Mirror therapy: A potential intervention for pain management

Summary The consequences of chronic pain and associated disabilities to the patient and to the health care system are well known. Medication is often the first treatment of choice for chronic pain, although side effects and high costs restrict long-term use. Inexpensive, safe and easy to self-administer non-pharmacological therapies, such as mirror therapy, are recommended as adjuncts to pain treatment. The purpose of this review is to describe the principles of use of mirror therapy so it can be incorporated into a health care delivery. The physiological rationale of mirror therapy for the management of pain and the evidence of clinical efficacy based on recent systematic reviews are also discussed. Mirror therapy, whereby a mirror is placed in a position so that the patient can view a reflection of a body part, has been used to treat phantom limb pain, complex regional pain syndrome, neuropathy and low back pain. Research evidence suggests that a course of treatment (four weeks) of mirror therapy may reduce chronic pain. Contraindications and side effects are few. The mechanism of action of mirror therapy remains uncertain, with reintegration of motor and sensory systems, restored body image and control over fear-avoidance likely to influence outcome. The evidence for clinical efficacy of mirror therapy is encouraging, but not yet definitive. Nevertheless, mirror therapy is inexpensive, safe and easy for the patient to self-administer.

Use of prostheses in lower limb amputee patients due to peripheral arterial disease / Uso de próteses em amputados de membros inferiores por doença arterial periférica

Objective To evaluate the indication of prosthesis during rehabilitation and the maintenance of their use or abandonment rate after discharge, as well as mortality of lower limb amputees due to peripheral arterial disease. Methods A retrospective and cross-sectional study carried out with lower limb amputee patients, at transfemoral and transtibial levels, due to vascular conditions. The sample was composed of 310 patients (205 men, 105 women, mean age 61.8 years), transfemoral (142) and transtibial (150) levels, unilateral or bilateral (18). A total of 217 were fitted with prosthesis and 93 did not. Nonparametric statistical tests with equality of two proportions, 95% confidence interval and p value <0,05 were used. Results Out of 195 patients we contacted, 151 were fitted with prosthesis and 44 not. Of those that were fitted with prosthesis, 54 still use it, 80 abandoned and 17 died. In the group without prosthesis, 27 were on wheelchair and 17 died. Mortality is statistically higher among patients who were not fitted with prosthesis and 34 death occur, on average, 3.91 years after amputation. Survival time of patients who were not fitted with prosthesis was smaller than those were fitted. Conclusion The use of prosthesis in lower limb amputees, due to vascular conditions, during rehabilitation is high. However, maintenance of prosthesis is not frequent after discharge. Early and high mortality is observed mainly among diabetic patients. .

Objetivo Avaliar a protetização, durante a reabilitação, e a manutenção do uso da prótese, e o índice de abandono da mesma após a alta, bem como a mortalidade dos pacientes amputados de membros inferiores por doença arterial periférica. Métodos Estudo retrospectivo e transversal com pacientes amputados de membros inferiores nos níveis transtibial e transfemoral de etiologia vascular. A amostra foi composta por 310 pacientes (205 homens e 105 mulheres, média de idade de 61,8 anos), nos níveis transfemoral (142) e transtibial (150), unilateralmente ou bilateralmente (18). Foram protetizados 217 pacientes e 93 não. Foram utilizados testes estatísticos não paramétricos de igualdade de duas proporções, intervalo de confiança para média de 95% (IC95%) e valor de p<0,05 Resultados . Dos 195 pacientes contatados, 151 haviam sido protetizados e 44 não. Dos protetizados, 54 mantinham-se usando suas próteses, 80 haviam abandonado o uso e 17 faleceram. No grupo dos não protetizados, 27 continuavam usando cadeira de rodas e 17 tinham evoluído para óbito. A mortalidade é estatisticamente maior nos pacientes não protetizados e os 34 óbitos ocorreram, em média, após 3,91 anos da amputação. O tempo de sobrevida dos pacientes não protetizados foi menor que o dos protetizados. Conclusão A protetização de pacientes amputados de membros inferiores de etiologia vascular durante a reabilitação é alta, mas a manutenção do uso da prótese é baixa após o término do tratamento. A mortalidade desses pacientes é elevada e ...

Tetraamputado y rehabilitación / Tetra-amputees and rehabilitation

Se presenta a un paciente de 63 años que en junio de 1991se le realizó desarticulación de ambas muñecas, amputación sobre rodilla derecha y bajo rodilla izquierda debido a una complicación de su patología de base: crioaglutininemia primaria Ig M a Frigori. Por su nivel socioeconómico de extrema pobreza y antecedentes de alcoholismo desde su infancia sumado a su patología se decidió independizarlo en silla de ruedas con adaptaciones y derivarlo a un centro geriátrico, objetivos que se cumplieron en siete semanas de hospitalización