[Effect of interactive scalp acupuncture on upper limb function in patients with hemiplegia after stroke].

OBJECTIVE: To explore the clinical effect of interactive scalp acupuncture combined with task-oriented mirror therapy on hemiplegia after stroke. METHODS: A total of 86 patients with hemiplegia after stroke were randomly divided into an observation group (43 cases, 2 cases dropped out) and a control group (43 cases, 2 cases dropped out). Both groups received routine treatment and rehabilitation treatment for stroke. The control group was treated with task-oriented mirror therapy, 40 min each time, once a day, 6 days a week. The observation group was treated with interactive scalp acupuncture at ipsilateral upper 1/5 and 2/5 of the parietal and temporal anterior oblique line and upper 1/5 and 2/5 of the parietal and temporal posterior oblique line on the basis of the treatment as the control group, 45 min each time, once a day, 6 days a week. Both groups were treated for 4 weeks. Before and after treatment and in follow-up of 8 weeks after treatment completion, the Fugl-Meyer assessment (FMA) score, modified Ashworth scale (MAS) score, shoulder abduction angle, wrist dorsiflexion angle and N20 latency and amplitude of somatosensory evoked potential were compared between the two groups. RESULTS: After treatment and in follow-up, the FMA scores were increased (P<0.01), the MAS scores were decreased (P<0.01) compared with those before treatment in the two groups; the FMA scores in the observation group were higher than those in the control group (P<0.01), the MAS scores were lower than those in the control group (P<0.01). After treatment and in follow-up, the shoulder abduction angle and wrist dorsiflexion angle was increased (P<0.01), the N20 latency was shortened and amplitude was increased (P<0.01) compared with that before treatment in both groups; the shoulder abduction angle and wrist dorsiflexion angle in the observation group was greater than that in the control group (P<0.01), the N20 latency was shorter than that in the control group (P<0.01), and the N20 amplitude was higher than that in the control group (P<0.01). CONCLUSION: Interactive scalp acupuncture combined with task-oriented mirror therapy can improve upper limb function in patients with hemiplegia after stroke, and reduce the muscular tone of the affected limb.

Comparisons of three different modes of digital mirror therapy for post-stroke rehabilitation: Preliminary results of randomized controlled trial.

Objective: Technologically adapted mirror therapy shows promising results in improving motor function for stroke survivors. The treatment effects of a newly developed multi-mode stroke rehabilitation system offering multiple training modes in digital mirror therapy remain unknown. This study aimed to examine the effects of unilateral mirror visual feedback (MVF) with unimanual training (UM-UT), unilateral MVF with bimanual training (UM-BT), and bilateral MVF with bimanual training (BM-BT) on clinical outcomes in stroke survivors, compared to classical mirror therapy (CMT). Methods: Thirty-five participants were randomly assigned to one of four groups receiving fifteen 60-minute training sessions for 3-4 weeks. The Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Chedoke Arm and Hand Activity Inventory (CAHAI), Revised Nottingham Sensory Assessment (rNSA), Motor Activity Log (MAL), and EQ-5D-5L were administered at pre- and post-intervention and at 1-month follow-up. Results: After intervention and follow-up, significant within-group treatment efficacies were found on most primary outcomes of the FMA-UE and CAHAI scores in all four groups. Significant within-group improvements in the secondary outcomes were found on the MAL and EQ-5D-5L index in the UM-BT group, and the rNSA tactile sensation and MAL quality of movement subscales in the BM-BT group. No significant between-group treatment efficacies were found. Conclusions: UM-UT, UM-BT, BM-BT, and CMT led to similar clinical effects on the FMA-UE and can be considered effective alternative interventions for post-stroke upper-limb motor rehabilitation. UM-BT and BM-BT showed within-group improvements in functional performance in the patients' affected upper limbs in real-life activities.

Efficacy of mental practice on paralyzed upper extremity function in the acute phase of stroke: a case study.

