BTX-A and Mirror Therapy for Chronic Stroke Spasticity

Fatih Sultan Mehmet Training and Research Hospital

Status: Completed

Conditions: Stroke; Spastic Hemiplegia

Treatments: Drug: Botulinum toxin type A (Botox®, Allergan); Procedure: Mirror Therapy; Procedure: Sham Mirror Therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT07331844

FSM AYNA BOTULİNUM

Details and patient eligibility

About

Stroke is one of the leading causes of disability worldwide, particularly affecting the upper extremities and thus negatively impacting patients' activities of daily living and quality of life. Upper extremity spasticity, characterized by increased muscle tone and tendon reflexes, leads to functional limitations. While Botulinum Toxin Type A (BTX-A) is widely used to manage spasticity and can temporarily alleviate symptoms, it does not directly support neuroplasticity and often requires repeated injections.

Mirror therapy (MT) has emerged as a promising rehabilitation approach with the potential to stimulate motor recovery and cortical reorganization. It is hypothesized that combining MT with BTX-A injections may more effectively reduce spasticity and improve upper extremity function.

In this study, a randomized, sham-controlled, double-blind, prospective design was employed to investigate the effects of adding MT to BTX-A treatment on spasticity and upper extremity motor function in stroke patients. A total of 30 patients, who received BTX-A injections, were divided into two groups: an experimental group receiving mirror therapy and a control group receiving sham therapy (using transparent glass). All patients also underwent a standardized conventional rehabilitation program, and the BTX-A injection protocol was kept consistent. Treatment efficacy was evaluated by comparing pre-injection measurements with those at six months post-injection, using the Brunnstrom Scale, Modified Ashworth Scale (MAS), Fugl-Meyer Scale, and a hand dynamometer. The findings are expected to shed light on the potential benefits of simultaneous MT and BTX-A administration, including reducing injection frequency, and to guide more comprehensive approaches in the rehabilitation of chronic stroke.

Enrollment: 30 patients

Sex: All

Ages: 18 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age ≥18 years
• Diagnosis of unilateral ischemic stroke
• Under the routine medical follow-up of the same clinician who plans upper extremity BTX treatment based on standard medical indications
• At least 3 months post-stroke
• Signed informed consent form
• Mini-Mental State Examination (MMSE) score >24
• Fugl-Meyer Assessment score <55
• Modified Ashworth Scale (MAS) score of 1-4

Exclusion criteria

• Any prior BTX-A or other injections administered to the upper extremity Severe cognitive impairment or any mental disorder preventing effective communication
• Concurrent enrollment in another experimental treatment program
• Visual or motor deficits that would prevent the application of mirror therapy
• History of multiple strokes
• Presence of neuromuscular pathology in the unaffected extremity
• Stroke due to a non-ischemic cause

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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30 participants in 2 patient groups

BTX-A and MİRROR THERAPY

Active Comparator group

Description:

Participants were asked to sit in a chair and place both forearms on an exercise table with their elbows flexed at 90 degrees. To administer mirror therapy, the direct view of both the healthy and the hemiplegic hand and wrist was blocked using a partition method. A mirror was then placed between the two forearms, ensuring that the mirror image of the healthy-side wrist overlapped with the position of the hemiplegic-side wrist. By observing the healthy hand's movements through the mirror during the exercises, a visual movement illusion was created for the hemiplegic hand.

Treatment:

Procedure: Mirror Therapy

Drug: Botulinum toxin type A (Botox®, Allergan)

BTX-A + Sham Mirror Therapy

Active Comparator group

Description:

In the sham group, however, a transparent glass was used instead of a mirror, and participants were asked to watch the wrist movements of the paralyzed side through the glass, providing visual feedback without creating an illusion. The sham procedure was applied for the same duration using the transparent glass

Treatment:

Procedure: Sham Mirror Therapy

Drug: Botulinum toxin type A (Botox®, Allergan)