With significant improvement shown your hospital should have had this in house at least 6 years ago. Where is the publicly available protocol on this? Survivors need to easily be able to find this.
Do you prefer your hospital incompetence NOT KNOWING? OR NOT DOING?
Effect of mirror therapy combined with somatosensory stimulation on motor recovery and daily function in stroke patients: A pilot study
Keywords
Introduction
The hemiparetic arm is one of the most devastating consequences after stroke.1 Approximately 30-66% of patients with stroke never regain motor function of the affected hand for the rest of their lives, which seriously affects their performance of daily functions.2 Several treatment techniques have been developed to improve motor control and function of the affected upper extremity for stroke patients, including, for example, robotic-assisted training3 and constraint-induced movement therapy.4, 5, 6 These treatment protocols involve significant equipment costs and/or continuous monitoring from therapists to closely guide the therapy.
Mirror therapy (MT) has been recommended as a simple, inexpensive alternative to treat motor function.7, 8 MT involves repetitive bimanual, symmetrical movement practice in which the patient moves the affected limb as much as she/he could while watching the reflective illusion of the unaffected limb from a mirror.9 Although the underlying mechanism remains uncertain, the studies of neural activities found that MT might activate areas within the premotor and somatosensory cortex and/or the mirror neuron system consisting of the frontotemporal region and superior temporal gyrus. This cortical activation might facilitate motor output in patients with hemiparesis.10, 11
The effects of MT on motor and daily function have been studied in patients with stroke.7, 8, 12 The findings of these clinical trials suggested positive effects of MT on reducing motor impairment as measured by the Brunnstrom stages of recovery and Fugl-Meyer assessment (FMA)7, 8, 12 and daily function as examined by the Functional Independence Measure (FIM).7 However, findings that MT modulated muscle tone and motor function (action research arm test, ARAT) were inconsistent and not significant.8, 12
The mesh glove (MG) is a two-channel electrical stimulator composed of two independent cathodes over the dorsal and volar side of the forearm and a common anode inside the glove that provides synchronous or reciprocal tonic sensory stimulation with different amplitudes. The MG was suggested to normalize muscle tone that ameliorates motor impairment in patients with stroke.13, 14, 15 Research showed that MG stimulation on the affected hand modulated the polarization and depolarization of the ascending afferent fibers. The damaged hemisphere received the controlled kinesthetic input from the spinal, subcortical level, changed the blood-oxygen level-dependent response in the sensorimotor cortex,16, 17 and induced a long-lasting modulated effect on motor cortical excitability.18
Combining two efficient treatment protocols to maximize the benefits from training has been advocated.19, 20 The key concept of both MT and MG is sensory manipulation (i.e., visual illusion and kinesthetic input),21, 22 and these two approaches share the same cortical reorganization mechanism to a certain degree. Combining both approaches might facilitate the sensorimotor cortex that controls movement and might augment somatosensory input and further treatment efficacy. In other words, MG functions to modulate sensory input to control the spasticity, and combining MG with MT may complement the insufficiency of MT to acquire better outcomes in motor or functional performance.
Considering that these two approaches share a similar cortical mechanism, this study combined MG with MT to investigate its possible effects on motor performance and daily function. We hypothesized that patients who received MG therapy coupled with MT would gain a larger effect in motor recovery and muscle tone than patients receiving MT alone and that daily function would be enhanced.
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