Effect of Mirror Therapy on Recovery of Upper Limb Function and Strength in Subacute Hemiplegia after Stroke

OBJECTIVE: To investigate the effect of mirror therapy on recovery of upper limb function and strength in subacute hemiplegia after stroke. METHOD: Fourty subacute hemiplegic stroke patients (onset <6 months) were enrolled and randomly assigned to either the mirror therapy (MT, n=19), or control group (n=21). MT group received mirror therapy for 30 minutes after each treatment, additionally with the traditional rehabilitation programs, 5 days per week for 4 weeks; 2 hours or more per day, 3 days or more per week. To measure the outcome, we performed the manual muscle test (MMT), manual function test (MFT) and Jarmar grip strength test. RESULTS: MT group showed significant improvements in MMT, grasp and lateral pinch force of grip strength test (p<0.05), compared to control group. Improvement in MFT was more evident in MT group (p<0.05). CONCLUSION: Mirror therapy can be used as an adjuvant therapeutic technique for improving upper limb function and strength for subacute hemiplegia.

Bilateral Thalamic Ischemic Injury : A case report

Thalamic infarction is frequently bilateral due to the nature of the vascular supply to the thalamic region, and is usually caused by cardiogenic embolism or emboli originating from the proximal basilar or vertebral artery. But there have been no reported case of bilateral thalamic ischemic injury. A 25-year old man was in coma after committing suicide, hanging his neck. MRI showed bilateral pulvinar ischemic injury. He showed disturbance in recent memory, calculation, and had bilateral hemianopsia, transcortical motor aphasia, intentional tremor, proprioceptive sensory dysfunction. He was treated with progressive physical therapy for ambulation, repeated stimuli with TENS for proprioception, given donepezil 5 mg and cognitive training for improvement of cognition. After discharge, he was able to walk independently at outdoors, and could do all activities of daily living by himself. All motor and sensory functions of upper and lower extremities were recovered except tremor and dynamic standing balance dysfunction.

Herpetic Multiphasic Disseminated Encephalomyelitis

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating conditions, which is usually monophasic. Recurrent ADEM and multiphasic disseminated encephalomyelitis (MDEM) is much less characterized entity, and its differentiation from multiple sclerosis (MS) poses a diagnostic challenge. We report a case of multiphasic disseminated encephalomyelitis (MDEM). The patient had two episodes of paraparesis and other neurologic symptoms, which were separated by 2 months. The patient presented with fever, headache, mental change, lower extremity weakness, voiding difficulty as well as focal neurologic deficits, which showed good response on steroid and acyclovir. Brain MRI revealed variable sized, multifocal, subcortical white matter lesions with gray matter involvement, and spine MRI revealed high signal intensity from C3 to T9 spinal cord. The CSF study showed elevated protein count and negative oligoclonal band.