Mirror Therapy in Lower Limb Amputees – A Look Beyond Primary Motor Cortex Reorganization

Background. Drastic functional reorganization was observed in the ipsilateral primary motor cortex (M1) of a Paralympic long jumper with a unilateral below-knee amputation in our previous study. However, it remains unclear whether long-term para-sports are associated with ipsilateral M1 reorganization since only 1 athlete with amputation was investigated. Objective. This study aimed to investigate the relationship between the long-term para-sports and ipsilateral M1 reorganization after lower limb amputation. Methods. Lower limb rhythmic muscle contraction tasks with functional magnetic resonance imaging and T1-weighted structural imaging were performed in 30 lower limb amputees with different para-sports experiences in the chronic phase. Results. Brain activity in the ipsilateral primary motor and somatosensory areas (SM1) as well as the contralateral dorsolateral prefrontal cortex, SM1, and inferior temporal gyrus showed a positive correlation with the years of routine para-sports participation (sports years) during contraction of the amputated knee. Indeed, twelve of the 30 participants who exhibited significant ipsilateral M1 activation during amputated knee contraction had a relatively longer history of para-sports participation. No significant correlation was found in the structural analysis. Conclusions. Long-term para-sports could lead to extensive reorganization at the brain network level, not only bilateral M1 reorganization but also reorganization of the frontal lobe and visual pathways. These results suggest that the interaction of injury-induced and use-dependent cortical plasticity might bring about drastic reorganization in lower limb amputees.

Download Full-text

Reorganization of the primary motor cortex following lower-limb amputation for vascular disease: a pre-post-amputation comparison

Disability and Rehabilitation ◽

10.1080/09638288.2016.1207110 ◽

2016 ◽

Vol 39 (17) ◽

pp. 1722-1728 ◽

Cited By ~ 1

Author(s):

Brenton Hordacre ◽

Lynley V. Bradnam ◽

Maria Crotty

Keyword(s):

Motor Cortex ◽

Vascular Disease ◽

Lower Limb ◽

Primary Motor Cortex ◽

Lower Limb Amputation ◽

Limb Amputation

Download Full-text

Effects of lower limb segmental muscle vibration on primary motor cortex short-latency intracortical inhibition and spinal excitability in healthy humans

Experimental Brain Research ◽

10.1007/s00221-021-06257-8 ◽

2021 ◽

Author(s):

Kodai Miyara ◽

Seiji Etoh ◽

Kentaro Kawamura ◽

Atsuo Maruyama ◽

Takehiro Kuronita ◽

...

Keyword(s):

Motor Cortex ◽

Lower Limb ◽

Primary Motor Cortex ◽

Intracortical Inhibition ◽

Short Latency ◽

Muscle Vibration ◽

Healthy Humans ◽

Spinal Excitability

Download Full-text

Abstract 204: Efficacy of Mirror Therapy Combined with Afferent Stimulation on Motor Impairment, Motor Function, and Daily Function in Chronic Stroke: A Randomized Controlled Trial

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.6.suppl_1.a204 ◽

2013 ◽

Vol 6 (suppl_1) ◽

Author(s):

Ching-yi Wu ◽

Pai-chuan Huang ◽

Keh-chung Lin ◽

Wen-ling Huang

Keyword(s):

