Yes / Phantom Limb pain (PLP) affects up to 85% of all patients following an amputation, causing debilitating effects on their quality of life. Mirror Therapy (MT) has been reported to have potential success for the alleviation of PLP. Current understanding of PLP and the efficacy of MT for its alleviation are still unclear, therefore guidelines for treatment protocols are lacking. This literature review assesses the current best evidence for using MT to alleviate PLP of patients with amputation. Method: The authors systematically searched the academic databases Medline, Amed, CINAHL and Google Scholar, using key search terms with inclusion and exclusion criteria to identify relevant articles on the use of MT in populations of patients suffering PLP after unilateral limb amputation. Findings: Seven primary papers were identified and appraised. All the articles reported significant PLP alleviation after using MT with a trend for achieving phantom limb movement (PLM) prior to pain relief. Conclusions: Mirror Therapy is a promising intervention for PLP. Regular MT sessions are required to maintain treatment effect. Causes of PLP and pathways to its alleviation may be multifactorial; therefore further well-conducted RCTs are required to identify best practice.

Introduction: This study investigates a new form of Mirror Therapy (MT), the Mirror Specs. Evidence suggests that MT is a non-invasive, cost effective method of reducing pain and increasing functioning in some chronic pain conditions. There is no clear explanation for the underlying mechanisms of MT, however, a plausible hypothesis suggests that adaptation to the Body Schema is an integral component. Aims and Hypotheses: The current study examined Body Schema adaptation in healthy participants when performing a Finger Tapping Task with both Mirror Specs and a Mirror Box. It was hypothesised that adaptation would be indicated by increases in Reaction Times (RTs) and Error Rates when comparing unimanual phases of a Finger Tapping Task, following a bimanual „adaptation‟ phase. It was hypothesised that there would be no difference between participants‟ ability to adapt to each device. Finally, the study proposed that there would be a relationship between the adaptation observed on the Finger Tapping Task and participants individual imagery abilities. Method: Participants performed 4 phases of a Finger Tapping Task with alternate bimanual and unimanual phases when using both the Mirror Specs and Mirror Box. Imagery abilities were measured using self-report questionnaires and a Motor Imagery computer task. Results and Discussion: Repeated Measures ANOVAs revealed reductions in RTs and Error Rates in Phase 3 compared to Phase 1 on the Finger Tapping Task. There were no differences between RTs and Error Rates when using the Mirror Specs and Mirror Box. These findings suggest that healthy participants were able to use each Mirror Device effectively and this provide impetus for the proposal that Mirror Specs could provide a practical, cost effective addition to rehabilitation services. Finally, there were no clinically significant relationships between use of the Mirror Devices and imagery abilities, thereby indicating imagery abilities did not influence how participants adapted to using the Mirror Devices.

No / Patient-led therapy, in which patients work outside therapy sessions without direct supervision, is a possible way to increase the amount of therapy stroke patients' receive without increasing staff demands. Here, we report patients' views of patient-led mirror therapy and lower limb exercises. 94 stroke survivors with upper and lower limb limitations at least 1-week post-stroke undertook 4 weeks of daily patient-led mirror therapy or lower limb exercise, then completed questionnaires regarding their experience and satisfaction. A convenience random sample of 20 participants also completed a semi-structured telephone interview to consider their experience in more detail and to capture their longer term impressions. Participants were generally positive about patient-led therapy. About 71% found it useful; 68% enjoyed it; 59% felt it "worked" and 88% would recommend it to other patients. Exercise was viewed more positively than the mirror therapy. Difficulties included arranging the equipment and their position, particularly for more severe strokes, loss of motivation and concerns about working unsupervised. Patient-led mirror therapy and lower limb exercises during in-patient rehabilitation is generally feasible and acceptable to patients but "light touch" supervision to deal with any problems, and strategies to maintain focus and motivation are needed. Implications for Rehabilitation Most stroke patients receive insufficient therapy to maximize recovery during rehabilitation. As increases in staffing are unlikely there is an imperative to find ways for patients to increase the amount of exercise and practice of functional tasks they undertake without increasing demands on staff. Patient-led therapy (also known as patient-directed therapy or independent practice), in which patients undertake exercises or functional tasks practice prescribed by a professional outside formal therapy sessions is one way of achieving this. It is widely used in community-based rehabilitation but is uncommon in hospital-based stroke care. We explored the feasibility and acceptability of two types of patient-led therapy during hospital-based stroke care; mirror therapy for the upper limb and exercises (without a mirror) for the lower limb. Here, we report patients' experiences of undertaking patient-led therapy. Patient-led mirror therapy and lower limb exercises during in-patient stroke rehabilitation is generally feasible and acceptable to patients but "light touch" supervision to deal with any problems, and strategies to maintain focus and motivation are needed.

