Upper limb disability and loss of motor function are mainly caused by a stroke. Recovering motor function after stroke has been a continuous challenge for rehabilitation and treatments. The success of physical therapy and rehabilitation therapy depends on the severity of the stroke and the area of the brain affected by the stroke. Several studies have investigated if other factors combined with motor training enhance motor recovery, or if there is no difference at all. A study done by Pan et al. investigated the use of electrical stimulation along with physical functional training in the recovery of motor function in stroke patients. A separate study done by Madhoun et al. combined mirror therapy and motor functions to investigate if there was any difference between the combined therapy and physical therapy in general.
Pan et al. demonstrated that stroke survivors that received electrical stimulation prior to physical functional training improved upper limb function. This type of motor training along with electrical stimulation facilitated corticomuscular functional connectivity. Electrical stimulation provided a steady somatosensory input. This was an ideal approach to appropriately stimulate the motor cortex. The median nerve was the specific target in this study due to its role in the flexion of three fingers in the hand which account for the majority of functions in the hand. This study demonstrated that in four weeks, the experimental group that received the electrical stimulation along with the physical functional training performed better at motor tasks than those of the control group, the group that did physical functional training without the electrical stimulation. In eight weeks, there was a significant improvement in hand function. The goal of this study was to demonstrate how electrical stimulation could facilitate and strengthen limb function and corticomuscular functional connectivity in chronic stroke patients.
The goal of the Madhoun et al. study was to investigate the effects of task-based mirror therapy in subacute stroke patients compared to the effects of occupational therapy. The study compared two groups, those that did the task-based mirror therapy, and the control group that only did the occupational therapy. The task-based mirror therapy group placed their unaffected limb on the anterior side of the mirror, while the affected limb was hidden, allowing the patient to only observe the unaffected limb. The patients then did various tasks, such as flexion of the fingers and wrist with different types of objects simultaneously with both limbs. The results of this study showed that both types of therapy demonstrated improvement in motor function and recovery but that the results from the task-based mirror therapy group were significantly better than the control.
In the Pan et al. study, the majority of the subjects that underwent electrical stimulation were at the chronic stage of stroke and they showed significant improvement in motor function. This was a type of improvement that many rehabilitation programs were not able to accomplish with stroke patients in the chronic stage. The results of the study demonstrated the importance of timing and the type of therapy in recovering motor function of stroke patients. The Madhoun et al. study did acknowledge some of its limitations. First, the study was conducted looking at results from subacute stroke patients, unlike the Pan et al. study that had results from chronic stroke patients. The long-term effects of task-based mirror therapy were also not investigated. It is important to keep in mind that the relationship between motor function and corticomuscular coherence differs between individuals due to its influence on the severity of the stroke and the area of the brain where the stroke occurred. Both studies demonstrated that physical therapy along with other therapeutic stimulation may enhance motor recovery after stroke.
References:
Madhoun, H. Y., Tan, B., Feng, Y., Zhou, Y., Zhou, C., & Yu, L. (2020). Task-based mirror therapy enhances the upper limb motor function in subacute stroke patients: a randomized control trial. European journal of physical and rehabilitation medicine, 56(3), 265–271. https://doi.org/10.23736/S1973-9087.20.06070-0
Pan, LL.H., Yang, WW., Kao, CL. et al. Effects of 8-week sensory electrical stimulation combined with motor training on EEG-EMG coherence and motor function in individuals with stroke. Sci Rep 8, 9217 (2018). https://doi.org/10.1038/s41598-018-27553-4
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