Development of a Mechatronic System for the Mirror Therapy

This paper fits into the field of research concerning robotic systems for rehabilitation. Robotic systems are going to be increasingly used to assist fragile persons and to perform rehabilitation tasks for persons affected by motion injuries. Among the recovery therapies, the mirror therapy was shown to be effective for the functional recovery of an arm after stroke. In this paper we present a master/slave robotic device based on the mirror therapy paradigm for wrist rehabilitation. The device is designed to orient the affected wrist in real time according to the imposed motion of the healthy wrist. The paper shows the kinematic analysis of the system, the numerical simulations, an experimental mechatronic set-up, and a built 3D-printed prototype.

Mirror Therapy Rehabilitation in Stroke: A Scoping Review of Upper Limb Recovery and Brain Activities

Background. Mirror therapy (MT) has been used as a treatment for various neurological disorders. Recent application of electroencephalogram (EEG) to the MT study allows researchers to gain insight into the changes in brain activity during the therapy. Objective. This scoping review is aimed at mapping existing evidence and identifying knowledge gaps about the effects of MT on upper limb recovery and its application for individuals with chronic stroke. Methods and Materials. A scoping review through a systematic literature search was conducted using PubMed, CINAHL, PsycINFO, and Scopus databases. Twenty articles published between 2010 and 2020 met the inclusion criteria. The efficacy of MT on upper limb recovery and brain activity during MT were discussed according to the International Classification of Functioning, Disability and Health (ICF). Results. A majority of the studies indicated positive effects of MT on upper limb recovery from the body structure/functional domain. All studies used EEG to indicate brain activation during MT. Conclusion. MT is a promising intervention for improving upper limb function for individuals with chronic stroke. This review also highlights the need to incorporate EEG into the MT study to capture brain activity and understand the mechanism underlying the therapy.

Application Of Mirror Therapy On Upper Extremity Motor Recovery In Post-Stroke Patients

Background: Stroke is a health problem for both developed and developing countries, including Indonesia. Paralysis in stroke is mainly due to damage to the internal capsule. This damage requires neuroplasticity involving a number of parts of the brain to restore. One therapy that is beneficial for neuroplasticity is Mirror Therapy (MT). MT is a rehabilitation tool that aims to restore some of the pathological conditions in which the body representation is affected, including post-stroke motor impairment. Methods: This research is a quantitative pre-experimental design with the type one group pretest-postest. The research subjects were 15 post-stroke patients in residency of Semarang. Research data were collected in August-September 2020. Sample selection with purposive sampling technique who conform inclusion criteria. The Fulg-Meyer Upper Extremity Assessment (FMA-UE) as an aoutcame measure that be avowed valid and reliabel. Data analysis using Paired Sample T-Test because of normally distributed. Results: Statistically the results represent a significant difference in the UE motor ability of post-stroke patients between baseline and after mirror therapy intervention, with a mean difference (5,14) and p value = 0.000 (ρ < 0,05). Application of MT effect on upper extremity motor recovery in post-stroke patients. Conclusions: MT program is an effective intervention for UE motor recovery and motor function improvement in post- stroke patients. MT program can be used as a standardized of hand rehabilitation intervention in hospital, clinics and homes.

Efeitos da Terapia Espelho na funcionalidade do membro superior pós-AVC: revisão integrativa

Introdução. O Acidente Vascular Cerebral (AVC) é um acometimento neurológico que pode ser classificado em dois tipos: isquêmico e hemorrágico, capazes de causarem uma série de alterações motoras, cognitivas e sensoriais. Nesse contexto, a Terapia Espelho é um recurso de baixo custo, implementado no tratamento para membros paralisados. Objetivo. Reunir informações através de uma busca na literatura a fim de verificar os efeitos da Terapia espelho na funcionalidade do membro superior afetado de pacientes pós-acidente vascular cerebral. Método. Foi realizada uma revisão integrativa da literatura por meio da busca de estudos nas bases de dados PubMed, BVS; CINAHL; Embase; Web of Science; Scopus. A seleção dos artigos se deu em quatro etapas: levantamento bibliográfico utilizando as palavras-chaves “Stroke” AND “paresis” OR “upper extremity” AND “mirror therapy”, leitura do título, leitura do resumo e leitura na íntegra dos artigos. Resultados. Foram identificados 310 estudos, dos quais 13 foram avaliados pela escala PEDro, tornando-se elegíveis para a revisão, de acordo com os critérios estabelecidos. Conclusão. A Terapia Espelho associada ou não a outras intervenções foi capaz de melhorar a funcionalidade do membro superior afetado de indivíduos, nos aspectos motores, sensitivos, atividade de vida diária, e proporcionou qualidade de vida dos pacientes pós-AVC.

Comparing the effectiveness of bimanual and unimanual mirror therapy in unilateral neglect after stroke: A pilot study

BACKGROUND: Unilateral neglect in stroke patients is a major obstacle to rehabilitation, which is a great challenge for therapists. OBJECTIVE: This study aimed to compare the effectiveness of bimanual mirror therapy (BMT) and unimanual mirror therapy (UMT), the two protocols of mirror therapy, for the reduction of the symptoms of unilateral neglect in stroke patients. METHODS: Twenty-eight individuals were randomly assigned to the UMT or BMT groups. Both groups received mirror therapy for 30 minutes per day, 5 days a week, for a period of 4 weeks. The Star Cancelation Test (SCT), Line Bisection Test (LBT), Picture Scanning test (PST), and Korean Catherine Bergego Scale (K-CBS) were used to measure the change in unilateral neglect, and the Korean version of the Modified Barthel Index (K-MBI) was used to evaluate activities of daily living (ADL). RESULTS: The results of SCT, LBT, PST, and K-CBS showed significant decreases in unilateral neglect in both groups (p < 0.05). K-MBI improved significantly in both groups (p < 0.05). There were significant differences between the two groups in the unilateral neglect tests (p < 0.05), but no significant difference in ADL evaluation (p > 0.05). CONCLUSIONS: Mirror therapy protocols can be applied to treat unilateral neglect in stroke patients. However, BMT may be more beneficial for reducing the symptoms of unilateral neglect.

