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AMT and conventional bimanual training for stroke rehabilitation: (a, b) AMT: grabbing and rolling a cylinder/holding a ball; (c, d) conventional bimanual training: grabbing and rolling a cylinder/holding a ball.
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Bimanual cooperation plays a vital role in functions of the upper extremity and daily activities. Based on the principle of bilateral movement, mirror therapy could provide bimanual cooperation training. However, conventional mirror therapy could not achieve the isolation of the mirror. A novel paradigm mirror therapy called associated mirror thera...
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This randomized controlled study aimed to investigate the effects of 8-week task-oriented activities of daily living (T-ADL) training on upper limb functions, activities of daily living (ADL), and quality of life (QoL) in chronic stroke patients. The 33 patients were randomly assigned to the T-ADL training or conventional occupational therapy (OT)...
Citations
... Upper extremity (UE) impairments are common both in children and adults [1,2]. Congenital anomalies -such as myopathies, spinal muscular atrophy, and cerebral palsy (CP) -as well as acquired neurological disorders -such as stroke, traumatic brain injury and spinal cord injury -often involve sensorimotor deficits to the UE. ...
Purpose: To conduct a systematic review on the impacts of using mechanical assistive devices on function, performance in activities and participation of persons with upper extremity impairments, and to synthesize the strengths and limitations of these devices.
Method: Three independent reviewers conducted systematic searches of articles published between 2003 and 2023 in Compendex, Inspec, Embase, PubMed/Medline, IEEE Xplore, and Web of Science, as well as manual searches on the RESNA website for conference papers over the same period. The
methodological quality of articles was appraised using the QualSyst tool.
Results: From the 34 retained studies, 28 mechanical devices were identified and classified into two categories: (1) mobile arm supports (MASs) designed to perform multiple activities, and (2) devices used to assist with a specific activity of daily living (ADL). Overall, MASs helped users to perform manual activities in elevation and/or against gravity. Specific ADL devices allowed users to perform unique activities requiring fine motor skills such as opening a medicine container. Some of these devices have advantages like portability, adaptability, low cost, and ease of use. Limitations most often reported included interference or mobility restraints.
Conclusion: This review synthesizes the impacts of mechanical devices on the three domains of the International Classification of Functioning, Disability and Health (ICF) for individuals with upper extremity impairments. Impacts regarding function and performance in activities were more often measured than participation. Future studies should include outcomes related to participation, as taking this aspect into account might favor successful continued use of assistive devices.
... Associated mirror therapy (AMT) adalah pendekatan yang layak dan praktis untuk meningkatkan pemulihan motorik lengan dan fungsi sehari-hari pada pasien stroke. Selain itu, AMT dapat meningkatkan kekuatan otot pasca stroke rehabilitasi (Zhuang, Ding, Shu, Chen, & Jia, 2021). Mirror therapy memiliki efek positif pada fungsi tangan dan dapat digunakan untuk rehabilitasi gerakan tangan yang tepat pada pasien stroke akut (Kim, & Yim, 2018). ...
... *Email: meivi.sesanelvira@gmail.com sehari-hari pada pasien stroke (Zhuang et al., 2021). Selain itu, AMT dapat meningkatkan ketangkasan manual pasca stroke rehabilitasi. ...