[Purpose] Mental practice (MP) is a method of rehabilitating upper extremity function on the affected side of the body post-stroke, with the aim of improving motor task performance through the sustained repetition of motor imagery (MI). However, most studies thus far have investigated MP for post-stroke paralytic upper limb function in patients in the chronic phase. Therefore, it is necessary to obtain evidence regarding whether MP is an effective intervention modality in the acute phase of stroke. In the present study, we examined the effects of an intervention combining mirror therapy and MP initiated during the acute phase of cerebral infarction. [Participant and Methods] A female patient >80 years of age with a cerebral infarction was studied. Prior to cerebral infarction, the patient was independent in her activities of daily living. [Results] As a result of MP, sufficient improvement was observed in the upper extremity function on the paralyzed side, as assessed using the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL). [Conclusion] In patients with MP initiated during the acute stroke phase, a combination of mirror therapy and action observation to enable vivid MI may elicit a more significant intervention effect.

The Use of Mirror Therapy in Peripheral Seventh Nerve Palsy: A Systematic Review.

BACKGROUND: Conservative therapy is currently the elective treatment for peripheric facial palsy according to scientific literature. The success of conservative therapy is due to physiotherapy and the application of its methods. The aim of this systematic review was to assess mirror therapy, a physiotherapeutic method. OBJECTIVES: The aim of the following systematic review is to evaluate the effectiveness of using mirror therapy in patients with peripheral paralysis of the seventh cranial nerve. METHODS: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The screening of literature was carried out on Cochrane, PEDro, PubMed/Medline, Scopus and Web of Science databases up until August 2022. All studies were randomized controlled trials (RCTs) and 5 articles met the inclusion criteria and were included in this study. The risk of bias was evaluated with PEDro and Jadad scales. DISCUSSION: In the present study, we reviewed 5 RCTs that compared mirror therapy with other physiotherapy treatments or placebo to reduce pain, depression and improve range of motion in patients with peripheric facial nerve palsy. CONCLUSIONS: Further studies are needed to determine the effectiveness of this type of treatment, but nevertheless the data obtained are very encouraging.

A Holistic Approach for Physiotherapy Rehabilitation of Girdlestone Arthroplasty With Infection and Concomitant Contralateral Spastic Hemiplegic Cerebral Palsy: A Case Report.

Girdlestone arthroplasty is a traditional approach for complicated infections occurring with contralateral spastic hemiplegic cerebral palsy, which presents intricate challenges in rehabilitation. In this case report, an 18-year-old girl came to a multispecialty hospital with a history of falls. She was an identified case of femoral head dislocation with acute osteomyelitis and a history of spastic hemiplegic cerebral palsy. She underwent girdlestone arthroplasty with additional upper tibial and ankle pin traction. After that, she was referred to physiotherapy management. To further aid recovery, rehabilitation protocol included a combination of static exercises, ankle pumps on the affected side, and stretching, bimanual hand-arm training with lower limb training on the unaffected side to reduce spasticity. Once the stitches were removed and traction discontinued, the focus shifted to improving mobility through basic activities like rolling and transitioning to sitting, gradually progressing to standing with the assistance of a walker and bimanual hand-arm training with lower limb training for spasticity. Outcome measures like functional independence measure, numerical pain rating scale, range of motion, and manual ability classification system were used to record patient progress during rehabilitation. This case report serves the crucial role physiotherapy plays in the treatment of orthopedic and neurological conditions in younger patients, with the ultimate goal of regaining functional independence and enhancing overall quality of life.

Video mirror feedback induces more extensive brain activation compared to the mirror box: an fNIRS study in healthy adults.

BACKGROUND: Mirror therapy (MT) has been shown to be effective for motor recovery of the upper limb after a stroke. The cerebral mechanisms of mirror therapy involve the precuneus, premotor cortex and primary motor cortex. Activation of the precuneus could be a marker of this effectiveness. MT has some limitations and video therapy (VT) tools are being developed to optimise MT. While the clinical superiority of these new tools remains to be demonstrated, comparing the cerebral mechanisms of these different modalities will provide a better understanding of the related neuroplasticity mechanisms. METHODS: Thirty-three right-handed healthy individuals were included in this study. Participants were equipped with a near-infrared spectroscopy headset covering the precuneus, the premotor cortex and the primary motor cortex of each hemisphere. Each participant performed 3 tasks: a MT task (right hand movement and left visual feedback), a VT task (left visual feedback only) and a control task (right hand movement only). Perception of illusion was rated for MT and VT by asking participants to rate the intensity using a visual analogue scale. The aim of this study was to compare brain activation during MT and VT. We also evaluated the correlation between the precuneus activation and the illusion quality of the visual mirrored feedback. RESULTS: We found a greater activation of the precuneus contralateral to the visual feedback during VT than during MT. We also showed that activation of primary motor cortex and premotor cortex contralateral to visual feedback was more extensive in VT than in MT. Illusion perception was not correlated with precuneus activation. CONCLUSION: VT led to greater activation of a parieto-frontal network than MT. This could result from a greater focus on visual feedback and a reduction in interhemispheric inhibition in VT because of the absence of an associated motor task. These results suggest that VT could promote neuroplasticity mechanisms in people with brain lesions more efficiently than MT. CLINICAL TRIAL REGISTRATION: NCT04738851.