Made available in DSpace on 2014-12-17T15:28:51Z (GMT). No. of bitstreams: 1 MorganaMN_DISSERT.pdf: 8378987 bytes, checksum: 55d0d3823fa6d9c47865791e3edefa62 (MD5) Previous issue date: 2012-08-24 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Mirror therapy (MT) is being used as a rehabilitation tool in various diseases, including stroke. Although some studies have shown its effectiveness, little is known about neural mechanisms that underlie the rehabilitation process. Therefore, this study aimed at assessing cortical neuromodulation after a single MT intervention in ischemic stroke survivors, by means of by functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS). Fifteen patients participated in a single thirty minutes MT session. fMRI data was analyzed bilaterally in the following Regions of Interest (ROI): Supplementary Motor Area (SMA), Premotor cortex (PMC), Primary Motor cortex (M1), Primary Sensory cortex (S1) and Cerebellum. In each ROI, changes in the percentage of occupation and beta values were computed. Group fMRI data showed a significant decreased in the percentage of occupation in PMC and cerebellum, contralateral to the affected hand (p <0.05). Significant increase in beta values was observed in the following contralateral motor areas: SMA, Cerebellum, PMC and M1 (p<0,005). Moreover, a significant decrease was observed in the following ipsilateral motor areas: PMC and M1 (p <0,001). In S1 a bilateral significant decrease (p<0.0005) was observed.TMS consisted of the analysis of Motor Evoked Potential (MEP) of M1 hotspot. A significant increase in the amplitude of the MEP was observed after therapy in the group (p<0,0001) and individually in 4 patients (p <0.05). Altogether, our results imply that single MT intervention is already capable of promoting changes in neurobiological markers toward patterns observed in healthy subjects. Furthermore, the contralateral hemisphere motor areas changes are opposite to the ones in the ipsilateral side, suggesting an increase system homeostasis. / A Terapia Espelho (TE) vem sendo usada como ferramenta de reabilita??o para v?rias doen?as, incluindo o Acidente Vascular Cerebral (AVC). Embora alguns estudos tenham mostrado sua efic?cia cl?nica, pouco se sabe sobre os mecanismos neurais que levam ? melhora observada. Desse modo, este estudo teve como objetivo avaliar a neuromodula??o cortical promovida pela interven??o ?nica da TE em pacientes acometidos por AVC, por meio da Resson?ncia Magn?tica funcional (fMRI, do ingl?s Functional Magnetic Resonance Imaging) e da Estimula??o Magn?tica Transcraniana (TMS, do ingl?s Transcranial Magnetic Stimulation). Quinze pacientes participaram de sess?o ?nica de trinta minutos de TE. Os dados de fMRI foram analisados nas seguintes regi?es de interesse (ROI), bilateralmente: ?rea Motora Suplementar (AMS), c?rtex pr?-motor (PM), c?rtex motor prim?rio (M1), c?rtex sensorial prim?rio (S1) e Cerebelo. Em cada ROI, as mudan?as na porcentagem de ocupa??o e os valores de beta foram avaliados. Os resultados revelaram redu??o significativa no percentual de ocupa??o no PM e cerebelo contralateral ? m?o afetada (p <0,05). Al?m disso, foi observado aumento significativo nos valores de beta nas seguintes ?reas motoras contralaterais: AMS, Cerebelo, PM e M1 (p <0,005) e diminui??o significativa nas seguintes ?reas motoras ipsilaterais: PM e M1 (p < 0,001). Nas ?reas sensoriais foi observada redu??o em S1 bilateralmente (p <0,0005). Pela TMS foi analisado o Potencial Evocado Motor (PEM) sobre o hot spot de M1. Aumento significativo na amplitude do PEM foi observado ap?s a terapia no grupo (p<0,0001), e individualmente em 4 pacientes (p <0,05). Assim, nossos resultados indicam que interven??o ?nica da TE muda marcadores neurobiol?gicos em dire??o ao padr?o observado em indiv?duos saud?veis. Al?m disso, as altera??es nas ?reas motoras do hemisf?rio contralateral s?o opostas as do lado ipsilateral, sugerindo um aumento na homeostase do sistema.