Background: Stroke is a disease caused by a sudden cessation of blood flow to the brain, either due to a blockage or rupture of a blood vessel. Stroke sufferers cannot carry out daily activities optimally, resulting in dependency in meeting their needs. Recovery efforts are carried out through rehabilitation. Mirror therapy is a rehabilitation therapy or exercise that relies on and trains motor imagery or imagination. The mirror will provide visual stimulation that the affected body part tends to imitate. Purpose: To analyze the effect of mirror therapy on fulfilling daily living activities (ADL) in elderly people with stroke. Method: This type of quasi-experimental research with a pre-post-test control group. The research was conducted in the work area of the Central Cimahi community health center with a sample size of 50 participants. The research lasted for 8 weeks through 4 stages which were carried out in 3 meetings a week with a duration of 20 minutes. Measurement of daily activities uses the Barthel Index observation sheet with 13 items. Results: In the intervention group there was a significant effect between mirror therapy before and after the intervention was given on the fulfillment of activities of daily living (ADL) in stroke elderly (p-value= 0.014). Meanwhile, the control group showed no significant change between before and after the mirror therapy intervention in fulfilling ADLs in stroke elderly (p-value= 0.083). This research shows that providing mirror therapy to elderly stroke sufferers can meet their ADL needs. Conclusion: Mirror therapy has proven effective in elderly stroke sufferers in meeting ADL needs. Suggestion: The elderly and their families should apply mirror therapy to increase the independence of the elderly in fulfilling ADLs. Keywords: Activity Daily Living (ADL); Elderly; Mirror Therapy; Stroke. Pendahuluan: Stroke merupakan penyakit yang disebabkan oleh terhentinya aliran darah ke otak secara tiba-tiba, baik karena adanya penyumbatan maupun pecahnya pembuluh darah. Penderita stroke tidak dapat melakukan aktivitas sehari-hari secara maksimal sehingga mengakibatkan ketergantungan dalam memenuhi kebutuhannya. Upaya pemulihan dilakukan melalui rehabilitasi. Mirror therapy merupakan terapi rehabilitasi atau latihan yang mengandalkan dan melatih motor imagery atau imajinasi. Cermin akan memberikan rangsangan visual yang cenderung ditiru oleh bagian tubuh yang terkena. Tujuan: Untuk menganalisis pengaruh mirror therapy terhadap pemenuhan activity daily living (ADL) pada lansia stroke. Metode: Jenis penelitian quasi eksperiment dengan kelompok kontrol pre-post test. Penelitian dilakukan di Wilayah Kerja Puskesmas Cimahi Tengah dengan jumlah sampel sebanyak 50 partisipan. Penelitian berlangsung selama 8 minggu melalui 4 tahap yang dilaksanakan dalam 3 kali pertemuan dalam seminggu dengan durasi 20 menit. Pengukuran aktivitas sehari-hari menggunakan lembar observasi Barthel Index dengan jumlah 13 item. Hasil: Pada kelompok intervensi terdapat pengaruh yang signifikan antara mirror therapy sebelum dan sesudah diberikan intervensi terhadap pemenuhan activity daily living (ADL) pada lansia stroke (p-value= 0.014). Sedangkan pada kelompok kontrol menunjukkan tidak adanya perubahan yang signifikan antara sebelum dan sesudah intervensi mirror therapy dalam pemenuhan ADL pada lansia stroke (p-value= 0.083). Penelitian ini menunjukkan bahwa pemberian mirror therapy pada lansia penderita stroke dapat memenuhi kebutuhan ADL mereka. Simpulan: Mirror therapy terbukti efektif pada lansia penderita stroke dalam memenuhi kebutuhan ADL. Saran: Lansia dan keluarganya sebaiknya menerapkan mirror therapy untuk meningkatkan kemandirian lansia dalam memenuhi ADL. Kata Kunci: Activity Daily Living (ADL); Lansia; Mirror Therapy; Stroke.
... In recent years, mirror box therapy has played an important part in the interventions offered by the healthcare provider in upper limb rehabilitation after stroke. Mirror therapy involves the use of a mirror that reflects the image of the unaffected upper limb in a way that the affected upper limb is visually replaced by its mirror image [1]. The mirror is positioned along the patient's midsagittal plane and enables simple exercises and functional tasks with the unaffected upper limb to be performed while looking at the mirror. ...
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.
... "VRT utilizes mirror neurons as the basis for its neurological (3) foundation." A study using magnetic resonance imaging found consistent results, showing a reorganization of the sensorimotor (4) cortex. ...
... activation. Supporting this physiological change, a study using magnetic resonance imaging found consistent results, showing a (4) reorganization of the sensorimotor cortex. ...
