IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume 7, Issue 1 (May.- Jun. 2013), PP 05-14 www.iosrjournals.org www.iosrjournals.org 5 | Page Comparison of Task Specific Exercises and Mirror Therapy to Improve Upper Limb Function in Subacute Stroke Patients Sneha S. Khandare 1 , R. M. Singaravelan 2 , Subhash M. Khatri 3 1 (Postgraduate student, College of Physiotherapy, PIMS, Loni- 413 736, India) 2 (Associate professor, College of Physiotherapy, PIMS, Loni- 413 736, India) 3 (Professor and Principal, College of Physiotherapy, PIMS, Loni- 413 736, India) Abstract: Stroke is the leading cause of long-term disability. Approximately 70% to 80% of people sustaining a stroke have upper limb (UL) impairment. Improving use of the affected UL is important however, because difficulty in using this UL in daily tasks has been associated with reduced quality of life. Additional effects of combining mirror therapy (MT) with Task Specific Exercises (TSE) to improve UL function post-stroke are unknown. Hence, primary objective of this study was to find out the effectiveness of combined TSE and MT interventions in sub-acute stroke patients to improve UL function and secondary objective was to compare the effectiveness of combined TSE and MT interventions with TSE alone and MT alone. Thirty-seven stroke patients were divided into 3 groups; Group A received TSE, Group B received MT and Group C received TSE as well as MT. Outcome measures were Action Research Arm Test, Fugl-Meyer Assessment and Voluntary Control Grading. All 3 groups showed statistically significant improvement on outcome measures but Group C improved more than the other 2 groups. Conclusion: TSE and MT interventions should be combined altogether in the treatment of sub-acute stroke patients to improve UL function. Keywords: Mirror therapy, Stroke, Task specific exercises, Task specific training, Upper limb function. I. Introduction Stroke is a major cause of disability in adults. One direct consequence of stroke is the loss of upper limb (UL) function. Whereas up to 83% of stroke survivors learn to walk again, it is estimated that only 5 to 20% of stroke survivors attain complete functional recovery of their affected UL [1, 2]. Approximately 70% to 80% of people who sustain a stroke have upper-extremity impairment [3]. Many of them do not regain functional use of the paretic UL, which can lead to difficulties in activities of daily living (ADLs) and to participate in community life [4]. At 6 months post-stroke, a substantial proportion (25%-53%) of people remain dependent in at least 1 ADL task, which often involves the use of unilateral or bilateral UL movement [5]. Despite of these stark statistics, fortunately it is encouraging that, recent studies capitalizing on the concept of experience-induced neural-plasticity have produced promising results using specific interventions aimed at UL improving function [6]. One such intervention is task specific exercise. Task-specific exercise (TSE) is defined as “a training or therapy where patient has to practice context- specific motor tasks and receive some form of feedback [7]; with regard to skill learning, it may be associated with different practice conditions, feedback and conditions of transfer ”[8,9]. TSE in rehabilitation focuses on improvement of performance in functional tasks through goal-directed practice and repetition. The focus is on training of functional tasks rather than impairments [10]. It has been recognized that „movement emerges from an interaction between the individual, the task and the environment in which the task is being carried out‟ [11], this model is consistent with TSE. Other similar terms that reflect these practice elements are: „task specific training‟ [10], „repetitive functional task practice‟, „repetitive task practice‟ [12], „task-related training‟ [13] and „task-orientated therapy‟ [14]. Isobel J. Hubbard et al. [10] has given five strategies to guide application of TSE in clinical practice which are consistent with the guidelines put forward by many other authors [15-20]. These guidelines can be formulated as five „R‟s as: TSE should be relevant, repetitive, randomly ordered, aim towards reconstruction of whole task and positively reinforced [10]. There is increasing evidence of neural plastic changes associated with TSE [21]. These changes are associated with specific skill learning, consistent with a learning-dependent model of neural plasticity [22, 23]. Learning is reported to be maximal for the specific task trained [24]. Another relatively new intervention to improve UL function is mirror therapy (MT). Presenting visual feedback about motor performance to improve the effect of training is widespread in rehabilitation. A relatively new way of using this visual feedback to help the patients is exploited in MT [25]. Vilayanur Ramachandran, neurologist from United States first experimented MT in patients who suffered from a phantom limb after amputation [26]. During MT practice sessions, patient has to sit in front of a mirror that is oriented parallel to his midline blocking the view of the affected or painful limb which is positioned behind the mirror. When looking into the mirror, patient sees the reflection of unaffected limb positioned as the affected limb. This arrangement is suited