No description available.

The purpose of this Master thesis was to evaluate the effects of the Mirror program on upper- limb motor recovery, self-sufficiency and active range of wrist movement in patients after brain injury. It was included sixteen participants within maximal four months after stroke. Patients were separated into experimental and control group, both with eight members. Experimental group underwent Mirror therapy. Both group participated in a standard rehabilitation program included Physiotherapy, Occupational therapy, physical therapy and movement practice on device. Experimental group patients additionally participated in Mirror therapy program for 30 mins, four times a week, for three weeks. The Fugl-Meyer Assessment, Functional Independence Measure and goniometric measurement of active movement were used to assess recovery of upper-limb movement. Mirror therapy improve upper-limb motor recovery in patients after brain injury. This research demonstrates it with significant difference between both groups, where the experimental group have improved (0,02). I have also proved Mirror therapy, when included in occupational therapy, improves the self-sufficiency of people with neurological deficit. Comparing the data from Functional Independence Measurement, I found the difference between groups statistically...

Soluções computacionais desenvolvidas para dispositivos móveis são cada vez mais comuns. A popularização de aplicativos móveis possibilitou o desenvolvimento de soluções para diversas áreas de grande potencial, como a área da saúde, entre ela a Terapia Ocupacional. Entre essas soluções, trabalhos apresentaram diversos métodos computacionais para o apoio a Terapia do Espelho. A terapia do espelho é um método que consiste na execução de exercícios com um membro saudável refletido em um espelho de modo que a visualização auxilie na redução da dor e na reabilitação do membro afetado. Essa terapia tem apresentado resultados, entre outros, na reabilitação para indivíduos que reportam dor do membro fantasma ou em recuperação pós-Acidente Vascular Cerebral (AVC). A literatura apresenta soluções computacionais para, entre outros, permitir a visualização do membro saudável a partir de tecnologias de realidade aumentada e de dispositivos vestíveis. Essas soluções muitas vezes são de difícil acesso e economicamente inviáveis. Um trabalho anterior, realizado em colaboração com equipe multidisciplinar, resultou na definição de um modelo de acompanhamento remoto que emprega dispositivos móveis para permitir o monitoramento de pacientes em tratamento por meio da terapia do espelho. Uma das limitações encontradas naquele trabalho foi o fato do terapeuta não conseguir acompanhar de maneira automática se o paciente está executando a terapia de maneira correta. Explorando essas contribuições e limitações, este trabalho teve como objetivo propor um modelo que permita o acompanhamento remoto da terapia do espelho com apoio de recursos de realidade aumentada. Como apoio computacional ao modelo, foi desenvolvida a aplicação para smartphones TEIRA (Terapia do Espelho Interativa com Realidade Aumentada) que, utilizada em conjunto com a tecnologia Google Cardboard, permite a execução da terapia do espelho com realidade aumentada. Além disso, com a integração do sistema TEIRA com o sistema de planejamento de intervenções ESPIM (Experience Sampling and Programmed Intervention Method), foi possível proporcionar um método de acompanhamento remoto com coleta de dados e vídeo. Consulta a especialistas indica que a solução apresenta benefícios potenciais para o monitoramento do paciente durante o acompanhamento remoto, que ajudem o paciente a executar a terapia de maneira correta. / Computational solutions developed for mobile devices are increasingly common. The popularization of mobile applications enabled the development of solutions for several areas of great potential, such as the health area, including Occupational Therapy. Among these solutions, papers presented several computational methods to support Mirror Therapy. Mirror therapy is a method that involves performing exercises with a healthy limb reflected in a mirror so that visualization helps in reducing pain and in rehabilitating the affected limb. This therapy has shown results, among others, in rehabilitation for individuals who report phantom limb pain or in post-stroke recovery. The literature presents computational solutions to, among others, allow