Background And Purpose: The use of VR training has increased the potential for motor learning and neuroplasticity during hand rehabilitation. m-CIMT enhances the use and skill of the paretic hand in daily life by improving the motor function. The purpose of this study was to evaluate the effectiveness of Virtual Reality Training (VRT) with Modied constraint-induced movement therapy (m-CIMT) on hand function in acute stroke subjects. Methodology: 30 acute stroke subjects who met inclusive criteria with MMSE 24 or > 24 and Brunnstrom's motor stage of hand recovery ≥ 4 were selected by using the lottery method. Subjects were randomly allotted to Group-A 15(experimental) and Group-B 15(control) after getting written consent from the subjects. Group-A received VRT along with m-CIMT, while Group-B received only m-CIMT hand function training. The study was conducted for a total of 12 sessions over 4 weeks. Pre-test and post-test evaluation of hand function done by using the Jebsen Taylor Hand Function Test (JTHFT) and Box and Block Test (BBT). Results: Pre-test and post-test values of JTHFT and BBT within the experimental and control groups showed statistically signicant improvement (p< 0.001). But comparatively, mean ± SD difference is greater in the experimental group than in control group. Discussion: This study revealed that integrated VRT with m-CIMT on hand function training in acute stroke subjects showed more improvement than Existing VRT and m-CIMT alone by increasing cortex representation and resulting in brain reorganization. Conclusion: Results of the study concluded that integrated VRT with m-CIMT hand function training shows more improvement in the recovery of hand function in acute stroke subjects than in m-CIMT.
... "VRT utilizes mirror neurons as the basis for its neurological (3) foundation." A study using magnetic resonance imaging found consistent results, showing a reorganization of the sensorimotor (4) cortex. ...
... activation. Supporting this physiological change, a study using magnetic resonance imaging found consistent results, showing a (4) reorganization of the sensorimotor cortex. ...
Background And Purpose: The use of VR training has increased the potential for motor learning and neuroplasticity during hand rehabilitation. m-CIMT enhances the use and skill of the paretic hand in daily life by improving the motor function. The purpose of this study was to evaluate the effectiveness of Virtual Reality Training (VRT) with Modied constraint-induced movement therapy (m-CIMT) on hand function in acute stroke subjects. Methodology: 30 acute stroke subjects who met inclusive criteria with MMSE 24 or > 24 and Brunnstrom's motor stage of hand recovery ≥ 4 were selected by using the lottery method. Subjects were randomly allotted to Group-A15(experimental) and Group-B 15(control) after getting written consent from the subjects. Group-Areceived VRT along with m-CIMT, while Group-B received only m-CIMT hand function training. The study was conducted for a total of 12 sessions over 4 weeks. Pre-test and post-test evaluation of hand function done by using the Jebsen Taylor Hand Function Test (JTHFT) and Box and Block Test (BBT). Results: Pre-test and post-test values of JTHFT and BBT within the experimental and control groups showed statistically signicant improvement (p< 0.001). But comparatively, mean ± SD difference is greater in the experimental group than in control group. Discussion: This study revealed that integrated VRT with m-CIMT on hand function training in acute stroke subjects showed more improvement than Existing VRT and m-CIMT alone by increasing cortex representation and resulting in brain reorganization. Conclusion: Results of the study concluded that integrated VRT with m-CIMThand function training shows more improvement in the recovery of hand function in acute stroke subjects than in m-CIMT.
... Stroke is one of the leading causes of death and disability worldwide (Chien et al., 2020), dramatically affecting the independence and quality of life of survivors. After stroke, about 80% of the patients continue to have upper extremity motor impairment (Zhuang et al., 2021). Stroke patients with upper extremity functional limitation are particularly susceptible to problems in performing daily activities (Ikbali Afsar et al., 2018). ...
Background
Motor imagery therapy (MIT) showed positive effects on upper limbs motor function. However, the mechanism by which MIT improves upper limb motor function is not fully understood. Therefore, our purpose was to investigate the changes in functional connectivity (FC) within and outside the sensorimotor network (SMN) induced by MIT associated with improvement in upper limb motor function in stroke patients.