Effect of Mirror Therapy on Post-Needling Pain Following Deep Dry Needling of Myofascial Trigger Point in Lateral Elbow Pain: Prospective Controlled Pilot Trial.

Background: This prospective randomized, controlled pilot trial to explore the immediate effect of adding Mirror Visual Feedback Therapy on pain sensitivity and motor performance among subjects suffering from post-needling pain diagnosed as Lateral Elbow Pain. Methods: A total of 49 participants (23 female, 26 male) were enrolled and randomly allocated to either the experimental group, which received Deep Dry Needling in the m. Brachioradialis, Ischemic Compression, Cold Spray, Stretching, and Mirror Visual Feedback Therapy (n = 25), or a control group without Mirror Visual Feedback Therapy (n = 24). Pre- and post-treatment evaluations included assessments of post-needling pain intensity, pressure pain threshold, two-point discrimination threshold, and maximum hand grip strength. Results: Intergroup analysis revealed a statistically significant reduction in post-needling pain intensity favoring the experimental group (U = 188.00, p = 0.034). Additionally, intragroup analysis showed significant improvements in post-needling pain intensity (MD = 0.400, SEM = 0.271, W = 137.00, p = 0.047) and pressure pain threshold (MD = 0.148 Kg/cm2, SEM = 0.038, W = 262.00, p < 0.001) within the experimental group following the intervention. Conclusions: These findings suggest a potential benefit of integrating Mirror Visual Feedback Therapy into treatment protocols for individuals with Lateral Elbow Pain experiencing post-needling discomfort. Further research is necessary to fully elucidate the clinical implications of these findings.

Effects of task-based mirror therapy on upper limb motor function in hemiplegia: study protocol for a randomized controlled clinical trial.

BACKGROUND AND PURPOSE: Research to date has lacked definitive evidence to determine whether mirror therapy promotes the recovery of upper extremity function after stroke. Considering that previous studies did not stratify patients based on structural retention, this may be one of the reasons for the negative results obtained in many trials. The goal evaluates the efficacy of TBMT (utilizing an innovatively designed mirror) versus standard occupational therapy for stroke patient's upper limb functionality. METHODS AND ANALYSIS: This single-center randomized controlled trial will involve 50 patients with stroke. All patients will be randomly assigned to either the task-based mirror therapy or the control group. The interventions will be performed 5 days per week for 4 weeks. The primary outcomes will be the mean change in scores on both the FMA-UE and modified Barthel Index (MBI) from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The other outcomes will include the Action Research Arm Test (ARAT), the Nine Hole Peg Test (9HPT), the Functional Independence Measure, and MRI. DISCUSSION: This trial will not only to establish that task-based mirror therapy (TBMT) could improve the recovery of hand function after stroke but also to explore the underlying mechanisms. We expect that this finding will clarify the brain activation and brain network mechanisms underlying the improvement of hand function with task-oriented mirror therapy and lead to new ideas for stroke hand function rehabilitation. TRIAL REGISTRATION: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR2300068855. Registered on March 1, 2023.

Application of immersive virtual reality mirror therapy for upper limb rehabilitation after stroke: a scoping review.

