People who experience a stroke often have difficulty performing routine arm and hand movements. Physical rehabilitation of the limbs includes multiple types of exercises and therapies. One kind is mirror therapy. This approach is a useful, low cost, and simple method to recover upper limb function. The patient moves the unaffected limb in a mirror, and the reflection tricks the brain into believing that the other limb is moving smoothly. Task-oriented mirror therapy (TOMT) is more effective than random limb movements. It increases precision, strength, and speed of recovery of the affected limb.
Another treatment option for people who have experienced a stroke is repetitive transcranial magnetic stimulation or rTMS. Past studies have shown positive results in recovering muscle-nerve control, along with improved eating and speaking abilities. Using rTMS is helpful in regaining upper-limb function. During this therapy, repetitive magnetic pulses are applied to specific areas of the brain to either activate or deactivate the nerve cells that control the muscles.
Combining magnetic and mirror therapy
This South Korean study recruited 24 people who had a stroke within the past three months. Twelve were placed in the control group and underwent rTMS therapy identical to the other twelve participants. However, the ‘study group’ also underwent TOMT. Four patients dropped out of the ‘study’ group for either personal reasons or due to scalp discomfort.
The mirror therapy lasted 30 minutes, five days a week for two weeks, and consisted of picking up sand, inserting a coin in a savings box, scooping sand with a spoon and wiping with a towel, all while looking into the mirror. The patient used the unaffected arm and hand to perform all tasks. The brain then registers the reflection as the affected side doing these movements.
The rTMS treatment lasted for 15 minutes on each day of training. Both groups also received 20 minutes of general exercises at each training session. Researchers measured the activation of the brain and hand function for specific tasks and movements.
Is the combination better?
Pinch grip and the box and block test significantly improved in the study group (rTMS plus TOMT) compared to the control group (rTMS only). The box and block tests evaluate precise hand movement and muscle excitability after experiencing a stroke. For this test, the person moves blocks of wood from one side of a box to the other side separated by a partition in a sixty-second period.
Both groups showed improved grip strength, pinch grip, and box and block test after the completion of the program. The authors concluded that the combination of rTMS and task-oriented therapies is more effective than doing one type of treatment alone. The combined therapy positively influenced damaged motor neurons by reorganizing the damaged portion of the brain, so there was better coordination between both sides.
Combining therapies appears to better the chance of regaining strength and manual dexterity after a stroke. Talk to your therapist about trying these two therapies together.
The lead author of this study is Jinhong Kim, Department of Physical Therapy, The Graduate School, Sahmyook University, Seoul, Republic of Korea.