Archive for category Mirror therapy

[Abstract + References] Unilateral Dorsiflexor Strengthening With Mirror Therapy to Improve Motor Function After Stroke: A Pilot Randomized Study

Abstract

Background: Independently, cross-education, the performance improvement of the untrained limb following unilateral training, and mirror therapy have shown to improve lower limb functioning poststroke. Mirror therapy has shown to augment the cross-education effect in healthy populations. However, this concept has not yet been explored in a clinical setting.

Objectives: This study set out to investigate the feasibility and potential efficacy of applying cross-education combined with mirror therapy compared with cross-education alone for lower limb recovery poststroke.

Methods: Thirty-one chronic stroke participants (age 61.7 ± 13.3) completed either a unilateral strength training (ST; n = 15) or unilateral strength training with mirror-therapy (MST; n = 16) intervention. Both groups isometrically strength trained the less-affected ankle dorsiflexors three times per week for 4 weeks. Only the MST group observed the mirror reflection of the training limb. Patient eligibility, compliance, treatment reliability, and outcome measures were assessed for feasibility. Maximal voluntary contraction (MVC; peak torque, rate of torque development, and average torque), 10-m walk test, timed up and go (TUG), Modified Ashworth Scale (MAS), and the London Handicap Scale (LHS) were assessed at pretraining and posttraining.

Results: Treatment and assessments were well tolerated without adverse effects. No between group differences were identified for improvement in MVC, MAS, TUG, or LHS. Only the combined treatment was associated with functional improvements with the MST group showing an increase in walking velocity.

Conclusion: Cross-education plus mirror therapy may have potential for improving motor function after stroke. This study demonstrates the feasibility of the combination treatment and the need for future studies with larger sample sizes to investigate the effectiveness of the treatment.

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[Abstract + References] A Mechatronic Mirror-Image Motion Device for Symmetric Upper-Limb Rehabilitation

Abstract

This paper presents an upper-limb rehabilitation device that provides symmetric bilateral movements with motion measurements using inertial sensors. Mirror therapy is one of widely used methods for rehabilitation of impaired side movements because voluntary movement of the unimpaired side facilitates reorganizational changes in the motor cortex. The developed upper-limb exoskeleton was equipped with two brushless DC motors that helped generate three axes of upper-limb movements corresponding to other arm movements that were measured using inertial sensors. In this study, inertial sensors were used to estimate the joint angles for three target upper-limb movements: elbow flexion and extension (flex/ext), wrist flex/ext, and forearm pronation and supination (pro/sup). Elbow flex/ext was performed by the actuator that was directly attached to the elbow joint. The actuation of the forearm pro/sup and wrist flex/ext shared one motor using a developed cable-driven mechanism, and two types of motion were selectively performed. We assessed the feasibility of the proposed mirror-image device with the accuracy and precision of the motion estimation and the actuation of joint movements. An individual could perform most upper-limb movements for activities of daily living using the proposed device.

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[Abstract] Comparison of Task Oriented Approach and Mirror Therapy for Poststroke Hand Function Rehabilitation

Abstract

Objective: The purpose of this study was to compare the effectiveness of task-oriented therapy and mirror therapy on improving hand function in post-stroke patients.
Methods: Total subjects 30 were randomly divided into two groups: the task-oriented group (15 patients) and the mirror therapy group (15 patients). The task-oriented group underwent task-oriented training for 45 mins a day for 5 days a week for 4 weeks. The mirror therapy group underwent a mirror therapy program under the same schedule as
task-oriented therapy. The manual dexterity and motor functioning of the hand were evaluated before the intervention and 4 weeks after the intervention by using FMA (Fugl-Meyer assessment) and BBT (Box & Block test).
Results: Hand function of all patients increased significantly after the 4-week intervention program on the evaluation of motor function and manual dexterity by FMA and BBT in both the groups of Task-Oriented approach and Mirror therapy, but Group A Task-oriented approach improved more significantly when compared to Group B Mirror therapy.
Conclusion: The treatment effect was more in patients who received a Task-Oriented approach compared to Mirror therapy. These findings suggest that the Task-Oriented approach was more effective in post stoke hand function rehabilitation.

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[Abstract] Timing-dependent interaction effects of tDCS with mirror therapy on upper extremity motor recovery in patients with chronic stroke: A randomized controlled pilot study

Highlights

  • The priming effect of dual tDCS was important to facilitate motor recovery in combination with mirror therapy in stroke.