Mirror therapy is a commonly used rehabilitation intervention in post stroke upper limb rehabilitation. Despite many potential technological developments, mirror therapy is routinely delivered through the use of a static mirror or mirror box. This review aims to synthesise evidence on the application of immersive virtual reality mirror therapy (IVRMT) in poststroke upper limb rehabilitation. A scoping review was performed on relevant English studies published between 2013 to 2023. Literature search was undertaken on APA PsycInfo, CINAHL, Cochrane Library, MEDLINE, PubMed and Web of Science between August 5 and 17, 2023. Additional studies were included from Google Scholar and reference lists of identified articles. A total of 224 records were identified, of which 8 full-text articles were selected for review. All included studies were published between 2019 and 2023, and from high- and upper-middle-income nations. All the studies were experimental (n = 8). The total sample size in the studies was 259, most of whom were stroke patients with upper limb weakness (n = 184). This review identified three major themes and two sub-themes based on the contents of the studies conducted on the application of IVRMT: IVRMT's technical application, feasibility and impact on clinical outcomes (motor recovery and adverse events). IVRMT was concluded to be a safe and feasible approach to post-stroke upper limb rehabilitation, offering enhanced engagement and motor recovery. However, more methodologically robust studies should be conducted to advance this area of practice, and to include a uniform IVRMT intervention protocol, dose, and use of outcome measure.

The efficiency of mirror therapy in peripheral nerve injuries.

Objectives: The purpose of this study was to investigate the effectiveness of mirror therapy on pain, sensory, and functional development in addition to conventional rehabilitation and occupational practices in patients with a peripheral nerve injury in the hand. Patients and methods: Twenty-six patients with peripheral nerve injury in the hand were included in this randomized controlled study between November 2017 and May 2018. The patients were randomly assigned to the mirror group (n=14) and the control (n=12) group. Both groups received conventional therapy in our clinic for 45 min a day during weekdays for six consecutive weeks. The mirror group received an additional 10-15 min of visual mirror therapy. Visual Analog Scale (VAS), Duruöz Hand Index, Quick Disabilities of the Arm, Shoulder, and Hand, Jebsen hand function test, and Semmes-Weinstein monofilament test were used for the assessment of pain, hand function, and sensation of the patients at baseline and after treatment. The handgrip strength of the patients was measured with a dynamometer. Results: A total of 20 patients (17 males, 3 females; mean age 31.9±16.5, range 16 to 65 years) completed the study, with 10 in each group. Statistically significant improvement was detected in hand skill functions, such as page-turning (p=0.004), backgammon packing (p=0.023), and heavy object lifting (p=0.029) in the mirror group. A statistically significant decrease was found in total scores of VAS after treatment in both groups (p<0.05). Conclusion: The results imply that mirror therapy integrated with conventional rehabilitation may aid additional benefits on hand functions in peripheral nerve injury. These results demonstrate that mirror therapy can be used in addition to the rehabilitation program of patients with peripheral nerve injury.

Mirror Therapy Reduces Pain and Preserves Corticomotor Excitability in Human Experimental Skeletal Muscle Pain.

Approaches to preserve corticomotor excitability (CE) are attracting interest as a treatment for pain-induced changes in neural plasticity. We determined the effects of mirror therapy (MT) on skeletal muscle pain. Fifteen healthy adults who received hypertonic saline injections (5.8% NaCl, 0.2 mL) into the first dorsal interosseous (FDI) muscle of the right hand to induce experimental skeletal muscle pain were assigned to either the "MT and injection" or "injection only" group. Post-injection, the "MT and injection" group observed their left index finger abducting and adducting for 4 min, creating the illusion that the right index finger was moving. The "injection only" group remained at rest. CE and pain were assessed by measuring motor-evoked potentials (MEPs) of the right FDI triggered by transcranial magnetic stimulation and the numerical rating scale (NRS), respectively. MEP amplitudes were significantly higher in the "MT and injection" group, a trend that persisted post-MT intervention (MT intervention; p < 0.01, post-1; p < 0.05). The time for the NRS score to reach 0 was notably shorter in the "MT and injection" group (p < 0.05). Our preliminary results suggested that MT decreases CE and pain in skeletal muscles, potentially preventing neural plasticity changes associated with skeletal muscle pain and providing early pain relief.

Efficacy of a Rehabilitation Program Using Mirror Therapy and Cognitive Therapeutic Exercise on Upper Limb Functionality in Patients with Acute Stroke.