visualization of the healthy limb from technologies of augmented reality and wearable devices. These solutions are often difficult to access and economically unfeasible. Previous work, conducted in collaboration with a multidisciplinary team, resulted in the definition of a remote monitoring model that uses mobile devices to allow the monitoring of patients being treated by means of mirror therapy. One of the limitations found in this work was that the therapist was unable to automatically follow up if the patient was performing the therapy correctly. Exploring these contributions and limitations, this work aimed to propose a model that allows remote monitoring of mirror therapy with the support of augmented reality resources. As a computational support to the model, the application was developed for TEIRA (Interactive Mirror Therapy with Augmented Reality) which, used in conjunction with the Google Cardboard technology, allows the execution of mirror therapy with reality increased. In addition, with the integration of the TEIRA system with the ESPIM (Experience Sampling and Programmed Intervention Method) intervention system, it was possible to provide a remote monitoring method with data and video collection. Expert consultation indicates that the solution has potential benefits for patient monitoring during remote monitoring, which will help the patient perform the therapy correctly.

Tyrimo objektas: fantominio skausmo ir raumenų jėgos pokytis po kineziterapijos ir grįžtamojo ryšio. Tyrimo tikslas: įvertini kineziterapijos ir grįžtamojo ryšio poveikį fantominiams skausmams ir šlaunies raumenų jėgai po šlaunies amputacijos. Hipotezė: manome, kad taikant kineziterapiją ir grįžtamąjį ryšį po šlaunies amputacijos, fantominių skausmų intensyvumas sumažės ir šlaunies raumenų jėga padidės labiau, nei taikant kineziterapiją be grįžtamojo ryšio. Uždaviniai: 1. Palyginti fantominių skausmų intensyvumą ir šlaunies raumenų jėgą po šlaunies amputacijos kineziterapijos pradžioje ir po įprastinės be grįžtamojo ryšio kineziterapijos. 2. Palyginti fantominių skausmų intensyvumą ir šlaunies raumenų jėgą po šlaunies amputacijos kineziterapijos pradžioje ir po kineziterapijos kartu su grįžtamuoju ryšiu. 3. Palyginti įprastinės kineziterapijos ir kineziterapijos kartu su grįžtamuoju ryšiu poveikį fantominių skausmų intensyvumui ir šlaunies raumenų jėgai. Rezultatai: Tyrimo pradžioje, kontrolinės grupės tiriamieji fantominį skausmą įvertino 6,17±0,75, tiriamosios grupės tiriamieji – 6,83±0,75 balais. Tyrimo pabaigoje, kontrolinė grupė – 5,86±0,75, tiriamoji grupė – 5,17±0,75 balais. Prieš kineziterapiją kontrolinėje grupėje, po amputacijos, šlaunį tiesiančių raumenų jėga buvo 3,00±0,00, lenkiančių – 3,33±0,52, pritraukiančių – 2,83±0,51 ir atitraukiančių – 2,50±0,55 balų; tiriamojoje grupėje, šlaunį lenkiančių raumenų jėga buvo 3,17±0,47, tiesiančių – 3,00±0,00... [toliau žr. visą tekstą] / The object: effects of physiotherapy with mirror therapy for phantom pain and thigh muscle strength after transfemoral. The objective: the alteration of phant pain and thigh muscle after physiotherapy and mirror therapy. Hyptohesis: We consider, that the application of physiotherapy with mirror therapy helps to reduce phantom pain and improve muscle strenght better than physiotherapy without mirror therapy. The aims: 1. To compare phantom pain and muscle force in the beginning of physiotherapy and after physiothepy. 2. To compare phantom pain and muscle force in the beginning of physiotherapy and after physiotherapy with mirrot therapy. 3. To compare physiotherapy with mirror therapy and physiotherapy without mirror therpy for phantom pain and muscle force. Results: Beginning of the study, the control group subjects phantom pain score 6.17 ± 0.75, experimental group subjects - 6.83 ± 0.75 points. End of the study, the control group - 5.86 ± 0.75, experimental group - 5.17 ± 0.75 points. Before physical therapy in the control group after the amputation, the thigh muscle stretching force was 3.00 ± 0.00, flexion - 3.33 ± 0.52, attracting - 2.83 ± 0.51 and distracting - 2.50 ± 0.55 scores, the experimental group, the thigh, the muscle strength was 3.17 ± 0.47, stretching - 3.00±0.00, attracting - 2.67±0.47 and distracting-2.83±0.37 points. Application of physical therapy procedures, after 3 weeks, the control group, after the amputation, the thigh flexion strength was 4.33 ± 0... [to full text]

