CC BY 4.0 · Journal of Health and Allied Sciences NU 2023; 13(02): 199-205
DOI: 10.1055/s-0042-1749422
Original Article

Outcomes of Combined Visual and Auditive Stimulation on Functions of Hand and Grip Strengths in Patients with Hemiplegia

Bhaswati Baishya
1   Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India
Kalidasan Varathan
1   Krupanidhi College of Physiotherapy, Bengaluru, Karnataka, India
› Author Affiliations


Background Stroke is a major ailment that results from hypoxia, ischemia, blockage, or hemorrhage. The recovery of hand functions is an essential goal in stroke patients' recovery.

Aim This study aimed to analyze the outcomes of rhythmic auditory stimulation (RAS) and mirror therapy on hand functions, as well as grip strength, in stroke patients.

Materials and Methods A quasiexperimental study has been used based on criteria of inclusion, 30 patients were enrolled. The participants were assigned to two groups, 15 patients each. Group A (control group) underwent traditional physiotherapy. Group B (experimental group) underwent RAS and mirror therapy. Both the groups received 20 minutes of treatment, 20 sessions in 1 month. The Action Research Arm Test (ARAT) and hand-held dynamometer were used to evaluate results. Paired t-test has been used to analyze the data with the SPSS software tool.

Results The paired t-test results showed that notable distinctions in ARAT mean pretest scores between two groups were not found. A notable change in ARAT results was present between the two groups with mean posttest score and difference in pretest to posttest. No notable distinctions in grip strength results were seen with mean pretest results. But a notable change was found in grip strength results among two groups with mean posttest scores.

Conclusion Combining RAS and mirror therapy programs has shown beneficial effects on hand functions, as well as grip strength of stroke patients and can be used as adjunct interventions along with conventional physiotherapy to encourage restoration of hand functions in hemiparetic patients.

Publication History

Article published online:
01 July 2022

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  • References

  • 1 Thorvaldsen P, Asplund K, Kuulasmaa K, Rajakangas AM, Schroll M. World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease. Stroke incidence, case fatality, and mortality in the WHO MONICA project. Stroke 1995; 26 (03) 361-367
  • 2 Diamond PT, Gale SD, Evans BA. Relationship of initial hematocrit level to discharge destination and resource utilization after ischemic stroke: a pilot study. Arch Phys Med Rehabil 2003; 84 (07) 964-967
  • 3 Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res 2017; 120 (03) 439-448
  • 4 Taylor FC, Suresh Kumar K. Stroke in India fact sheet (updated 2012). Accessed April 28, 2022 at:
  • 5 Gobindram A. Stroke care: experiences and clinical research in stroke units in Chennai. Ann Indian Acad Neurol 2006; 9 (04) 193
  • 6 Yan T, Hui-Chan CW, Li LS. Functional electrical stimulation improves motor recovery of the lower extremity and walking ability of subjects with first acute stroke: a randomized placebo-controlled trial. Stroke 2005; 36 (01) 80-85
  • 7 Luke C, Dodd KJ, Brock K. Outcomes of the Bobath concept on upper limb recovery following stroke. Clin Rehabil 2004; 18 (08) 888-898
  • 8 Park JY, Chang M, Kim KM, Kim HJ. The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients. J Phys Ther Sci 2015; 27 (06) 1681-1683
  • 9 Trombly CA, Quintana LA. The effects of exercise on finger extension of CVA patients. Am J Occup Ther 1983; 37 (03) 195-202
  • 10 Kim JH, Lee BH. Mirror therapy combined with biofeedback functional electrical stimulation for motor recovery of upper extremities after stroke: a pilot randomized controlled trial. Occup Ther Int 2015; 22 (02) 51-60
  • 11 Hatem SM, Saussez G, Della Faille M. et al. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci 2016; 10: 442
  • 12 Ahn JY, Kim H, Park CB. Effects of whole-body vibration on upper extremity function and grip strength in patients with subacute stroke: a randomised single-blind controlled trial. Occup Ther Int 2019; 2019: 5820952
  • 13 Street AJ, Magee WL, Bateman A, Parker M, Odell-Miller H, Fachner J. Home-based neurologic music therapy for arm hemiparesis following stroke: results from a pilot, feasibility randomized controlled trial. Clin Rehabil 2018; 32 (01) 18-28
  • 14 Kim JR, Jung MY, Yoo EY, Park JH, Kim SH, Lee J. Effects of rhythmic auditory stimulation during hemiplegic arm reaching in individuals with stroke: an exploratory study. Hong Kong J Occup Ther 2014; 24 (02) 64-71
  • 15 Sulivan O'SB, Schmitz TJ, Fulk GD. eds Physical Rehabilitation. Stroke. 6th edition. Philadelphia, PA: F.A. Davis Company; 2014: 685
  • 16 Jung-Hee KI, Sung-Gook PA, Hyun-Jung LI, Gyung-Choon PA, Moon-Hyung KI, Byoung-Hee LE. Effects of the combination of rhythmic auditory stimulation and task-oriented training on functional recovery of subacute stroke patients. J Phys Ther Sci 2012; 24 (12) 1307-1313
  • 17 Da Silva Mendes JC, Freysteinson WM, de Melo Gamboa R, Pereira V. Mirror Therapy: can be this technique used on facial disfigurement?. Revista E-Psi. 2017; 7 (01) 25-38
  • 18 Kim JH, Lee B. The effect of mirror therapy on functional recovery of upper extremity after stroke: a randomized pilot study. J Exp Stroke Transl Med 2017; 10 (01) 1-7
  • 19 Paik YR, Kim SK, Lee JS, Jeon BJ. Simple and task-oriented mirror therapy for upper extremity function in stroke patients: a pilot study. Hong Kong J Occup Ther 2014; 24 (01) 6-12
  • 20 Raglio A, Zaliani A, Baiardi P. et al. Active music therapy approach for stroke patients in the post-acute rehabilitation. Neurol Sci 2017; 38 (05) 893-897
  • 21 El Shemy SA, Abd El-Maksoud GM. Mirror therapy versus cross education on wrist extension and hand grip strength in children with hemiparesis. Bull Fac Phys Ther 2009;14(02):
  • 22 Sathian K, Greenspan AI, Wolf SL. Doing it with mirrors: a case study of a novel approach to neurorehabilitation. Neurorehabil Neural Repair 2000; 14 (01) 73-76
  • 23 Dobkin BH, Dorsch A. New evidence for therapies in stroke rehabilitation. Curr Atheroscler Rep 2013; 15 (06) 331
  • 24 Wang SM, Lin CY, Tse TH. et al. Effects of rhythmic auditory stimulation on upper-limb movement speed in patients with schizophrenia spectrum disorders. Eur Arch Psychiatry Clin Neurosci 2021; 271 (08) 1445-1453
  • 25 Jennifer AStevens. Mary Ellen Phillips Stoykov Using motor imagery in the rehabilitation of Hemiparesis. Arch Phys Med Rehabil 2003; 84 (07) 1090-1092
  • 26 Zhuang JY, Ding L, Shu BB, Chen D, Jia J. Associated mirror therapy enhances motor recovery of the upper extremity and daily function after stroke: a randomized control study. Neural Plast 2021; 2021: 7266263