Bruder N (2010) Faculty of 1000 evaluation for Robot assisted therapy for long-term upper-limb impairment after stroke. F1000—post-publication peer review of the biomedical literatureGoogle Scholar
Bullock IM et al (2012) Assessing assumptions in kinematic hand models: a review. In: 4th IEEE RAS/EMBS international conference on biomedical robotics and biomechatronicsGoogle Scholar
Emerson et al (2016) Control Implementation for an Integrated robotic and virtual mirror therapy system for stroke rehabilitation. In 2016 IEEE 14th international workshop on advanced motion control (AMC)Google Scholar
Lum P, Burgar CG et al (2005) The mime robotic system for upper-limb neuro-rehabilitation: results from a clinical trial in subacute stroke. In: 9th International conference on rehabilitation robotics, pp 511–514Google Scholar
Morris C et al (2017) Low-cost assistive robot for mirror therapy rehabilitation. In: Proceedings of the 2017 IEEE international conference on robotics and biomimetics, pp 2057–2062Google Scholar
Narang G et al (2013) Use of unobtrusive human-machine interface for rehabilitation of stroke victims through robot assisted mirror therapy. In: Technologies for practical robot applications (TePRA), 2013 IEEE international conference on, pp 1–6Google Scholar
Pu S-W et al (2016) Anthropometry-based structural design of a hand exoskeleton for rehabilitation. In: 23rd International conference on mechatronics and machine vision in practice (M2VIP)Google Scholar
Shahbazi M et al (2014) A framework for supervised robotics-assisted mirror rehabilitation therapy. In: 2014 IEEE/RSJ international conference on intelligent robots and systems (IROS 2014)Google Scholar
Sydney Hand Surgery Pty Ltd (2017) Sydney hand surgery clinic. Available: http://www.sydneyhandsurgeryclinic.com.au/anatomy.asp. Accessed 2017
Archive for category Mirror therapy
Saebo, Inc. is a medical device company primarily engaged in the discovery, development and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 100,000 clients around the globe achieve a new level of independence.
In 2001, two occupational therapists had one simple, but powerful goal – to provide neurological clients access to transformative and life changing products.
At the time, treatment options for improving arm and hand function were limited. The technology that did exist was expensive and inaccessible for home use. With inadequate therapy options often leading to unfavorable outcomes, health professionals routinely told their clients that they have “reached a plateau” or “no further gains can be made”. The founders believed that it was not the clients who had plateaued, but rather their treatment options had plateaued.
Saebo’s commitment – “No Plateau in Sight” – was inspired by this mentality; and the accessible, revolutionary solutions began.
Saebo’s revolutionary product offering was based on the latest advances in rehabilitation research. From the SaeboFlex which allows clients to incorporate their hand functionally in therapy or at home, to the SaeboMAS, an unweighting device used to assist the arm during daily living tasks and exercise training, “innovation” and “affordability” can now be used in the same sentence.
Over the last ten years, Saebo has grown into a leading global provider of rehabilitative products created through the unrelenting leadership and the strong network of clinicians around the world. As we celebrate our history and helping more than 100,000 clients regain function, we are growing this commitment to affordability and accessibility even further by making our newest, most innovative products more accessible than ever.
[Abstract] THE EFFICACY OF MIRROR THERAPY IN ADDITION TO CONVENTIONAL THERAPY VERSUS CT ALONE IN THE ACUTE AND CHRONIC STAGES OF STROKE BASED ON THE ACTION RESEARCH AND ARM TEST: A META-ANALYSIS – Full Text PDF
Background: Stroke is one of the leading causes of long term disability for adults and costs the healthcare system 34 billion dollars annually.1-3 Directly after a stroke up to 85% of survivors have an impairment of the upper extremity.4 Previous research has shown mirror therapy (MT) is beneficial for improving function in the upper extremity.5-16
Objective: The objective of this meta-analysis was to determine the efficacy of MT in addition to conventional therapy (CT) versus CT alone in the different stages of stroke rehabilitation including the acute and chronic. 5,7-17
Methods: A literature review was conducted in the fall of 2018 and consisted of the following databases: Pubmed, Medline, and CINAHL. The studies were assessed and reviewed on the specified inclusion/exclusion criteria. A fixed effect size model of 2 groups was used for the included studies to generate the Q-value, P-value, effect size, and confidence interval.