Soluções computacionais desenvolvidas para dispositivos móveis são cada vez mais comuns. A popularização de aplicativos móveis possibilitou o desenvolvimento de soluções para diversas áreas de grande potencial, como a área da saúde, entre ela a Terapia Ocupacional. Entre essas soluções, trabalhos apresentaram diversos métodos computacionais para o apoio a Terapia do Espelho. A terapia do espelho é um método que consiste na execução de exercícios com um membro saudável refletido em um espelho de modo que a visualização auxilie na redução da dor e na reabilitação do membro afetado. Essa terapia tem apresentado resultados, entre outros, na reabilitação para indivíduos que reportam dor do membro fantasma ou em recuperação pós-Acidente Vascular Cerebral (AVC). A literatura apresenta soluções computacionais para, entre outros, permitir a visualização do membro saudável a partir de tecnologias de realidade aumentada e de dispositivos vestíveis. Essas soluções muitas vezes são de difícil acesso e economicamente inviáveis. Um trabalho anterior, realizado em colaboração com equipe multidisciplinar, resultou na definição de um modelo de acompanhamento remoto que emprega dispositivos móveis para permitir o monitoramento de pacientes em tratamento por meio da terapia do espelho. Uma das limitações encontradas naquele trabalho foi o fato do terapeuta não conseguir acompanhar de maneira automática se o paciente está executando a terapia de maneira correta. Explorando essas contribuições e limitações, este trabalho teve como objetivo propor um modelo que permita o acompanhamento remoto da terapia do espelho com apoio de recursos de realidade aumentada. Como apoio computacional ao modelo, foi desenvolvida a aplicação para smartphones TEIRA (Terapia do Espelho Interativa com Realidade Aumentada) que, utilizada em conjunto com a tecnologia Google Cardboard, permite a execução da terapia do espelho com realidade aumentada. Além disso, com a integração do sistema TEIRA com o sistema de planejamento de intervenções ESPIM (Experience Sampling and Programmed Intervention Method), foi possível proporcionar um método de acompanhamento remoto com coleta de dados e vídeo. Consulta a especialistas indica que a solução apresenta benefícios potenciais para o monitoramento do paciente durante o acompanhamento remoto, que ajudem o paciente a executar a terapia de maneira correta. / Computational solutions developed for mobile devices are increasingly common. The popularization of mobile applications enabled the development of solutions for several areas of great potential, such as the health area, including Occupational Therapy. Among these solutions, papers presented several computational methods to support Mirror Therapy. Mirror therapy is a method that involves performing exercises with a healthy limb reflected in a mirror so that visualization helps in reducing pain and in rehabilitating the affected limb. This therapy has shown results, among others, in rehabilitation for individuals who report phantom limb pain or in post-stroke recovery. The literature presents computational solutions to, among others, allow visualization of the healthy limb from technologies of augmented reality and wearable devices. These solutions are often difficult to access and economically unfeasible. Previous work, conducted in collaboration with a multidisciplinary team, resulted in the definition of a remote monitoring model that uses mobile devices to allow the monitoring of patients being treated by means of mirror therapy. One of the limitations found in this work was that the therapist was unable to automatically follow up if the patient was performing the therapy correctly. Exploring these contributions and limitations, this work aimed to propose a model that allows remote monitoring of mirror therapy with the support of augmented reality resources. As a computational support to the model, the application was developed for TEIRA (Interactive Mirror Therapy with Augmented Reality) which, used in conjunction with the Google Cardboard technology, allows the execution of mirror therapy with reality increased. In addition, with the integration of the TEIRA system with the ESPIM (Experience Sampling and Programmed Intervention Method) intervention system, it was possible to provide a remote monitoring method with data and video collection. Expert consultation indicates that the solution has potential benefits for patient monitoring during remote monitoring, which will help the patient perform the therapy correctly.

