Mirror therapy for stroke patients was reported to be effective in improving upper-extremity motor function and daily life activity performance. In addition, game-based virtual reality can be realized using a gesture recognition (GR) device, and various tasks can be presented. Therefore, this study investigated changes in upper-extremity motor function, quality of life, and neck discomfort when using a GR device for mirror therapy to observe the upper extremities reflected in the mirror.
A total of 36 subjects with chronic stroke were randomly divided into 3 groups: GR mirror therapy (n=12), conventional mirror therapy (n=12), and control (n=12) groups. The GR therapy group performed 3D motion input device-based mirror therapy, the conventional mirror therapy group underwent general mirror therapy, and the control group underwent sham therapy. Each group underwent 15 (30 min/d) intervention sessions (3 d/wk for 5 weeks). All subjects were assessed by manual function test, neck discomfort score, and Short-Form 8 in pre- and post-test.
Upper-extremity function, depression, and quality of life in the GR mirror therapy group were significantly better than in the control group. The changes of neck discomfort in the conventional mirror therapy and control groups were significantly greater than in the GR mirror therapy group.
We found that GR device-based mirror therapy is an intervention that improves upper-extremity function, neck discomfort, and quality of life in patients with chronic stroke.
In patients with acute stroke that occurred >6 months previously, 85% have upper-limb disorders, and 55% to 75% have upper-limb disorders . The upper-limb movement function is decreased due to weakening of upper-limb muscles, which is primarily caused by changes in the central nervous system and secondarily by weakness due to inactivity and reduced activity [2,3].
Activities of daily living are limited due to body dysfunction, and most stroke patients have limited social interaction; these disorders reduce the quality of life [4–6]. In addition, stroke patients may experience depression due to reduced motivation . Depression results in loss of interest and joy, anxiety, fear, hostility, sadness, and anger, which negatively affect functional recovery and rehabilitation in stroke patients .
Constraint-induced movement therapy, action observation training, and mirror therapy have been recently studied as therapies for upper-extremity motor function . These interventions are used to increase the use of paralyzed limbs to overcome disuse syndromes, observe and imitate movement, and change the neural network involved in movement. Providing various tasks in upper-extremity rehabilitation is necessary and virtual reality is used as a method for providing various tasks [9,10].
Interventions using virtual reality require cognitive factors, such as judgment and memory, as the task progresses. It can use visual and auditory stimuli, and can induce interest and motivation, helping stroke patients to be mentally stable and motivated . Gesture recognition (GR) is a topic that studies the reading of these movements using algorithms. These GR algorithms mainly focus on the movement of arm, hands, eyes, legs, and other body parts. The main idea is to capture body movements using capture devices and send the acquired data to a computer . A remarkable example is shown in physical rehabilitation, where the low-cost hardware and algorithms accomplish outstanding results in therapy of patients with mobility issues. A 3D motion input device is required for upper-body rehabilitation in virtual reality. The Leap motion controller, a GR input device, has been recently released, which monitors hand and finger movements and reflects them on the monitor . In addition, game-based virtual reality can be realized using a GR device, and various tasks can be presented.
Mirror therapy has been used as a therapeutic intervention for phantom pain in amputees. The painful and paralyzed body parts are covered with a mirror. The mirror is placed in the center of the body, and the movement of the paralyzed body is viewed through the mirror. The patient has a visual illusion that the paralyzed side is normally moving . Mirror therapy for stroke patients was reported to be effective in upper-extremity motor function and daily life activity performance . However, conventional mirror therapy methods require high concentration and can become tedious, making active participation difficult . In addition, conventional mirror therapy differs from the actual situation wherein a mirror positioned at the center of the body should be viewed with the head sideways. Because patients are in a suboptimal posture, they may have neck discomfort after mirror therapy. The body has muscle strength disproportion when maintaining poor posture for a long time. This results in inadequate tension on adjacent muscles and joints, resulting in movement restriction, reduced flexibility, pain, and changes in bone and soft tissue .
This study investigated the effect on upper-extremity motor function, quality of life, and neck discomfort by using GR device mirror therapy in patients with chronic stroke, and evaluated the efficacy of this technique.