Results: The results favored MT in addition to CT as compared to CT alone in all stages of stroke rehabilitation. MT in addition to CT used in the acute stage of stroke rehabilitation was favored over MT in addition to CT used in the chronic stage of stroke rehabilitation.
Conclusion: This meta-analysis supports current literature that MT in addition to CT is more effective in improving upper extremity function than CT alone in all stages of stroke rehabilitation. The minimal to moderate effect found in the acute stage of stroke rehabilitation suggests that MT in addition to CT is more beneficial in the acute stage of stroke rehabilitation as compared to use in the chronic stage of stroke rehabilitation. The evidence should, however, be interpreted with caution until further studies are included.
[Abstract] Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review
Virtual reality (VR) has emerged as a therapeutic tool facilitating motor learning for balance and gait rehabilitation. The evidence, however, has not yet resulted in standardized guidelines. The aim of this study was to systematically review the application of VR-based rehabilitation of balance and gait in 6 neurologic cohorts, describing methodologic quality, intervention programs, and reported efficacy.
This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. VR-based treatments of Parkinson disease, multiple sclerosis, acute and chronic poststroke, traumatic brain injury, and cerebral palsy were researched in PubMed and Scopus, including earliest available records. Therapeutic validity (CONTENT scale) and risk of bias in randomized controlled trials (RCT) (Cochrane Collaboration tool) and non-RCT (Newcastle-Ottawa scale) were assessed.
Ninety-seven articles were included, 68 published in 2013 or later. VR improved balance and gait in all cohorts, especially when combined with conventional rehabilitation. Most studies presented poor methodologic quality, lacked a clear rationale for intervention programs, and did not utilize motor learning principles meticulously. RCTs with more robust methodologic designs were widely recommended.
Our results suggest that VR-based rehabilitation is developing rapidly, has the potential to improve balance and gait in neurologic patients, and brings additional benefits when combined with conventional rehabilitation. This systematic review provides detailed information for developing theory-driven protocols that may assist overcoming the observed lack of argued choices for intervention programs and motor learning implementation and serves as a reference for the design and planning of personalized VR-based treatments.
[ARTICLE] Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial – Full Text
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.
[Abstract + References] Investigation of the effects of mirror therapy on the spasticity, motor function and functionality of impaired upper limbs in chronic stroke patients
Strokes lead to different levels of disability. During the chronic stage, hemiparesis, spasticity and motor deficits may cause loss of functional independence. Mirror therapy aims to reduce deficits and increase functional recovery of the impaired upper limb. This study aimed to evaluate the effects of mirror therapy on upper limb spasticity and motor function, as well as its impact on functional independence in chronic hemiparetic patients.
In this quasi-experimental study, eight chronic hemiparetic patients (age 55.5 ± 10.8 years) were assessed to determine their degree of spasticity (Modified Ashworth Scale), level of upper limb motor function (Fugl-Meyer Assessment) and functionality (Functional Independence Measure). All participants received 12 sessions of mirror therapy delivered three times per week, over a period of 4 weeks. Participants were re-evaluated post-intervention and these results were compared to their pre-intervention scores to determine the impact of mirror therapy.
A decrease in spasticity was observed, with significant improvements in shoulder extensors (P=0.033) and a significant increase in motor function (P=0.002). The therapeutic protocol adopted did not have a significant effect on functional independence (P=0.105).
Mirror therapy led to improvements in upper limb spasticity and motor function in chronic hemiparetic stroke patients. No effects on functional independence were observed. Further research with a larger number of patients is needed to provide more robust evidence of the benefits of mirror therapy in chronic hemiparetic stroke patients.