Gambaran Peningkatan Kemampuan Motorik Ekstremitas Atas Setelah Pemberian Mirror Therapy Pada Pasien Pasca Stroke : Literature Review

Stroke is a serious health problem with high incidence and mortality, and causes disability in patients. It causes complex problems, one of which is motor disorders, especially the upper extremities. Impaired motor function causes functional limitations and disabilities in stroke patients. Mirror Therapy is a new technique that is simple and able to improve upper extremity function with the concept of visual illusion. This study aimed to describe of the motoric improvement of the upper extremities after the implementation of Mirror Therapy in post-stroke patients. This study was a literature review by searching for articles from databases such as PubMed, Science Direct, and Google Scholar. The articles were chosen based on several inclusion and exclusion criteria as well as a feasibility test. The number of articles that was appropriate and reviewed was five. The results of review of the five articles showed that Mirror Therapy was proven to be able to improve the motoric skills of post-stroke patients with an average difference of 13.68 using the Fugl Meyer Assessment of Upper Extremity (FMA-UE) measuring instrument. The most common type of stroke was ischemic stroke (64.6%), and it was more common in males (72.3%) with an average age of 52.84 years. Mirror Therapy could improve the upper extremity motor skills in post-stroke patients. This study is expected to be the basis of action in performing physiotherapy management, especially in improving upper extremity motor skills in post-stroke patients with Mirror Therapy interventions.Keywords : Mirror skills; Motor Therapy; Post stroke AbstrakStroke merupakan masalah kesehatan yang penting dengan kejadian dan kematian tinggi dan menyebabkan kecacatan pada penderita. Permasalahan yang ditimbulkan kompleks, salah satunya gangguan motorik khususnya ekstremitas atas. Fungsi motorik yang terganggu menyebabkan keterbatasan fungsional dan disabilitas pada pasien stroke sehari-hari. Mirror therapy merupakan teknik baru yang sederhana dan mampu memperbaiki fungsi ekstremitas atas dengan konsep ilusi visual. Penelitian ini bertujuan untuk mengetahui gambaran peningkatan motorik ekstremitas atas setelah pemberian mirror therapy pada pasien pasca stroke. Penelitian menggunakan literature review dengan pencarian artikel melalui database seperti PubMed, Science Direct, dan Google Scholar. Artikel diambil berdasarkan kriteria inklusi dan eksklusi, serta dilakukan uji kelayakan. Jumlah artikel yang sesuai dan dilakukan review (n=5). Hasil literature review lima artikel menunjukkan bahwa pemberian mirror therapy terbukti dapat meningkatkan kemampuan motorik ekstremitas atas pasien pasca stroke dengan rata-rata selisih peningkatan sebesar 13,68 menggunakan alat ukur Fugl Meyer Assessment of Upper Extremity (FMA-UE). Jenis stroke terbanyak yaitu stroke iskemik 64,6% dan jenis kelamin laki-laki lebih banyak 72,3% dengan karakteristik rata-rata usia 52,84 tahun. Mirror Therapy dapat meningkatkan kemampuan motorik ekstremitas atas pasien pasca stroke. Diharapkan menjadi dasar tindakan dalam melakukan manajemen fisioterapi, mengenai masalah peningkatan kemampuan motorik ekstremitas atas pada pasien pasca stroke dengan intervensi mirror therapy.Kata kunci: Kemampuan motorik; Mirror therapy; Pasca stroke

Postural Difference between the Interventions Reflecting the Concept of Mirror Therapy in Healthy Subjects

(1) Background: Mirror therapy is one of the promising interventions for the upper limb rehabilitation of stroke patients. Postural asymmetry during mirror therapy was pointed out as a possibility to influence stroke patients’ rehabilitation negatively. However, it is still difficult to find studies on the postural changes in mirror therapy concept interventions. This study compared three methods of postural differences as follows: traditional mirror therapy (mirror); displaying the real-time movement of the unaffected side on the screen above the affected side (screen); and playing a pre-recorded movement of the unaffected side on a tablet placed on a movable box where the affected hand is put inside (movable). (2) Methods: to observe a kinematic difference, we recruited 16 healthy volunteers to go through three different interventions (mirror, screen, movable). The motion capture system made observations on the postures before and during interventions, then compared and analyzed. (3) Results: while using the mirror, the sitting posture was observed to become asymmetric, and the following unique posture was observed where the target hand went further from the trunk while performing tasks. In addition, the shoulder of the target side came forward, and the difference between both elbow flexion angles was also observed. On the other hand, the screen or movable device did not cause a significant change in the sitting posture, and no additional postural differences were observed either. (4) Conclusions: mirror therapy showed a tendency to cause lateral flexion opposite the target hand, thus, creating additional postural change. However, developed methods controlled spine tilt, and enabled the keeping of the midline while sitting during the intervention.