Methods
A total of 26 hemiplegic stroke patients were randomly divided into MIT (n = 13) and control (n = 13) groups. Fugl-Meyer Assessment Upper Extremity Scale (FMA-UL), Modified Barthel Index (MBI) and resting-state functional magnetic resonance imaging (rs-fMRI) were evaluated in the two groups before treatment and 4 weeks after treatment. The efficacy of MIT on motor function improvement in stroke patients with hemiplegia was evaluated by comparing the FMA-UL and MBI scores before and after treatment in the two groups. Furthermore, the FC within the SMN and between the SMN and the whole brain was measured and compared before and after different treatment methods in stroke patients. The correlation analysis between the improvement of upper limbs motor function and changes in FC within the SMN and between the SMN and the whole brain was examined.
Results
The FCs between ipsilesional primary motor cortex (M1.I) and contralateral supplementary motor area (SMA.C), M1.I and ipsilesional SMA (SMA.I), and SMA.C and contralateral dorsolateral premotor cortex (DLPM.C) significantly increased in the control group but decreased in the MIT group; while the FC between SMA.C and contralateral primary somatosensory cortex (S1.C) significantly increased in the control group but showed no significant difference in the MIT group. The FCs between M1.I and the ipsilesional hippocampal gyrus and ipsilesional middle frontal gyrus significantly decreased in the control group but increased in the MIT group; while the FC in the contralateral anterior cingulate cortex significantly increased in the MIT group but there was no significant difference in the control group. The results of the correlation analysis showed that the differences in abnormal intra-FCs within the SMN negatively correlated with the differences in FMA and MBI, and the difference in abnormal inter-FCs of the SMN positively correlated with the differences in FMA and MBI.
Conclusions
MIT can improve upper limb motor function and daily activities of stroke patients, and the improvement effect of conventional rehabilitation therapy (CRT) combined with MIT is significantly higher than that of CRT alone. CRT may improve the upper limb motor function of stroke patients with hemiplegia mainly through the functional reorganization between SMN, while MIT may mainly increase the interaction between SMN and other brain networks.
... In addition, skin oil on the scalp will affect the optical signal; accordingly, we wipe the oil from the patient's head with oil-absorbing paper before the experiment to ensure the signal quality. Based on previous experience, we have also found that reducing the influence of natural light and sound improves the collection of fNIRS signals; therefore, we collect all data in a dark and quiet environment30 .Previous studies have shown that MT can effectively improve finger flexibility after stroke31 , especially for the upper limb rehabilitation of subacute patients 32 , and therefore shows great promise in restoring motor function and improving the ability to perform daily activities after cerebral hemisphere damage 33 , 34 , 35 , 36 . When a patient moves their unaffected arm, an optical illusion formed by a mirror is considered by the patient to be the movement of their affected hand, Copyright © 2024 JoVE Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License jove.com ...
... Several current interventions are used to improve upper and lower limb function, including mirror therapy (MT) [4], constraint-induced movement therapy [5], acupuncture [6], afferent stimulation [7] and robot-assisted therapy [8]. However, these interventions have some shortcomings such as poor repeatability, boring, high cost and difficult evaluation [6,9]. ...
Background
Upper and lower limb impairment is common after stroke. Electromyographic biofeedback therapy is a non-invasive treatment, and its effectiveness in functional rehabilitation of the limb after stroke still remains uncertain.
Objective
The objective of this study was to evaluate whether electromyographic biofeedback can improve upper and lower limb dysfunction in stroke patients.
Methods
PubMed, Embase, Cochrane Library, and Physiotherapy Evidence Database (PEDro) were searched from inception to 1st May 2022. Inclusion criteria were randomized controlled clinical trials of electromyographic biofeedback therapy interventions reporting changes in upper and lower limb function in post-stroke patients. Data were extracted by two independent reviewers and pooled in random-effects models using Review manager (RevMan) software.