Applying evidence-based therapies in stroke rehabilitation plays a crucial role in this process, as they are supported by studies and results that demonstrate their effectiveness in improving functionality, such as mirror therapy (MT), cognitive therapeutic exercise (CTE), and task-oriented training. The aim of this study was to assess the effectiveness of MT and CTE combined with task-oriented training on the functionality, sensitivity, range, and pain of the affected upper limb in patients with acute stroke. A longitudinal multicenter study recruited a sample of 120 patients with acute stroke randomly and consecutively, meeting specific inclusion and exclusion criteria. They were randomly allocated into three groups: a control group only for task-oriented training (TOT) and two groups undergoing either MT or CTE, both combined with TOT. The overall functionality of the affected upper limb, specific functionality, sensitivity, range of motion, and pain were assessed using the Fugl-Meyer Assessment Upper Extremity (FMA-UE) scale validated for the Spanish population. An initial assessment was conducted before the intervention, a second assessment after completing the 20 sessions, and another three months later. ANCOVA analysis revealed statistically significant differences between the assessments and the experimental groups compared to the control group, indicating significant improvement in the overall functionality of the upper limb in these patients. However, no significant differences were observed between the two experimental groups. The conclusion drawn was that both therapeutic techniques are equally effective in treating functionality, sensitivity, range of motion, and pain in the upper limb following a stroke.

A randomized controlled trial on the effectiveness of mirror therapy in improving strength, range of movement and muscle activity, in people with carpal tunnel syndrome.

BACKGROUND: There is little information on the potential effects of mirror therapy (MT) on motor recovery in individuals with Carpal Tunnel Syndrome (CTS). PURPOSE: To compare the effectiveness of a MT protocol versus a therapeutic exercise (TE) protocol, in improving strength, range of motion (ROM), muscle activity, pain, and functionality in patients with CTS. STUDY DESIGN: Randomized clinical trial. METHODS: Thirty-nine participants with unilateral CTS were divided into two groups: (i) MT group (n = 20) that followed an exercise protocol applied to the unaffected hand reflected in a mirror, and (ii) TE group (n = 19) that followed the same exercise protocol using the unaffected hand but without a mirror. Strength, wrist ROM, muscle activity, pain and functionality, were assessed at baseline (T0), after treatment (T1) and one month after treatment (T2). RESULTS: At T1, the MT group showed significantly higher wrist flexion-extension ROM compared to TE (p = 0.04, d = 0.8), maintained at T2 (p = 0.02, d = 0.8). No significant changes were observed in ulnar-radius deviation, pronosupination, or fatigue following either MT or TE (p > 0.05). MT exhibited enhanced handgrip strength at T1 (p = 0.001, d = 0.7), as well as an increase in the extensor carpi radialis (ECR) and flexor carpi radialis (FCR) maximum muscle activity (p = 0.04, d = 1.0; p = 0.03, d = 0.4). At T1, both groups decreased pain (p = 0.002, d = 1.1; p = 0.02, d = 0.7), and improved functionality (p < 0.001, d = 0.8; p = 0.01, d = 0.5) (MT and TE respectively). DISCUSSION: MT led to enhancements in wrist flexion-extension movement, handgrip strength and functionality unlike TE. MT notably increased muscle activity, particularly in the ECR and FCR muscles. CONCLUSIONS: MT is a favorable strategy to improve wrist flexion-extension ROM, handgrip strength, ECR and FCR muscle activity, and functionality in people with unilateral CTS.

Complex Regional Pain Syndrome after Distal Radius Fracture-Case Report and Mini Literature Review.

This study explores the impact of the complex regional pain syndrome (CRPS) on the lives and mobility of patients, with a particular focus on its emergence as a late complication of distal radius fractures (DRFs), a common occurrence, especially among an aging population. The absence of a standardized treatment for the CRPS and the challenge of predicting its occurrence make it a complex medical issue. This research aims to shed light on the effects of treating the CRPS through a case study involving a 75-year-old woman with untreated osteoporosis who experienced a Colles fracture after a fall. The initial management involved repositioning and stabilizing the fractured forearm with a plaster cast, followed by an operation using percutaneous pinning via a Kirschner wire. Subsequently, the patient developed CRPS symptoms and was admitted to the rehabilitation department three months post-fracture. The affected forearm exhibited swelling, warmth, pain, and severely limited range of motion. Treatment involved a combination of medications, physiotherapy, and kinesiotherapy. Significantly, the patient experienced notable improvement following these interventions. This study underscores the absence of a definitive standard for CRPS treatment but suggests that proper rehabilitation and pharmaceutical interventions can contribute positively to patient outcomes. The case further highlights the potential association between DRF and CRPS development, emphasizing the need for continued research in this field.

Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study.

BACKGROUND: Phantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood. OBJECTIVES: The aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS). METHODS: Sixty participants were recruited from the rehabilitation program in São Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education. RESULTS: We found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks. CONCLUSION: These results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contributes to the understanding of the underlying topographical patterns in the motor-related circuits associated with pain after amputations.

Physiotherapy: A potential and novel treatment approach for phantom limb pain in post-amputee patients - A systematic review.

Objective: To evaluate the efficacy of conventional and novel non-pharmacologic, non-invasive therapeutic interventions in physiotherapy for the treatment of phantom limb pain (PLP) in post-amputee patients. Methods: A systematic search for the articles was conducted in multiple electronic databases such as PUBMED, Google Scholar, EMBASE, Cochrane library and Physiotherapy Evidence Database (PEDro), following the PRISMA method and only published articles from the last 12 years (2010-2022) evaluating the efficacy of different physiotherapy interventions for the treatment of PLP in post-amputee patients were included. The methodological quality and risk of bias of the articles were assessed and evaluated by two independent reviewers using the PEDro scale, Methodological index for non-randomized studies scale (MINORS), and Cochrane collaboration's assessment tool. Result: A total of 1840 articles were identified, out of which 17 articles (11 RCTs and 6 pilot studies) were ultimately chosen after the full-text screening. After reviewing the articles, evidence identified in RCTs and pilot studies indicates towards significant improvement in reducing the severity of PLP in post-amputee patients by using different physiotherapy interventions. Conclusion and discussion: Physiotherapy interventions with advance modalities and exercises can be used to increase the overall effectiveness of the treatment and to reduce the severity of phantom limb pain in post-amputee patients. However, due to the lack of consistent evidence for a given intervention, it becomes even more difficult to reach a majority consensus as to which intervention better assess all the mechanism of PLP thereby alleviating the problem of PLP in post-amputee patients. Therefore, more rigorous randomized controlled trials will be required in the future to reach a conclusion.

Effects of mirror therapy with electrical stimulation for upper limb recovery in people with stroke: a systematic review and meta-analysis.

PURPOSE: To provide updated evidence about the effects of MT with ES for recovering upper extremities motor function in people with stroke. METHODS: Systematic review and meta-analysis were completed. Methodological quality was assessed using the version 2 of the Cochrane risk-of-bias tool. The GRADE approach was employed to assess the certainty of evidence. RESULTS: A total of 16 trials with 773 participants were included in this review. The results demonstrated that MT with ES was more effective than sham (standardized mean difference [SMD], 1.89 [1.52-2.26]) and ES alone (SMD, 0.42 [0.11-0.73]) with low quality of evidence, or MT alone (SMD, 0.47[0.04-0.89]) with low quality of evidence for improving upper extremity motor control assessed using Fugl-Meyer Assessment. MT with ES had significant improvement of (MD, 6.47 [1.92-11.01]) the upper extremity gross gripping function assessed using the Action Research Arm Test compared with MT alone with low quality of evidence. MT combined with ES was more effective than sham group (SMD, 1.17 [0.42-1.93) for improving the ability to perform activities of daily living with low quality of evidence assessed using Motor Activity Log. CONCLUSION: MT with ES may be effective in improving upper limb motor recovery in people with stroke.

Combining Mirror Therapy (MT) and Electrical Stimulation (ES) modality could improve upper limb motor control, gross gripping function, and performance in ADLs based on ICF for people with stroke.Those individuals with subacute stroke are recommended as the optimal target group for the combined MT and ES.

Robotic mirror therapy for stroke rehabilitation through virtual activities of daily living.

