But your doctor should have already created protocols on mirror therapy.
Did your stroke doctor and hospital do ONE FUCKING THING with this from 13 years ago?
Do you prefer your hospital incompetence NOT KNOWING? OR NOT DOING?
Mirror therapy in the motor recovery of upper extremity
The latest here also from 13 years ago:
Mirror Therapy Promotes Recovery From Severe Hemiparesis: A Randomized Controlled Trial
2008, Neurorehabilitation and Neural Repair
Christian Dohle, MD, MPhil, Judith Püllen, Antje Nakaten, Jutta Küst, PhD, Christian Rietz, PhD, and Hans Karbe, MD
Background
. Rehabilitation of the severely affected paretic arm after stroke represents a major challenge, especially in the presence of sensory impairment.
Objective
. To evaluate the effect of a therapy that includes use of a mirror to simulate the affected upper extremity with the unaffected upper extremity early after stroke.
Methods
. Thirty-six patients with severe hemiparesis because of a first-ever ischemic stroke in the territory of the middle cerebral artery were enrolled, no more than 8 weeks after the stroke. They completed a protocol of 6 weeks of additional therapy (30 minutes a day, 5 days a week), with random assignment to either mirror therapy (MT) or an equivalent control therapy (CT). The main outcome measures were the Fugl-Meyer subscores for the upper extremity, evaluated by independent raters through videotape. Patients also underwent functional and neuropsychological testing.
Results
. In the subgroup of 25 patients with distal plegia at the beginning of the therapy, MT patients regained more distal function than CT patients. Furthermore, across all patients, MT improved recovery of surface sensibility. Neither of these effects depended on the side of the lesioned hemisphere. MT stimulated recovery from hemineglect.
Conclusions
. MT early after stroke is a promising method to improve sensory and attentional deficits and to support motor recovery in a distal plegic limb.
Keywords:
Stroke rehabilitation; Arm; Mirror therapy; Randomized clinical trial; Motor recovery; Hemineglect
Among the different syndromes following stroke, the severely paretic arm is one of the most devastating.
1
For its alleviation, few effective therapeutic options exist. Basic research demonstrated that the functional deficits after stroke are determined by factors that include the extent of structural damage and the level of cortical stimulation during active or passive movement of the affected limb.
2
This mechanism doubly disadvantages patients with severe hemiparesis. First, the motor impairment regularly prevents active use of the arm for functionally relevant activities, leading to a reduction of its cortical representation. Second, severe hemiparesis is often accompanied by sensory deficits.
3
Thus, even when limb usage is increased (eg, during therapies), the resulting cortical activation is limited.As an alternative, mirror therapy (MT) has been proposed as potentially beneficial. For this approach, a mirror is placed in the participant’s midsagittal plane, presenting the patient the mirror image of his or her nonaffected arm as if it were the affected one (Figure 1). This approach was first introduced by Ramachandran and coworkers for arm amputees, where the mirror image of the intact arm was used to simulate its amputated counterpart. By this procedure, illusory perceptions were induced and phantom
pain in the “virtual” limb was often relieved.
4
MT was also postulated to alleviate chronic hemiparesis after stroke.
5
In their pilot study in 9 chronic stroke patients, Altschuler and colleagues reported effects of this treatment on “patients’ movement ability in terms of range of motion, speed, and accuracy,” especially for patients with severe hemiparesis.
6
Unfortunately, the effects of the therapy were not described in detail, which makes it difficult to understand the specific improvements achieved. Subsequently, mainly small scale case studies have been published, employing MT in combination with various other therapy approaches.
7-9
In a randomized controlled study on chronic stroke patients, Rothgangel and coworkers reported functional improvement during MT, but the 2 therapy groups differed at baseline.
10
Recently, the benefit of MT for the recovery of lower limb movements in subacute and chronic stroke patients was demonstrated in a high-quality randomized controlled trial design.
11
The concept of MT has been further substantiated neuro-physiologically. An imaging experiment demonstrated that inversion of the visual image of a hand can elicit lateralized cortical activations.
12
In other words, when a right hand is used, but perceived as a left hand, this leads to an additional activation of the right hemisphere (and vice versa). As recovery mechanisms are known to be most prominent within the first 3 months after stroke,
13
it is reasonable to assume that MT might be most effective when applied within this time window. In summary, there is increasing evidence that MT might be an effective method to support recovery from severe hemiparesis beyond more established rehabilitation procedures based on active or passive movement execution. However, it remains unclear which symptoms can be improved. Thus, the following single-blinded randomized trial was designed to evaluate the potential beneficial effect of viewing the mirror image of the unaffected upper limb on recovery in patients with severe hemiparesis early after stroke. As previous data indicated different degrees of lateralization for proximal and distal motor function,
14-16
these aspects were analyzed separately. Preliminary data have been reported in abstract form.
