Upper Limb Mirror Therapy with Bilateral Transcutaneous Electrical Nerve Stimulation to Improve Upper Limb Functions in Patients with Stroke

The stimulator is a 120z Dual-Channel TENS Unit (ITO Physiotherapy \& Rehabilittaion, Co, Ltd, Tokyo, Japan). The TENS stimulation will be at 100 Hz, with 0.2 ms square pulses at an intensity of twice the sensory threshold (defined as the minimum intensity at which subject reported feeling a tingling sensation and below the motor threshold as indicated by the absence of muscle twitching, to provide sensory stimulation to both paretic and intact arms. Two pairs of disposable surface electrodes will be applied over the median nerve from the carpal tunnel to the flexor digitorum superficialis and the superficial radial nerve from the extensor pollicis longus to the extensor digitorum communis, with the cathode on the proximal site, and the anode on the distal site.

"A customised angle-adjustable frame with a mirror board will be used. All subjects are instructed to perform~1. Elbow flexion and extension exercise~2. Forearm pronation and supination exercise~3. Wrist flexion and extension exercise~4. Wrist radial and ulnar deviation exercise~5. Fingers opposition exercise~6. Gripping exercise~The subject will complete bilaterally upper limb exercises during the 30 minutes period.~Intact arm will be placed in front of mirror, and paretic arm will be placed behind the mirror.~Joints involved will be flexed and extended in full available range in sitting positon, in order to improve the active control of elbow joint, wrist joint and all fingers joint respectively.~Participants will be encouraged to focus on the image of intact arm when performing upper limb exercises bilaterally."

"A customised angle-adjustable frame with a mirror board will be used while the reflecting surface of the mirror was covered with paper. All subjects are instructed to perform~1. Elbow flexion and extension exercise~2. Forearm pronation and supination exercise~3. Wrist flexion and extension exercise~4. Wrist radial and ulnar deviation exercise~5. Fingers opposition exercise~6. Gripping exercise~The subject will complete bilaterally upper limb exercises during the 30 minutes period.~Intact arm will be placed in front of covered mirror, and paretic arm will be placed behind the covered mirror.~Joints involved will be flexed and extended in full available range in sitting positon, in order to improve the active control of elbow joint, wrist joint and all fingers joint respectively."

Standardized upper limb training