Can Mirror Visual Feedback Improve Motor Outcomes after Nerve Repair? A Randomized Controlled Trial

Document Type : Original article

Authors

1 MSc Student of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

2 2. PhD of Occupational Therapy, Assistant Professor, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

3 3. MSc of Occupational Therapy, Department of Hand and Upper Extremity, Hazrate Fateme Zahra Educational and Medical Hospital, Tehran, Iran

4 4. MD. Assistant Professor of Hand surgery, Sina Hospital, Faculty Member of Medical Department, Tehran University of Medical Sciences, Tehran, Iran

5 5. MSc student of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background and Aim: Restoration of motor and sensory functions in the hand after nerve repair is a complex process based on multi-level cellular, chemical, and functional changes occuring from finger tips to cerebral cortex. The aim of the present study was to determine the effect of Mirror Visual Feedback (mirror therapy) on improving motor outcomes after median /ulnar nerve repair.
Materials and Methods: A total of 20 patients (18 men, 2 women; mean age: 28 years) with acute complete ulnar, median, or combined median and ulnar nerve transections at the distal forearm level participated in the present randomized controlled trial study. Experimental group received the mirror therapy program for 15 minutes per day in addition to the traditional rehabilitation program, 5 days a week for 4 weeks, while control group received only the traditional rehabilitation program. Outcome measures including Total Active Motion (TAM), Opposition grade, Purdue pegboard test, and Box and Block Test were given prior to (4-6th week after surgery), and after (12th week after surgery) the treatment.
Results: The final analysis was performed on 14 patients. The AROM of fingers, opposition and dexterity significantly improved in the post-test in both groups; however, there were no significant differences between the two groups. However, the results of Box and Block test revealed more improvement in the experimental group (p=0.06).
Conclusion: Based on statistical analysis, Mirror therapy, in combination with the traditional rehabilitation program, has no significant effect on motor outcomes improvement, compared with that on the control group. But, the results suggest that mirror therapy is effective in improving the dexterity and Active Range of Motion.
 

Keywords

References

  1. Tubiana R, Thomine JM, Machin E. Examination of the hand and wrist. 2nd ed. London: Martin Dunitz; 1996. P. 1.##
  2. Freeland AE. Hand Fracture: Repair, Reconstruction, and Rehabilitation. 2nd ed. Michigan: Elsevier Inc; 2000. P. 1.##
  3. Skirven TM, Osterman AL, Fedorczyk JM, Amadio PC. Rehabilitation of the hand and upper extremity. 6th ed. Philadelphia: Mosby; 2011. P. 619-645.##
  4. Wall JT, Xu J, Wang X. Human brain plasticity: an emerging view of the multiple substrangeand mechanisms that cause cortical changes and related sensory dysfunctions after injuries of sensory inputs from the body. Brain 2002; 39(2):181-215.##
  5. Lundborg G, Rosen B. Hand function after nerve repair. ActaPhysiolo 2007; 189(2):207-17.##
  6. Lundborg G. Nerve injury and repair- a challenge to the plastic brain. Journal of the Peripheral Nervous System. 2003;8(4):209-26.##
  7. Svens B, Rosen B. Early sensory re-learning after median nerve repair using mirror training and sense substitution. Hand therapy 2009; 14(3):75-82.##
  8. Rosen B, Lundborg G. Early use of artificial sensibility to improve sensory recovery after repair of the median and ulnar nerve. Scand J PlastReconstrSurg Hand Surg 2003; 37(1):54-7.##
  9. Ramachandran VS, Rogers- Ramachandran D, Cobb S. Touching the phantom limb. Nature 1995; 377(6549):489-90.##

10. Ramachandran VS, Rogers- Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc R SocLond B BiolSci 1996; 263(1369):377-86.##

