Did your stroke doctor and hospital do ONE FUCKING THING with this from 13 years ago?
Mirror therapy in the motor recovery of upper extremity
EUR MED PHYS 2008;44(Suppl. 1 to No. 3)
A. SCIUSCO, G. DITRENTA, A. RAHINÒ, S. DAMIANI, M. MEGNA, M. RANIERI, G. MEGNA
It is well known that the adult nervous system preserves a plasti-city potential that is able to guarantee partial recovery after an injury. It has also already been demonstrated that mirror-neurons play a key role in the activity of human neural circuits, i.e. in the observation-imitation-learning process. A new therapeutic rehabilitation treatment called mirror therapy exploits the mirror-neurons system activation, trying to lead the nervous system plasticity.In the present study, mirror therapy combined with conventional therapy has been compared with conventional therapy alone in the motor recovery of the upper limbs. A total of 14 patients with brain injuries in a sub-acute or chronic phase participated in the trial, divided into two equal groups. Before and after the rehabilitation pro-gram, each patient underwent examination and complete physiatric evaluation (Mini-Mental State Examination [MMSE], Functional Independence Measure [FIM], Fugl-Meyer Assessment [FMA], Modified Ashworth Scale [MAS]). After 4 weeks, the subjects treated with the mirror therapy combination showed a slightly lower grade of spasticity, an improvement in the motor ability of the arms and in the general posture, and a greater autonomy. As compared with the traditional rehabilitation techniques, mirror therapy may offer an additional effective strategy promoting recovery from brain injuries.
Introduction
Recent studies show that upper limb impairment affects 85% of stroke patients, and that most of stroke patients with initial upper limb impairment still have significant functional problems five years after the acute event1-3. However, there is ample evidence suggesting that, after injury, plastic changes occur in the brain in order to compensate for loss of function in damaged areas 4. For example,research with both animal models and humans has shown that the organization of the adult cerebral cortex can change substantially as a result of practice and experience[5,6]. Furthermore, experience-dependent change can occur at multiple levels of the central nervous system, from the molecular or synaptic level to the level of cortical maps and large-scale neural networks7,8.Reorganization of motor functions immediately around the stroke site (ipsilesional) is likely to be important in motor recovery after stroke, and a contribution of other brain areas in the affected hemisphere is also possible9. Moreover, it has been demonstrated that central adaptations occur in networks controlling the paretic as well as the nonparetic lower limb after stroke10. Understanding how pathophysiological and brain plasticity mechanisms are related to Department of Neurological and Psychiatric Sciences, Physical Medicine and Rehabilitation, University of Bari “Aldo Moro” functional outcome and recovery of the upper limb should help to improve rehabilitation interventions in the future11.Currently, although intensive therapy for the upper limb after stroke is associated with small but statistically significant improvements in neuromuscular and functional outcomes, scientific results are still unclear about the effectiveness of specific upper limb rehabilitation strategies12,13. Therapeutic approaches (e.g., Bobath or motor relearning approach) can vary between clinicians without sufficient evidence that one approach is better than another in improving upper limb function, and the best practice for the rehabilitation of the upper limb is thus still undefined14,15. Despite these considerations there is growing support that some specific interventions may be beneficial for patients with limited upper limb function, e.g.constraint-induced movement therapy (CIMT)16, strength training17and bilateral arm training18. Recently, Rizzolatti’s et al discovery of mirror neurons in humans, which fire both execute movements and observing movements, has opened up new prospects for alternative neurological rehabilitation techniques19-21. In the last few years some studies have suggested that not only movement, but also imaging and observing movement, could stimulate motor circuits and improve motor recovery 22-25. Motor imagery may provide an effective means of stimulating those brain regions normally involved in planning and controlling movements of the paralyzed limb26. Combined with evidence indicating that motor simulation and action share common parieto frontal mechanisms,these observations raise the possibility that imagery may present a viable means of stimulating damaged brain circuits in paralyzed patients27,28. Furthermore, imagining hand movements could stimulate the redistribution of brain activity which accompanies recovery of hand function, resulting in a reduced motor deficit29,30. Functional brain imaging studies of healthy subjects suggest that excitability of the primary motor cortex ipsilateral to a unilateral hand movement is facilitated by viewing a mirror reflection of the moving hand31. Mirror therapy is a relatively new therapeutic intervention that focuses on moving the unimpaired limb32. In stroke patients, this technique involves performing movements of the unimpaired limb while watching its mirror reflection superimposed
