You mean your mentors and senior researchers are so out-of-date that they didn't realize mirror therapy has been proven for years? And they let you do this waste of time and money?
mirror therapy (96 posts to October 2012 )
Mirror Therapy Rehabilitation in Stroke: A Scoping Review of Upper Limb Recovery and Brain Activities
Nurulhuda Jaafar,1 Ahmad Zamir Che Daud,1 Nor Faridah Ahmad Roslan
,2 and Wahidah Mansor3,4,51Centre for Occupational Therapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia
2Department of Rehabilitation Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
3Microwave Research Institute, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
4School of Electrical Engineering, College of Engineering, UiTM Shah Alam, Malaysia
5Computational Intelligence Detection, Health & Wellness ReNeU, UiTM Shah Alam, Malaysia
Abstract
Background.
Mirror therapy (MT) has been used as a treatment for various neurological disorders. Recent application of electroencephalogram (EEG) to the MT study allows researchers to gain insight into the changes in brain activity during the therapy.
Objective.
This scoping review is aimed at mapping existing evidence and identifying knowledge gaps about the effects of MT on upper limb recovery and its application for individuals with chronic stroke.
Methods and Materials.
A scoping review through a systematic literature search was conducted using PubMed, CINAHL, PsycINFO, and Scopus databases. Twenty articles published between 2010 and 2020 met the inclusion criteria. The efficacy of MT on upper limb recovery and brain activity during MT were discussed according to the International Classification of Functioning, Disability and Health (ICF).
Results. A majority of the studies indicated positive effects of MT on upper limb recovery from the body structure/functional domain. All studies used EEG to indicate brain activation during MT.
Conclusion.
MT is a promising intervention for improving upper limb function for individuals with chronic stroke. This review also highlights the need to incorporate EEG into the MT study to capture brain activity and understand the mechanism underlying the therapy.
1. Introduction
Stroke is the second largest cause of early death and secondary disabilities [1]. Motor skills are among the crucial areas affected by stroke, and recovery from stroke typically takes more than six months, especially in the upper limbs. Evidence shows that about 83% of stroke survivors are able to walk again; however, only 5% to 20% of survivors achieve full functional recovery of affected upper limbs [2].
Several therapies using different technological sophistication levels have emerged to restore motor function after stroke. Dr. Ramachandran introduced mirror therapy (MT) in the 1990s to manage numerous other conditions, including motor disorders [3]. This therapy is based on visual stimulation. Visual feedback is given to the individual using a mirror that reflects the nonaffected limb to make the brain believe that what the individual sees is the affected limb moving without difficulty [4]. Unilateral and bilateral procedures have been implemented since the introduction of MT. In the unilateral procedure, activities are performed only on the unaffected limb. In the bilateral procedure, the individual attempts to move the affected limb as much as possible to mimic the reflected movements of the unaffected limb. Although there are different variations in MT setup and procedure, all methods serve to aid the recovery of the affected limb by stimulating the regions of the brain associated with movement, sensation, and pain [5]. The literature suggests that recovery between the first three to six months of onset is largely natural [6]. Recovery in the stroke context is defined as restoring the ability to perform a movement in the same way as before the injury [7].
The selection and classification of outcomes in stroke rehabilitation are primarily based on the International Classification of Functioning, Disability and Health (ICF) framework. The domains in the ICF include human functioning, which comprises body structure/function, activity, and participation. In any intervention study focusing on the stroke population, it may be crucial for scholars to address the effects of the interventions on the body structure/function domain. However, it is equally crucial to examine the effects of these changes on individual activity and participation domains [8].
Advanced electroencephalogram (EEG) technology for analysing brainwave signals has brought a new perspective in stroke research by capturing meaningful electrophysiological features of neuron activities [9]. Predicting therapy outcomes is more difficult in the chronic phase where the duration since stroke onset is six months or more. This is because motor recovery is not necessarily linked to the degree of the initial injury. Several complex mechanisms of dynamic neuroplasticity occurs after the initial stroke lesion [10]. Therefore, predicting motor function requires the use of complementary techniques. EEG is one of the neurophysiological techniques that can provide helpful information for predicting clinical outcomes. EEG is not only used for “for predicting clinical outcomes.” Evidence also suggests that EEG may provide insightful information on neural activity changes and interhemispheric differences [11, 12]. It is presently feasible for researchers to objectively evaluate changes in brain activity before and after the intervention. The MT study continues to evolve with various protocols and different targeted populations. The previous MT reviews have focused on all stroke phases [5, 13]; however, there are limited studies that emphasised the changes in brain activity after MT for individuals having chronic stroke only. Therefore, the purpose of this review is to map existing evidence and knowledge gaps concerning MT on brain activity and upper limb recovery among individuals with chronic stroke.
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