Results
Our analyses included 10 studies enrolling a total of 303 participants. Electromyographic biofeedback therapy can effectively improve limb function after stroke (standardized mean difference [SMD], 0.44; 95% confidence interval [CI], 0.12–0.77; P = 0.008) and in subgroup analyses, the effect sizes of short-term effect (SMD, 0.33; 95% CI, 0.02–0.64; P = 0.04) was significant, but the long-term was not (SMD, 0.61; 95% CI, -0.11–1.33; P = 0.10). In addition, Electromyographic biofeedback therapy can improve the active range of motion of shoulder (SMD, 1.49; 95% CI, 2.22; P<0.0001) and wrist joints (SMD, 0.77; 95% CI, 0.13–1.42; P = 0.02) after stroke.
Conclusion
In this meta-analysis, electromyographic biofeedback therapy intervention can improve upper and lower limb function in patients with stroke. Short-term (less than one month) improvement after electromyographic biofeedback therapy was supported, while evidence for long-term (more than one month) benefits was lacking. Range of motion in the glenohumeral and wrist joints were improved. Stronger evidence for individualized parameters, such as optimal treatment parameters and intervention period, is needed in the future.
Systematic review registration
[ https://www.crd.york.ac.uk/prospero/display_record.php?recordID=267596 ], identifier [ CRD42022354363 ].
... The mirror neurons obtain the essential signals to commence the process of neuroplasticity by perceiving the movement of the opposite healthy limb in the mirror [173]. Mirror therapy (MT), a visual illusion-based intervention technique, is regarded as a bilateral treatment in addition to traditional physical intervention techniques [173,174]. Patients are instructed to move both arms in the MT environment. The healthy extremity is positioned in front of a mirror, and when the healthy part is triggered, the illusion of movement of the paretic side is established. ...
... Finally, after a thorough screening and selection process, eight studies were deemed to meet the inclusion criteria and were selected for further analysis. These eight studies underwent data extraction and subsequent synthesis and analysis as part of the systematic review and meta-analysis [12,[24][25][26][27][28][29][30]. ...
... These trials examined the effects of interventions involving both general and mixed MVF. The primary focus of assessment in these trials was on upper limb function, which was evaluated using the ABILHAND questionnaire [27], Fugl-Meyer assessment (FMA) [12,24,26,[28][29][30], and manual function test (MFT) [25] as outcome measures. In addition, the intervention period was variously included as 3 [12,29], 4 [30], 5 [25,26], 6 [24,27], and 8 weeks [28]. ...
... The primary focus of assessment in these trials was on upper limb function, which was evaluated using the ABILHAND questionnaire [27], Fugl-Meyer assessment (FMA) [12,24,26,[28][29][30], and manual function test (MFT) [25] as outcome measures. In addition, the intervention period was variously included as 3 [12,29], 4 [30], 5 [25,26], 6 [24,27], and 8 weeks [28]. Our research indicates that associated mirror therapy is an effective strategy for facilitating motor recovery and daily functioning in individuals with stroke-affected limbs. ...
Mirror visual feedback (MVF), a noninvasive treatment method, is attracting attention as a possibility to promote the recovery of upper limb function in stroke patients. However, the cognitive effects of this therapy have received limited attention in the existing literature. To address this gap, we conducted a systematic review and meta-analysis to investigate the relationship between upper limb function and cognition in stroke patients and to evaluate the effect of MVF on improving upper limb function. A comprehensive search was performed on the Embase, MEDLINE, and PubMed databases to identify original articles and clinical studies published between 2013 and 2022. Qualitative analysis was performed using the Cochrane Risk of Bias tool, and in the quantitative analysis, a random-effects model was used as the effect model, and standard mean difference (SMD) was used as the effect measure. Eight studies that met the inclusion criteria were entered in the analysis. Data extraction included an assessment tool for upper extremity function. Results of the quantitative analysis demonstrate that MVF was effective in improving upper extremity function in stroke patients (SMD = 0.94, 95% CI 0.69 to 1.20). In conclusion, this systematic review and meta-analysis provides evidence supporting the effectiveness of MVF in improving upper limb function in stroke patients. However, further studies are needed to investigate the cognitive effects of MVF and elucidate the underlying mechanisms.