Bakgrund: För de som överlever en stroke drabbas många av kraftiga funktionsnedsättningar. Nedsatt motorisk funktion är en av de vanligaste funktionsnedsättningarna. Spegelterapi är en relativt ny behandlingsmetod som visats ha god effekt på att återfå funktion. Det finns en kunskapslucka inom området och evidensen kring spegelterapi behöver stärkas. Där spelar litteraturöversikter en väsentlig roll för att uppdatera om det rådande evidensläget samt optimera framtida forskning.  Syfte: Att undersöka evidensläget för effekterna av spegelterapi på motorisk funktion i övre extremitet hos personer med hemipares efter stroke i ett subakut och kroniskt stadium.  Metod: Studien genomfördes med en litteraturstudie där randomiserade kontrollerade studier inkluderades. Sökningar genomfördes i databaserna PubMed och Cinahl. Artiklarnas enskilda risk för snedvridning granskades enligt PEDro-scale och resultatets sammanvägda tillförlitlighet granskades enligt “Bedömning tillförlitlighet systematisk översikt”. Resultat: Totalt inkluderades nio artiklar där alla bedömdes ha låg risk för snedvridning enligt PEDro-scale. Av de nio visade fem artiklar en signifikant skillnad till interventionsgruppens fördel. Den sammanvägda bedömningen gällande effekten av spegelterapi på motorisk funktion i övre extremitet visade på en låg (++) tillförlitlighet enligt “Bedömning tillförlitlighet systematisk översikt”. Konklusion: Fler än hälften av studierna visade att spegelterapi har effekt och är en säker rehabiliteringsmetod för personer med stroke och nedsatt motorisk funktion i övre extremitet. Ytterligare forskning av hög kvalitet behövs för att säkert kunna styrka dess effektivitet. / Background: For those who survive a stroke, many suffer from severe disabilities. Impaired motor function function is one of the most common disabilities. Mirror therapy is a relatively new treatment method that has been shown to be effective in regaining function. There is a knowledge gap in this area, and the evidence regarding mirror therapy needs to be strengthened. Literature reviews play an essential role in updating the current state of evidence and optimizing future research. Purpose: To investigate the evidence regarding the effects of mirror therapy on motor function in the upper extremities of individuals with hemiparesis following stroke in a subacute and chronic stage. Method: The study was conducted through a literature review, including randomized controlled trials. Searches were conducted in the PubMed and Cinahl databases. The individual risk of bias of the articles was assessed using the PEDro scale, and the combined reliability of the results was assessed using the “Bedömning tillförlitlighet systematisk översikt”. Results: In total, nine articles were included, all assessed to have low risk of bias according to the PEDro scale. Of these nine, five articles demonstrated a significant advantage for the intervention group. The combined assessment regarding the effect of mirror therapy on upper extremity motor function showed low (++) reliability according to the "Bedömning tillförlitlighet systematisk översikt" Conclusion: More than half of the studies showed that mirror therapy is effective and a safe rehabilitation method for individuals with stroke and impaired motor function in the upper extremity. Further high-quality research is needed to definitively confirm its effectiveness.