Mirror therapy is a standard technique of rehabilitation for recovering motor and vision abilities of stroke patients, especially in the case of asymmetric limb function. To enhance traditional mirror therapy, robotic mirror therapy (RMT) has been proposed over the past decade, allowing for assisted bimanual coordination of paretic (affected) and contralateral (healthy) limbs. However, state-of-the-art RMT platforms predominantly target mirrored motions of trajectories, largely limited to 2-D motions. In this paper, an RMT platform is proposed, which can facilitate the patient to practice virtual activities of daily living (ADL) and thus enhance their independence. Two similar (but mirrored) 3D virtual environments are created in which the patients operate robots with both their limbs to complete ADL (such as writing and eating) with the assistance of the therapist. The recovery level of the patient is continuously assessed by monitoring their ability to track assigned trajectories. The patient's robots are programmed to assist the patient in following these trajectories based on this recovery level. In this paper, the framework to dynamically monitor recovery level and accordingly provide assistance is developed along with the nonlinear controller design to ensure position tracking, force control, and stability. Proof-of-concept studies are conducted with both 3D trajectory tracking and ADL. The results demonstrate the potential use of the proposed system to enhance the recovery of the patients.

Evidence of mirror therapy for recruitment of ipsilateral motor pathways in stroke recovery: A resting fMRI study.

Mirror therapy (MT) has been proposed to promote motor recovery post-stroke through activation of mirror neuron system, recruitment of ipsilateral motor pathways, or/and increasing attention toward the affected limb. However, neuroimaging evidence for these mechanisms is still lacking. To uncover the underlying mechanisms, we designed a randomized controlled study and used a voxel-based whole-brain analysis of resting-state fMRI to explore the brain reorganizations induced by MT. Thirty-five stroke patients were randomized to an MT group (n â€‹= â€‹16) and a conventional therapy (CT) group (n â€‹= â€‹19) for a 4-week intervention. Before and after the intervention, the Fugl-Meyer Assessment Upper Limb subscale (FMA-UL) and resting-state fMRI were collected. A healthy cohort (n â€‹= â€‹16) was established for fMRI comparison. The changes in fractional amplitude of low-frequency fluctuation (fALFF) and seed-based functional connectivity were analyzed to investigate the impact of intervention. Results showed that greater FMA-UL improvement in the MT group was associated with the compensatory increase of fALFF in the contralesional precentral gyrus (M1) region and the re-establishment of functional connectivity between the bilateral M1 regions, which facilitate motor signals transmission via the ipsilateral motor pathways from the ipsilesional M1, contralesional M1, to the affected limb. A step-wise linear regression model revealed these two brain reorganization patterns collaboratively contributed to FMA-UL improvement. In conclusion, MT achieved motor rehabilitation primarily by recruitment of the ipsilateral motor pathways. Trial Registration Information: http://www.chictr.org.cn. Unique Identifier. ChiCTR-INR-17013644, submitted on December 2, 2017.

Case-based report of graded motor imagery experience in traumatic brachial plexus injury: The art of moving without moving.

BACKGROUND: We reported a 24-year-old woman who sustained multiple upper limb injuries after a traffic accident in March 2017. She sustained a C7-T1 brachial plexus injury and radial nerve injury on the left side diagnosed in November 2017. The patient underwent radial nerve reconstruction. The patient began her comprehensive therapy program in January 2018. PURPOSE: To describe the use of graded motor imagery (GMI) and outcomes after traumatic brachial plexus palsy. We presented changes in electromyographic (EMG) activity of target muscles during task execution and functional status following 10-session GMI therapy. STUDY DESIGN: Case report. METHODS: The program included 4 sessions of motor imagery and 6 sessions of a combination of motor imagery and mirror therapy. RESULTS: The patient successfully participated in the program with reported improvements in EMG activity, functional status, emotional well-being, and body awareness. CONCLUSIONS: GMI therapy appears to have peripheral motor effects, including altered surface EMG activity and contributes to a favorable outcome in the functional level of the affected arm. An improved emotional state and awareness of the affected hand could have a positive effect on function. Future long-term randomized controlled trials are needed to investigate the cumulative peripheral effects of treatment of graded motor imagery and the effects of variables mediating its effects on functional performance in patients with nerve injury.