- The effects of mirror therapy on clinical improvement in hemiplegic lower extremity rehabilitation in subjects with chronic stroke. Int Scholarly Sci Res Innov. 2015;9(2):163–166. Google Scholar
- Effects of mirror therapy on subacute stroke patients’ brain waves and upper extremity functions. J Phys Ther Sci. 2012;24(11):1119–1122 Crossref, Google Scholar
- Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther.1987;67(2):206–207. https://doi.org/10.1093/ptj/67.2.206Crossref, Google Scholar
- Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair. 2009;23(3):209–217. https://doi.org/10.1177/1545968308324786 Crossref, Google Scholar
- Systematic review: effectiveness of mirror therapy for lower extremity post-stroke. Hong Kong J Occup Ther. 2015;26:51–59. https://doi.org/10.1016/j.hkjot.2015.12.003 Crossref, Google Scholar
- The effects of mirror therapy on the gait of subacute stroke patients: a randomized controlled trial. Clin Rehabil. 2015;29(4):348–354. https://doi.org/10.1177/0269215514542356 Crossref, Google Scholar
- The mirror therapy program enhances upper-limb motor recovery and motor function in acute stroke patients. Am J Phys Med Rehabil.2012;91(8):689–700. https://doi.org/10.1097/PHM.0b013e31824fa86 Crossref, Google Scholar
- Effect of mirror therapy combined with somatosensory stimulation on motor recovery and daily function in stroke patients: a pilot study. J Formos Med Assoc. 2014;113(7):422–428. https://doi.org/10.1016/j.jfma.2012.08.008 Crossref, Google Scholar.
- Estudo de confiabilidade da aplicação da Escala de Fugl-Meyer no Brasil. Rev Brasil Fisioter. 2006;10(2):177–183. https://doi.org/10.1590/S1413-35552006000200007Crossref, Google Scholar.
- Effects of mirror therapy through functional activities and motor standards in motor function of the upper limb after stroke. Fisioter Pesqui. 2014;21(3):264–270 Google Scholar
- Efeitos da terapia espelho na reabilitação do membro superior pós-acidente vascular cerebral. Saúde (Santa Maria). 2015;41(1):157–164. Google Scholar
- Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil Neural Repair. 2011;25(3):223–233. https://doi.org/10.1177/1545968310385127 Crossref, Google Scholar.
- Ministério da Saúde. Secretaria de Atenção à Saúde. Diretrizes de atenção à reabilitação da pessoa com acidente vascular cerebral. 2013. http://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_atencao_reabilitacao_acidente_vascular_cerebral.pdf(accessed 17 June 2019) Google Scholar
- Mirror therapy for upper limb rehabilitation in chronic patients after stroke. Fisioter Mov. 2016;29(2):287–293. https://doi.org/10.1590/0103-5150.029.002.AO07Crossref, Google Scholar
- Evolução funcional de utentes após AVC nos primeiros seis meses após a lesão. Ess Fisi Online. 2005;1(3):3–20 Google Scholar
- Clinically important differences for the upper extremity Fugl-Meyer scale in people with minimal to moderate impairment due to chronic stroke. Phys Ther. 2012;92(6):791–798. https://doi.org/10.2522/ptj.20110009 Crossref, Google Scholar
- The effects of mirror therapy with tasks on upper extremity function and self-care in stroke patients. J Phys Ther Sci. 2015;27(5):1499–1501. https://doi.org/10.1589/jpts.27.1499 Crossref, Google Scholar
- Validação da versão brasileira da Medida de Independência Funcional. Acta Fisiatr. 2004;1(2):72–76 Google Scholar.
- Cortical mechanisms of mirror therapy after stroke. Neurorehabil Neural Repair. 2015;29(5):444–452. https://doi.org/10.1177/1545968314554622 Crossref, Google Scholar
- Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial. Arch Phys Med Rehabil.2014;95(11):2000–2005. https://doi.org/10.1016/j.apmr.2014.06.020 Crossref, Google Scholar.
- As incapacidades físicas de pacientes com acidente vascular cerebral: ações de enfermagem. Enfermería Global; 2009;8(15):1–12 Google Scholar
- Mirror therapy for patients with severe arm paresis after stroke: a randomized controlled trial. Clin Rehabil.2013;27(4):314–324. https://doi.org/10.1177/0269215512455651 Crossref, Google Scholar
- Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial. Stroke. 1999;30(11):2369–2375 Crossref, Google Scholar
- Effect and mechanism of mirror therapy on rehabilitation of lower limb motor function in patients with stroke hemiplegia. Biomed Res.2017;28(22):10165–10170. Google Scholar.