17
Background
. Rehabilitation of the severely affected paretic arm after stroke represents a major challenge, especially in the presence of sensory impairment.
Objective
. To evaluate the effect of a therapy that includes use of a mirror to simulate the affected upper extremity with the unaffected upper extremity early after stroke.
Methods
. Thirty-six patients with severe hemiparesis because of a first-ever ischemic stroke in the territory of the middle cerebral artery were enrolled, no more than 8 weeks after the stroke. They completed a protocol of 6 weeks of additional therapy (30 minutes a day, 5 days a week), with random assignment to either mirror therapy (MT) or an equivalent control therapy (CT). The main outcome measures were the Fugl-Meyer subscores for the upper extremity, evaluated by independent raters through videotape. Patients also underwent functional and neuropsychological testing.
Results
. In the subgroup of 25 patients with distal plegia at the beginning of the therapy, MT patients regained more distal function than CT patients. Furthermore, across all patients, MT improved recovery of surface sensibility. Neither of these effects depended on the side of the lesioned hemisphere. MT stimulated recovery from hemineglect.
Conclusions
. MT early after stroke is a promising method to improve sensory and attentional deficits and to support motor recovery in a distal plegic limb.
Keywords:
Stroke rehabilitation; Arm; Mirror therapy; Randomized clinical trial; Motor recovery; Hemineglect
Among the different syndromes following stroke, the severely paretic arm is one of the most devastating.
1
For its alleviation, few effective therapeutic options exist. Basic research demonstrated that the functional deficits after stroke are determined by factors that include the extent of structural damage and the level of cortical stimulation during active or passive movement of the affected limb.
2
This mechanism doubly disadvantages patients with severe hemiparesis. First, the motor impairment regularly prevents active use of the arm for functionally relevant activities, leading to a reduction of its cortical representation. Second, severe hemiparesis is often accompanied by sensory deficits.
3
Thus, even when limb usage is increased (eg, during therapies), the resulting cortical activation is limited.As an alternative, mirror therapy (MT) has been proposed as potentially beneficial. For this approach, a mirror is placed in the participant’s midsagittal plane, presenting the patient the mirror image of his or her nonaffected arm as if it were the affected one (Figure 1). This approach was first introduced by Ramachandran and coworkers for arm amputees, where the mirror image of the intact arm was used to simulate its amputated counterpart. By this procedure, illusory perceptions were induced and phantom
pain in the “virtual” limb was often relieved.
4
MT was also postulated to alleviate chronic hemiparesis after stroke.
5
In their pilot study in 9 chronic stroke patients, Altschuler and colleagues reported effects of this treatment on “patients’ movement ability in terms of range of motion, speed, and accuracy,” especially for patients with severe hemiparesis.
6
Unfortunately, the effects of the therapy were not described in detail, which makes it difficult to understand the specific improvements achieved. Subsequently, mainly small scale case studies have been published, employing MT in combination with various other therapy approaches.
7-9
In a randomized controlled study on chronic stroke patients, Rothgangel and coworkers reported functional improvement during MT, but the 2 therapy groups differed at baseline.
10
Recently, the benefit of MT for the recovery of lower limb movements in subacute and chronic stroke patients was demonstrated in a high-quality randomized controlled trial design.
11
The concept of MT has been further substantiated neuro-physiologically. An imaging experiment demonstrated that inversion of the visual image of a hand can elicit lateralized cortical activations.
12
In other words, when a right hand is used, but perceived as a left hand, this leads to an additional activation of the right hemisphere (and vice versa). As recovery mechanisms are known to be most prominent within the first 3 months after stroke,
13
it is reasonable to assume that MT might be most effective when applied within this time window. In summary, there is increasing evidence that MT might be an effective method to support recovery from severe hemiparesis beyond more established rehabilitation procedures based on active or passive movement execution. However, it remains unclear which symptoms can be improved. Thus, the following single-blinded randomized trial was designed to evaluate the potential beneficial effect of viewing the mirror image of the unaffected upper limb on recovery in patients with severe hemiparesis early after stroke. As previous data indicated different degrees of lateralization for proximal and distal motor function,
14-16
these aspects were analyzed separately. Preliminary data have been reported in abstract form.
17
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