dorsiflexion of the ankle joint was improved. The dorsiflexion angle of the ankle joint did not change after mirror therapy. CONCLUSIONS: The patients may have concentrated on rapid switching of the plantar dorsiflexion, and may have not paid attention to the angle. Input of visual illusion by mirror therapy may have affected the motor image formation on the paralyzed side. IMPLICATIONS: Physical Therapy can help hemiplegia people by clarify the effect voluntary facilitation of lower limbs with hemiplegia. KEYWORDS: Mirror Therapy, Hemiplegia, Voluntary facilitation. FUNDING ACKNOWLEDGEMENTS: unfound. CONTACT: k-saito@d2.dion.ne.jp

ETHICS COMMITTEE: Tokyo Metoropolitan Rehabilitation Hospital ethics committee