Clinic- and Home-Based Practice of Mirror Therapy Preceding Augmented Reality in Stroke Rehabilitation: A Crossover Study

Stroke rehabilitation in clinic- and home-based settings may yield differential effects on motor and functional outcomes. To investigate the effects of mirror therapy preceding augmented-reality therapy in the clinic and home setting. Single-blinded, randomized crossover study. Rehabilitation clinics and home environment of participants. Thirty-one stroke survivors. Participants were randomized to receive clinic-based practice first or home-based practice first. The intervention involved mirror therapy-primed augmented-reality practice. Participants received nine treatment sessions, with a 3-wk washout period between two phases. Outcome measures included the Fugl-Meyer Assessment Scale of Upper Extremity (FMA-UE), Berg Balance Scale (BBS), Chedoke Arm and Hand Activity Inventory, Motor Activity Log (MAL), and Stroke Impact Scale (SIS). Clinic-based practice significantly improved the FMA-UE (p = .04), BBS (p = .01), and SIS Mobility domain scores (p = .05). Home-based practice showed a trend for better performance on the MAL. Clinic-based practice revealed retention of treatment gains at the 3-mo follow-up assessment on the FMA-UE (p = .01) and the Activities of Daily Living-Instrumental Activities of Daily Living (p = .01), Mobility (p = .02), and Hand Function (p = .03) domains of the SIS. Clinic-based practice improved motor and balance deficits, whereas home-based practice may enhance functional arm use. Practice setting is relevant for consideration in stroke rehabilitation. Plain-Language Summary: Research supports the benefits of using augmented reality in stroke rehabilitation. Stroke rehabilitation that includes mirror therapy has also shown promising benefits. This study investigated the effects of using mirror therapy before augmented-reality therapy to improve motor and balance after a stroke. Stroke survivors participated in sessions in either a clinic- or a home-based setting. The results showed that the clinic-based sessions led to more improvements in motor and balance, whereas the home-based sessions improved patients' use of the affected arm in real-life situations. The findings suggest the need to take into consideration the occupational therapy practice setting as part of stroke rehabilitation. Clinic- and home-based practice may complement each other to optimize the effects of stroke rehabilitation.