Abstract
Background. Mirror therapy has been used in rehabilitation for multiple indications since the 1990s. Current evidence supports some of these indications, particularly for cerebrovascular accidents in adults and cerebral palsy in children. Since 2000s, computerized or robotic mirror therapy has been developed and marketed.Objectives. To map the extent, nature, and rationale of research activity in robotic or computerized mirror therapy and the type of evidence available for any indication. To investigate the relevance of conducting a systematic review and meta-analysis on these therapies. Method. Systematic scoping review. Searches were conducted (up to May 2018) in the Cochrane Library, Google Scholar, IEEE Xplore, Medline, Physiotherapy Evidence Database, and PsycINFO databases. References from identified studies were examined. Results. In sum, 75 articles met the inclusion criteria. Most studies were publicly funded (57% of studies; n = 43), without disclosure of conflict of interest (59% of studies; n = 44). The main outcomes assessed were pain, satisfaction on the device, and body function and activity, mainly for stroke and amputees patients and healthy participants. Most design studies were case reports (67% of studies; n = 50), with only 12 randomized controlled trials with 5 comparing standard mirror therapy versus virtual mirror therapy, 5 comparing second-generation mirror therapy versus conventional rehabilitation, and 2 comparing other interventions. Conclusion. Much of the research on second-generation mirror therapy is of very low quality. Evidence-based rationale to conduct such studies is missing. It is not relevant to recommend investment by rehabilitation professionals and institutions in such devices.
1. Introduction
Mirror therapy was originally described by Ramachandran and Rogers-Ramachandran, who suggested its use in amputees with phantom limb pain [1]. They introduce an inexpensive new device: a mirror was placed vertically on a table so that the mirror reflection of the patient’s intact hand was superimposed on the felt position of the phantom [1]. This standard mirror therapy has been used in rehabilitation for multiple indications since the 1990s [2]. A good level of evidence supports some of these indications, particularly for cerebrovascular accidents in adults [3, 4] and cerebral palsy in children [5]. Cost is very low, because a simple little and not specifically dedicated mirror can be used [1]. Dedicated mirror boxes cost about $65 each [6].
Since 2000s, virtual reality or robot has been developed and marketed to treat various diseases as a more technologically sophisticated version of the standard mirror therapy introduced in 1996 [7, 8]. Robotic devices and virtual reality are increasingly used and assessed in rehabilitation and research [9, 10]. This second-generation devices are probably much more expensive than standard mirror therapy: they often present a technological complexity that requires investment, constant maintenance, and highly qualified operators [11]. Low cost virtual reality device costs about $252 to purchase [12]. Low cost robotic device for robotic gait rehabilitation was estimated to cost $25,000, which is less than 10% of the price of device currently available in Brazil for the same indication [13]. For some indications, virtual reality such as robotics has no greater effectiveness than more conventional techniques [14, 15]. Studies evaluating the impact on various outcomes of these mirror therapy devices exist [8, 16, 17], but no review summarizes the available data.
The purpose of this review was as follows: (1) to map the extent, nature, and rationale of research activity in robotic or computerized mirror therapy; (2) to summarize the main sources and types of evidence available about the effectiveness of these therapies for any indication; (3) to investigate the relevance of conducting a systematic review and meta-analysis on these therapies.[…]
Continue —> Do Robotics and Virtual Reality Add Real Progress to Mirror Therapy Rehabilitation? A Scoping Review
TBI Rehabilitation 