Ankle exercises via Mirror Therapy after stroke: co-design of the equipment, who might benefit, and dose-finding.

Bajuaifer, Sarah (2021) Ankle exercises via Mirror Therapy after stroke: co-design of the equipment, who might benefit, and dose-finding. Doctoral thesis, University of East Anglia.

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Mirror therapy (MT) has been applied successfully for upper limb motor rehabilitation following stroke. Lower limb mirror therapy (LLMT) is less understood but might also enhance motor recovery after stroke to improve walking ability. Robust studies are needed to fill the gaps in the current knowledge, develop evidence-based guidelines and ease implementation in clinical practice. In this thesis, multiple method research was used to investigate who might benefit from LLMT, the set-up of the device and what might be an appropriate dose of therapy.

A systematic review was conducted to elucidate current knowledge on the effect of LLMT motor recovery (Study I). The review examined the influence of time after stroke, level of paresis, and dose of therapy on recovery. The review revealed that LLMT enhances motor recovery and that it might be beneficial for people with severe paresis and who are less than six months post-stroke. The review highlighted a dearth of information about the effective dose.

A novel LLMT prototype device was constructed using an iterative co-design approach via focus groups involving 26 people including stroke survivors and physiotherapists (Study II). The main characteristics of the prototype are: the ability to produce MT ankle exercise from an upright sitting posture, an adjustable angle, and a lightweight device. The prototype can be used in clinical practice and subsequent research after clinical efficacy testing.

The prototype device was used in a subsequent study to determine the maximum tolerable dose (MTD) of ankle exercise using a 3+3 rule-based dose-finding (Study III). The study suggested an MTD of 35 min/day for ankle exercise via MT. Thus, to be used in subsequent dose-ranging studies to find the recommended Phase II dose. Then, Phase III clinical efficacy trial.

Therefore, LLMT is treatment worthy for future investigations to help stroke survivors return to walking.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User: Chris White
Date Deposited: 08 Feb 2022 08:48
Last Modified: 08 Feb 2022 08:48

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