Abstract

This study was a randomized, controlled pilot trial to investigate the timing-dependent interaction effects of dual transcranial direct current stimulation (tDCS) in mirror therapy (MT) for hemiplegic upper extremity in patients with chronic stroke. Thirty patients with chronic stroke were randomly assigned to three groups: tDCS applied before MT (prior-tDCS group), tDCS applied during MT (concurrent-tDCS group), and sham tDCS applied randomly prior to or concurrent with MT (sham-tDCS group). Dual tDCS at 1 mA was applied bilaterally over the ipsilesional M1 (anodal electrode) and the contralesional M1 (cathodal electrode) for 30 min. The intervention was delivered five days per week for two weeks. Upper extremity motor performance was measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the Action Research Arm Test (ARAT), and the Box and Block Test (BBT). Assessments were administered at baseline, post-intervention, and two weeks follow-up. The results indicated that concurrent-tDCS group showed significant improvements in the ARAT in relation to the prior-tDCS group and sham-tDCS group at post-intervention. Besides, a trend toward greater improvement was also found in the FMA-UE for the concurrent-tDCS group. However, no statistically significant difference in the FMA-UE and BBT was identified among the three groups at either post-intervention or follow-up. The concurrent-tDCS seems to be more advantageous and time-efficient in the context of clinical trials combining with MT. The timing-dependent interaction factor of tDCS to facilitate motor recovery should be considered in future clinical application.

via Timing-dependent interaction effects of tDCS with mirror therapy on upper extremity motor recovery in patients with chronic stroke: A randomized controlled pilot study – Journal of the Neurological Sciences

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[VIDEO] Mirror Therapy Combined With Electrical Stimulation Using SaeboStim Micro – YouTube

https://www.saebo.com

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.

via Mirror Therapy Combined With Electrical Stimulation Using SaeboStim Micro – YouTube

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[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

ABSTRACT

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.

Aaron Larson
May 2019

Full Text PDF

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[Abstract] Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

 

via Advantages of virtual reality in the rehabilitation of balance and gait: Systematic review. – PubMed – NCBI

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[Abstract] How to perform mirror therapy after stroke? Evidence from a meta-analysis

Abstract

BACKGROUND:

A recently updated Cochrane review for mirror therapy (MT) showed a high level of evidence in the treatment of hemiparesis after stroke. However, the therapeutic protocols used in the individual studies showed significant variability.

OBJECTIVE:

A secondary meta-analysis was performed to detect which parameters of these protocols may influence the effect of MT for upper limb paresis after stroke.

METHODS:

Trials included in the Cochrane review, which published data for motor function / impairment of the upper limb, were subjected to this analysis. Trials or trial arms that used MT as group therapy or combined it with electrical or magnetic stimulation were excluded. The analysis focused on the parameters mirror size, uni- or bilateral movement execution, and type of exercise. Data were pooled by calculating the total weighted standardized mean difference and the 95% confidence interval.

RESULTS:

Overall, 32 trials were included. The use of a large mirror compared to a small mirror showed a higher effect on motor function. Movements executed unilaterally showed a higher effect on motor function than a bilateral execution. MT exercises including manipulation of objects showed a minor effect on motor function compared to movements excluding the manipulation of objects. None of the subgroup differences reached statistical significance.

CONCLUSIONS:

The results of this analysis suggest that the effects on both motor function and impairment of the affected upper limb depend on the therapy protocol. They furthermore indicate that a large mirror, unilateral movement execution and exercises without objects may be parameters that enhance the effects of MT for improving motor function after stroke.

 

via How to perform mirror therapy after stroke? Evidence from a meta-analysis. – PubMed – NCBI

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[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

Abstract

Background

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.

Material/Methods

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.

Results

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.

Conclusions

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.

Background

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 [,].

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 []. 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 [,].

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.

[…]

 

Continue —>  Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial

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Figure 2
(A) Gesture recognition mirror therapy group, (B) Conventional mirror therapy, (C) Control group.

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[Abstract + References] Investigation of the effects of mirror therapy on the spasticity, motor function and functionality of impaired upper limbs in chronic stroke patients

Background/Aims

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.

Methods

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.

Results

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).

Conclusions

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.

 

References

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

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