Effects of “closed-loop rehabilitation”-based digital mirror therapy on upper limb function in patients with stroke_West China Medical Journal

Authors：

DING Li ¹ , RONG Jifeng ² , CUI Xiao ³ , TIAN Jing ¹ , SHAO Peng ⁴ , WANG Hewei ¹ , CHEN Shugeng ¹ , YU Luying ⁵ ,  JIA Jie ^1,5,6

1. Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai 200040, P. R. China;
2. Department of Rehabilitation, the First Rehabilitation Hospital of Shanghai, Shanghai 200090, P. R. China;
3. Department of Rehabilitation, Shanghai Changning Tianshan Traditional Medicine Hospital, Shanghai 200051, P. R. China;
4. Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, P. R. China;
5. Department of Rehabilitation Medicine, Huashan Hospital Fudan University Jing’an Branch, Shanghai 200040, P. R. China;
6. National Clinical Research Center for Geriatric Disease, Huashan Hospital Fudan University, Shanghai 200040, P. R. China;

Corresponding author：

JIA Jie, Email: shannonjj@126.com

Keywords：

Closed-loop rehabilitation; Mirror therapy; Upper limb; Stroke

DOI：

10.7507/1002-0179.201805135

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Objective To explore the effect of " closed-loop rehabilitation”-based digital mirror therapy (MT) on the recovery of upper limb function after stroke. Methods Between December 2017 and April 2018, 90 stroke patients were recruited and randomly assigned to digital MT group (MG) or conventional group (CG), with 45 in each group. Patients in MG received digital MT for 60 minutes and subsequent hand function rehabilitation for 30 minutes, which was a " closed-loop rehabilitation”; moreover, patients in CG received therapeutic exercises, occupational therapy, and hand function rehabilitation for 30 minutes separately (totally 90 minutes). Both interventions were daily provided, 5 days per week and lasting for 4 weeks. Clinical assessments were provided before and after the interventions, including the Fugl-Meyer Assessment Upper Limb (FAM_UL) for motor function evaluation, the Modified Barthel Index (MBI) for the activities of daily life (ADL) evaluation, and the Modified Ashworth Scale (MAS) for the spasticity of wrist extensor/flexor. Results Five patients did not complete the study (3 in MG and 2 in CG), so there were totally 85 subjects analysed in the end. After 4-week interventions, significant improvements of FMA_UL scores (Pre: MG, 25.86±17.41; CG, 21.71±15.60. Post: MG, 33.43±17.08; CG, 26.48±16.47) and MBI scores (Pre: MG, 66.62±21.73; CG, 59.14±21.58. Post: MG, 84.62±15.06; CG, 71.10±19.95) were found in both groups; moreover, higher scores of FMA_UL and MBI were investigated in MG comparing with CG after interventions. However, there were no significantly differences in MAS. Conclusions The " closed-loop rehabilitation”-based digital MT can improve the motor function of upper limb and the ability of ADL in patients with stroke. Moreover, it is more effective than conventional treatments.

Citation： DING Li, RONG Jifeng, CUI Xiao, TIAN Jing, SHAO Peng, WANG Hewei, CHEN Shugeng, YU Luying, JIA Jie. Effects of “closed-loop rehabilitation”-based digital mirror therapy on upper limb function in patients with stroke. West China Medical Journal, 2018, 33(10): 1232-1237. doi: 10.7507/1002-0179.201805135 Copy