It is well known that the adult nervous system preserves a plasti-city potential that is able to guarantee partial recovery after an injury. It has also already been demonstrated that mirror-neurons play a key role in the activity of human neural circuits, i.e. in the observation-imitation-learning process. A new therapeutic rehabilitation treatment called mirror therapy exploits the mirror-neurons system activation, trying to lead the nervous system plasticity.In the present study, mirror therapy combined with conventional therapy has been compared with conventional therapy alone in the motor recovery of the upper limbs. A total of 14 patients with brain injuries in a sub-acute or chronic phase participated in the trial, divided into two equal groups. Before and after the rehabilitation pro-gram, each patient underwent examination and complete physiatric evaluation (Mini-Mental State Examination [MMSE], Functional Independence Measure [FIM], Fugl-Meyer Assessment [FMA], Modified Ashworth Scale [MAS]). After 4 weeks, the subjects treated with the mirror therapy combination showed a slightly lower grade of spasticity, an improvement in the motor ability of the arms and in the general posture, and a greater autonomy. As compared with the traditional rehabilitation techniques, mirror therapy may offer an additional effective strategy promoting recovery from brain injuries.
Introduction
Recent studies show that upper limb impairment affects 85% of stroke patients, and that most of stroke patients with initial upper limb impairment still have significant functional problems five years after the acute event1-3. However, there is ample evidence suggesting that, after injury, plastic changes occur in the brain in order to compensate for loss of function in damaged areas 4. For example,research with both animal models and humans has shown that the organization of the adult cerebral cortex can change substantially as a result of practice and experience[5,6]. Furthermore, experience-dependent change can occur at multiple levels of the central nervous system, from the molecular or synaptic level to the level of cortical maps and large-scale neural networks7,8.Reorganization of motor functions immediately around the stroke site (ipsilesional) is likely to be important in motor recovery after stroke, and a contribution of other brain areas in the affected hemisphere is also possible9. Moreover, it has been demonstrated that central adaptations occur in networks controlling the paretic as well as the nonparetic lower limb after stroke10. Understanding how pathophysiological and brain plasticity mechanisms are related to Department of Neurological and Psychiatric Sciences, Physical Medicine and Rehabilitation, University of Bari “Aldo Moro” functional outcome and recovery of the upper limb should help to improve rehabilitation interventions in the future11.Currently, although intensive therapy for the upper limb after stroke is associated with small but statistically significant improvements in neuromuscular and functional outcomes, scientific results are still unclear about the effectiveness of specific upper limb rehabilitation strategies12,13. Therapeutic approaches (e.g., Bobath or motor relearning approach) can vary between clinicians without sufficient evidence that one approach is better than another in improving upper limb function, and the best practice for the rehabilitation of the upper limb is thus still undefined14,15. Despite these considerations there is growing support that some specific interventions may be beneficial for patients with limited upper limb function, e.g.constraint-induced movement therapy (CIMT)16, strength training17and bilateral arm training18. Recently, Rizzolatti’s et al discovery of mirror neurons in humans, which fire both execute movements and observing movements, has opened up new prospects for alternative neurological rehabilitation techniques19-21. In the last few years some studies have suggested that not only movement, but also imaging and observing movement, could stimulate motor circuits and improve motor recovery 22-25. Motor imagery may provide an effective means of stimulating those brain regions normally involved in planning and controlling movements of the paralyzed limb26. Combined with evidence indicating that motor simulation and action share common parieto frontal mechanisms,these observations raise the possibility that imagery may present a viable means of stimulating damaged brain circuits in paralyzed patients27,28. Furthermore, imagining hand movements could stimulate the redistribution of brain activity which accompanies recovery of hand function, resulting in a reduced motor deficit29,30. Functional brain imaging studies of healthy subjects suggest that excitability of the primary motor cortex ipsilateral to a unilateral hand movement is facilitated by viewing a mirror reflection of the moving hand31. Mirror therapy is a relatively new therapeutic intervention that focuses on moving the unimpaired limb32. In stroke patients, this technique involves performing movements of the unimpaired limb while watching its mirror reflection superimposed
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