11. Rizzolatti G. The mirror neurons system and its function in humans. AnatEmbryol 2005; 210(5-6):419-2.##

12. Cattaneo L, Rizzolatti G. The mirror neurons system. Arch Neural 2009; 66(5):557-60.##

13. Cacchio A, De BlasisV, De Blasis E, Santilli V, Spacca G. Mirror therapy in complex regional pain syndrome type 1 of the upper limb in stroke patients. Neurorehabil & Neural Repair 2009; 2(1):1-8.##

14. Giraux P, Sirigu A. Illusory movements of the paralyzed limb restore motor cortex activity. NeuroImage 2003; 20:S107–S111.##

15. Moseley GL. Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomized controlled trial. Pain 2004;108(1-2):192-98.##

16. Selles RW, Schreuders TA, Stam HJ. Mirror therapy in patients with causalgia (complex regional pain syndrome type II) following peripheral injury: two cases. Rehabil med 2008;40(4):312-14.##

17. Mercier C, Sirigu A. Training with virtual visual feedback to alleviate phantom limb pain. Neurorehabil Neural Repair 2009; 2(1):1-8.##

18. Chan BL, Witt R, Charrow AP, et al. Mirror therapy for phantom limb pain. N Engl J Med 2007;357(21):2206-7.##

19. Yavuzer G, Selles R, Sezer N, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil2008; 89(3):393-98.##

20. Stevens JA, Stoykov ME. Using motor imagery in the rehabilitation of hemiparesis. Arch Phys Med Rehabil 2003; 84(7):1090-92.##

21. Dohle C, Pullen J, Nakaten A, Kust J, Rietz C, Karbe H. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair 2008;2(1):1-9.##

22. Byl NN, McKenzie A. Treatment effectiveness for patients with a history of repetitive hand use and focal hand dystonia: a planned, prospective follow-up study. J Hand Ther 2000; 13(4):289-301.##

23. Rostami HR, Tabatabai S, Babadi N. Effect of mirror therapy on hand function in patients with orthopedic injuries. Razi journal of medical sciences. 2012(103);19:9-16.##

24. Rosen B, Lundborg G. Training with a mirror in rehabilitation of the hand. Scand J PlastReconstrSurg Hand Surg 2005; 39(2):104–8.##

25. Rosen B, Vikstrom P, Turner S, et al. Enhanced early sensory outcome after nerve repair as a result of immediate post-operative re-learning: A randomized control trial. J Hand SurgEur 2014; 10(3):1-9##

26. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patient for the clinician. Journal of psychiatric research 1975;12(3):189-98.##

27. Foroughan M, Jafati Z, Shirin B, GhaemMaghamFarahani Z, Rahgozar M. Validation of mini-mental state examination(MMSE) in orderly population of Tehran. Advance in cognitive Science 2008; 10(238):29-37.##

28. Lindberg PG, Feydy A, Le Viet DL, Maier MA, Drape JL. Diffusion tensor imaging of the median nerve in recurrent carpal tunnel syndrome –initial experience. European radiology. 2013;23(11):3115-23.##

29. Radomski MV, Trombly Latham CA. Occupational therapy for physical dysfunction. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. P. 1139-38.##

30. Reliability and Validity of arm function assessment with standardized guidelines for the Fugel- Meyer Test, Action Research Arm Test and Box and Block Test: a multicenter study. 2005;19(4):404-411.##

31. Lundborg G. Brain plasticity and hand surgery: An overview. J Hand Surg Eur. 2000;25(3):242-52 ##

32. Chen R, Cohen LG, Hollett M. Nervous system recognition following injury. Neuroscience 2002; 111(4):761-773.##

33. Jacobs KM, Donoghue JP. Reshaping the cortical motor map by unmasking latent intracortical connections. Science. 1991;251(4996):944-47##

The Scientific Journal of Rehabilitation Medicine
Volume 5, Issue 2
July and August 2016
Pages 76-85

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History

  • Receive Date: 28 July 2015
  • Revise Date: 05 October 2015
  • Accept Date: 17 January 2016
  • First Publish Date: 21 June 2016

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