1.	Dobkin BH. Rehabilitation after stroke. N Engl J Med, 2005, 352(16): 1677-1684.
2.	Ramachandran VS, Rogersramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci, 1996, 263(1369): 377-386.
3.	Thieme H, Morkisch N, Mehrholz J, et al. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev, 2018(7): CD008449.
4.	贾杰. " 中枢-外周-中枢”闭环康复—脑卒中后手功能康复新理念. 中国康复医学杂志, 2016, 31(11): 1180-1182.
5.	Nojima I, Mima T, Koganemaru S, et al. Human motor plasticity induced by mirror visual feedback. J Neurosci, 2012, 32(4): 1293-1300.
6.	Chang MY, Kim HH, Kim KM, et al. Effects of observation of hand movements reflected in a mirror on cortical activation in patients with stroke. J Phys Ther Sci, 2017, 29(1): 38-42.
7.	Michielsen ME, Selles RW, van der Geest JN, et al. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase Ⅱ randomized controlled trial. Neurorehabil Neural Repair, 2011, 25(3): 223-233.
8.	丁力, 贾杰. 镜像疗法在中老年脑卒中患者功能恢复中的应用现状. 老年医学与保健, 2015, 21(3): 188-190.
9.	Kim J, Yi J, Song CH. Kinematic analysis of head, trunk, and pelvic motion during mirror therapy for stroke patients. J Phys Ther Sci, 2017, 29(10): 1793-1799.
10.	Mehnert J, Brunetti M, Steinbrink J, et al. Effect of a mirror-like illusion on activation in the precuneus assessed with functional near-infrared spectroscopy. J Biomed Opt, 2013, 18(6): 066001.
11.	Hoermann S, Ferreira Dos Santos L, Morkisch N, et al. Computerised Mirror therapy with Augmented Reflection Technology for early stroke rehabilitation: clinical feasibility and integration as an adjunct therapy. Disabil Rehabil, 2017, 39(15): 1503-1514.
12.	Lee HM, Li PC, Fan SC. Delayed mirror visual feedback presented using a novel mirror therapy system enhances cortical activation in healthy adults. J Neuroeng Rehabil, 2015, 12(1): 56.
13.	各类脑血管疾病诊断要点. 各类脑血管疾病诊断要点. 中华神经科杂志, 1996(6): 60-61.
14.	Fugl-Meyer AR, Jääskö L, Leyman I, et al. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med, 1975, 7(1): 13-31.
15.	Bohannon RW, Smith MB. Interrater reliability of a modified ashworth scale of muscle spasticity. Phys Ther, 1987, 67(2): 206-207.
16.	Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J, 1965, 14: 61-65.
17.	Michielsen ME, Smits M, Ribbers GM, et al. The neuronal correlates of mirror therapy: an fMRI study on mirror induced visual illusions in patients with stroke. J Neurol Neurosurg Psychiatry, 2011, 82(4): 393-398.
18.	Franz EA, Fu Y, Moore M, et al. Fooling the brain by mirroring the hand: brain correlates of the perceptual capture of limb ownership. Restor Neurol Neurosci, 2016, 34(5): 721-732.
19.	Wang J, Fritzsch C, Bernarding J, et al. Cerebral activation evoked by the mirror illusion of the hand in stroke patients compared to normal subjects. NeuroRehabilitation, 2013, 33(4): 593-603.
20.	Matthys K, Smits M, Van der Geest JN, et al. Mirror-induced visual illusion of hand movements: a functional magnetic resonance imaging study. Arch Phys Med Rehabil, 2009, 90(4): 675-681.
21.	Dohle C, Puellen J, Nakaten A, et al. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair, 2009, 23(3): 209-217.
22.	Garrison KA, Winstein CJ, Aziz-Zadeh L. The mirror neuron system: a neural substrate for methods in stroke rehabilitation. Neurorehabil Neural Repair, 2010, 24(5): 404-412.
23.	Stephenson JL, De Serres SJ, Lamontagne A. The effect of arm movements on the lower limb during gait after a stroke. Gait Posture, 2010, 31(1): 109-115.

