IMPORTANCE: Stroke rehabilitation in clinic- and home-based settings may yield differential effects on motor and functional outcomes. OBJECTIVE: To investigate the effects of mirror therapy preceding augmented-reality therapy in the clinic and home setting. DESIGN: Single-blinded, randomized crossover study. SETTING: Rehabilitation clinics and home environment of participants. PARTICIPANTS: Thirty-one stroke survivors. INTERVENTION: 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. OUTCOMES AND MEASURES: 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). RESULTS: Clinic-based practice significantly improved the FMA-UE (p = 0.04), BBS (p = 0.01), and SIS Mobility domain scores (p = 0.05). 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 = 0.01) and the Activities of Daily Living-Instrumental Activities of Daily Living (p = 0.01), Mobility (p = 0.02), and Hand Function (p = 0.03) domains of the SIS. CONCLUSIONS AND RELEVANCE: 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.
Copyright by the Amerrican Occupational Therapy Association Inc. Reprinted with permission.

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