- Prevalence of spasticity post stroke. Clin Rehabil. 2002;16(5):515–522. https://doi.org/10.1191/0269215502cr512oa Crossref, Google Scholar
- Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2013;94(6):1023–1030. https://doi.org/10.1016/j.apmr.2013.02.007 Crossref, Google Scholar
- Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89(3):393–398. https://doi.org/10.1016/j.apmr.2007.08.162 Crossref, Google Scholar.
via Investigation of the effects of mirror therapy on the spasticity, motor function and functionality of impaired upper limbs in chronic stroke patients | International Journal of Therapy and Rehabilitation
This paper developed a robotics-assisted device for the stroke patients to perform the hand rehabilitation. Not only the system can perform passive range of motion exercises for impaired hand, but also can perform mirror therapy for pinching and hand grasping motions under the guidance of the posture sensing glove worn on patient’s functional hand. Moreover, the framework and operation flow of the developed system has been and delineated in this paper. Practical results with human subjects are shown in this paper to examine the usability of proposed system, trial experiment of advance mirror therapy that use the proposed system to interact with realities is also presented in this paper.
[NEWS] New Virtual Reality Therapy game could offer relief for patients with chronic pain, mobility issues
A Virtual Reality Therapy game (iVRT) which could introduce relief for patients suffering from chronic pain and mobility issues has been developed by a team of UK researchers.
Dr Andrew Wilson and colleagues from Birmingham City University built the CRPS app in collaboration with clinical staff at Sandwell and West Birmingham Hospitals NHS Trust for a new way to tackle complex regional pain syndrome and to aid people living with musculoskeletal conditions.
Using a head mounted display and controllers, the team created an immersive and interactive game which mimics the processes used in traditional ‘mirror therapy’ treatment. Within the game, players are consciously and subconsciously encouraged to stretch, move and position the limbs that are affected by their conditions.
Mirror therapy is a medical exercise intervention where a mirror is used to create areflective illusion that encourages patient’s brain to move their limb more freely. This intervention is often used by occupational therapists and physiotherapists to treat CRPS patients who have experienced a stroke. This treatment has proven to be successful exercises are often deemed routine and mundane by patients, which contributes to decline in the completion of therapy.
Work around the CRPS project, which could have major implications for other patient rehabilitation programmes worldwide when fully realised, was presented at the 12th European Conference on Game Based Learning (ECGBL) in France late last year.
Dr Wilson, who leads Birmingham City University’s contribution to a European research study into how virtual reality games can encourage more physical activity, and how movement science in virtual worlds can be used for both rehabilitation and treatment adherence, explained, “The first part of the CRPS project was to examine the feasibility of being able to create a game which reflects the rehabilitation exercises that the clinical teams use on the ground to reduce pain and improve mobility in specific patients.”
“By making the game enjoyable and playable we hope family members will play too and in doing so encourage the patient to continue with their rehabilitation. Our early research has shown that in healthy volunteers both regular and casual gamers enjoyed the game which is promising in terms of our theory surrounding how we may support treatment adherence by exploiting involvement of family and friends in the therapy processes.”
The CRPS project was realized through collaborative working between City Hospital, Birmingham, and staff at the School of Computing and Digital Technology, and was developed following research around the provision of a 3D virtual reality ophthalmoscopy trainer.
Andrea Quadling, Senior Occupational Therapist at Sandwell Hospital, said “The concept of using virtual reality to treat complex pain conditions is exciting, appealing and shows a lot of potential. This software has the potential to be very helpful in offering additional treatment options for people who suffer with CRPS.”
[Abstract] Immersive virtual reality mirror therapy for upper limb recovery following stroke – A pilot study
Objective This study was designed to examine the feasibility of immersive virtual reality(VR) mirror therapy for upper limb paresis after stroke using a head-mounted display, and provide preliminary evidence of efficacy.
Design Ten outpatients with chronic stroke, upper limb hemiparesis, and a low predisposition for motion sickness completed a 12-session program of 30 minutes each of immersive VR mirror therapy. The VR system provided the illusion of movement in the hemiparetic upper limb while suppressing the visual representation of the non-paretic side. Feasibility was assessed via patient compliance, adverse event tracking, the System Usability Scale, and the Simulator Sickness Questionnaire. Preliminary efficacy was evaluated using the Fugl-Meyer Upper Extremity (FM-UE) and Action Research Arm Test.
Results Immersive VR mirror therapy for patients with chronic stroke was safe, well-tolerated, and without adverse events, such as simulator sickness. Motor outcomes revealed a small improvement for the FM-UE from 21.7 (SD= 8.68) to 22.8 (SD= 9.19) that did not achieve statistical significance (p=0.084).
Conclusion Four weeks of immersive virtual reality mirror therapy was well-tolerated by chronic stroke patients. Our findings support further clinical trials of immersive VR technologies and visually-enhanced mirror therapies for stroke survivors.