1. Dobkin BH. Rehabilitation after stroke. N Engl J Med, 2005, 352(16): 1677-1684.
2. Ramachandran VS, Rogersramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci, 1996, 263(1369): 377-386.
3. Thieme H, Morkisch N, Mehrholz J, et al. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev, 2018(7): CD008449.
4. 贾杰. " 中枢-外周-中枢”闭环康复—脑卒中后手功能康复新理念. 中国康复医学杂志, 2016, 31(11): 1180-1182.
5. Nojima I, Mima T, Koganemaru S, et al. Human motor plasticity induced by mirror visual feedback. J Neurosci, 2012, 32(4): 1293-1300.
6. Chang MY, Kim HH, Kim KM, et al. Effects of observation of hand movements reflected in a mirror on cortical activation in patients with stroke. J Phys Ther Sci, 2017, 29(1): 38-42.
7. Michielsen ME, Selles RW, van der Geest JN, et al. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase Ⅱ randomized controlled trial. Neurorehabil Neural Repair, 2011, 25(3): 223-233.
8. 丁力, 贾杰. 镜像疗法在中老年脑卒中患者功能恢复中的应用现状. 老年医学与保健, 2015, 21(3): 188-190.
9. Kim J, Yi J, Song CH. Kinematic analysis of head, trunk, and pelvic motion during mirror therapy for stroke patients. J Phys Ther Sci, 2017, 29(10): 1793-1799.
10. Mehnert J, Brunetti M, Steinbrink J, et al. Effect of a mirror-like illusion on activation in the precuneus assessed with functional near-infrared spectroscopy. J Biomed Opt, 2013, 18(6): 066001.
11. Hoermann S, Ferreira Dos Santos L, Morkisch N, et al. Computerised Mirror therapy with Augmented Reflection Technology for early stroke rehabilitation: clinical feasibility and integration as an adjunct therapy. Disabil Rehabil, 2017, 39(15): 1503-1514.
12. Lee HM, Li PC, Fan SC. Delayed mirror visual feedback presented using a novel mirror therapy system enhances cortical activation in healthy adults. J Neuroeng Rehabil, 2015, 12(1): 56.
13. 各类脑血管疾病诊断要点. 各类脑血管疾病诊断要点. 中华神经科杂志, 1996(6): 60-61.
14. Fugl-Meyer AR, Jääskö L, Leyman I, et al. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med, 1975, 7(1): 13-31.
15. Bohannon RW, Smith MB. Interrater reliability of a modified ashworth scale of muscle spasticity. Phys Ther, 1987, 67(2): 206-207.
16. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J, 1965, 14: 61-65.
17. Michielsen ME, Smits M, Ribbers GM, et al. The neuronal correlates of mirror therapy: an fMRI study on mirror induced visual illusions in patients with stroke. J Neurol Neurosurg Psychiatry, 2011, 82(4): 393-398.
18. Franz EA, Fu Y, Moore M, et al. Fooling the brain by mirroring the hand: brain correlates of the perceptual capture of limb ownership. Restor Neurol Neurosci, 2016, 34(5): 721-732.
19. Wang J, Fritzsch C, Bernarding J, et al. Cerebral activation evoked by the mirror illusion of the hand in stroke patients compared to normal subjects. NeuroRehabilitation, 2013, 33(4): 593-603.
20. Matthys K, Smits M, Van der Geest JN, et al. Mirror-induced visual illusion of hand movements: a functional magnetic resonance imaging study. Arch Phys Med Rehabil, 2009, 90(4): 675-681.
21. Dohle C, Puellen J, Nakaten A, et al. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair, 2009, 23(3): 209-217.
22. Garrison KA, Winstein CJ, Aziz-Zadeh L. The mirror neuron system: a neural substrate for methods in stroke rehabilitation. Neurorehabil Neural Repair, 2010, 24(5): 404-412.
23. Stephenson JL, De Serres SJ, Lamontagne A. The effect of arm movements on the lower limb during gait after a stroke. Gait Posture, 2010, 31(1): 109-115.

West China Medical Journal

Effects of “closed-loop rehabilitation”-based digital mirror therapy on upper limb function in patients with stroke

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