Motor Cortex ◽

Primary Motor Cortex ◽

Motor Impairment ◽

Manual Dexterity ◽

Cortical Reorganization ◽

Mirror Therapy ◽

Motor Impairments ◽

Significant Group ◽

Afferent Stimulation ◽

Daily Function

Background: Studies have found that both mirror therapy (MT) and mesh-glove (MG) afferent stimulation reduce motor impairments after stroke. MT might recruit the premotor cortex or balance neural activation within the primary motor cortex toward the affected hemisphere. And MG stimulation might result in plastic changes in the primary motor cortex and induce an effect on motor cortical excitability. Adding MG to MT might further augment cortical reorganization. In addition, combining two treatment protocols has been advocated as a way to improve treatment efficacy in stroke rehabilitation. A combined protocol such as MT combined with MG (MT+MG) might broaden aspects of treatments effects. This study aimed to demonstrate the comparative efficacy of MT+MG, MT, and a conventional task-oriented training (CT). Methods: This study recruited forty-three participants with chronic stoke at the mild to moderate level of motor impairments. Participants were randomly assigned to one of the three groups: MT+MG, MT, or CT groups. All participants in these three groups received a 1.5-hour training session per day, 5 days/week for 4 weeks. Treatment outcomes included motor impairment measured by the Fugl-Meyer Assessment (FMA), motor functions measured by the Box and Block Test (BBT) indicating manual dexterity and 10-Meter Walk Test (10 MWT) indicating ambulation function, and daily function measured by the ABILHAND Questionnaire. Evaluations were administered before and after the 4-week treatments. Results: Significant effects on the FMA (p =.045), the BBT (p = .019), and the 10-MWT (velocity of self-pace: p =.011; stride of self-pace: p =.002; velocity of ASAP: p = .025) were found among the three groups. Post hoc analyses showed that MT+MG and MT groups elicited significantly better FMA total scores compared to the CT group (p = 0.0032 and 0.0031). MT+MG and CT groups performed significantly better on the BBT compared to the MT group (p = 0.007 and 0.036). MT+MG and CT groups performed significantly better on three of four 10 MWT subscales, the velocity of self-pace (p = 0.004 and 0.031), the stride of self-pace (p = 0.016 and 0.016), and the velocity of as-soon-as-possible (p = 0.014 and 0.023) than MT. There were no significant group effects on ABILHAND Questionnaire. Conclusions: The MT+MG group specifically demonstrated superior benefits on manual dexterity and ambulation function over the MT group. Both MT+MG and MT treatments showed significant benefits on the reduction of motor impairment. However, MT+MG and MT protocols did not yield extra benefits on daily function. Future studies might include functional task practice to enhance generalizability of the treatment effects to daily function in patients with various severities of motor impairments. The retention effect of MT + MG needs further investigation.

Download Full-text

Effects of phantom exercises on pain, mobility, and quality of life among lower limb amputees; a randomized controlled trial

BMC Neurology ◽

10.1186/s12883-021-02441-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anna Zaheer ◽

Arshad Nawaz Malik ◽

Tahir Masood ◽

Sahar Fatima

Keyword(s):

Quality Of Life ◽

Lower Limb ◽

Controlled Trial ◽

Phantom Limb ◽

Mirror Therapy ◽

Randomized Controlled ◽

Sf 36 ◽

Experimental Group ◽

Lower Limb Amputees

Abstract Background The objective of the current study is to evaluate the effects of phantom exercises on phantom limb pain, mobility status, and quality of life in lower limb amputees treated with mirror therapy and routine physiotherapy. Methods It is a randomized controlled trial in which 24 unilateral lower limb amputees (above and below the knee) were randomly assigned to two equal groups i.e., control group (mirror therapy and conventional physical therapy) and experimental group in which, phantom exercises were given, additionally. Physical therapy included conventional therapeutic exercises while phantom exercises include imagining the movement of the phantom limb and attempting to execute these movements Data were collected at baseline, after 2 and 4 weeks of intervention using VAS (pain), AMP (mobility) and RAND SF-36 Version 1.0 (QOL) questionnaires. All statistical analyses were done with IBM SPSS 25.0 with 95% CI. Results Twenty-four amputees (17 males and 7 females) participated in this trial. The Mean age of the participants in experimental and control groups was 45.3 ± 11.1 years and 40.5 ± 12.5 years respectively. After the intervention, the pain (VAS score) was significantly lower in the experimental group (p = 0.003). Similarly, the experimental group demonstrated a significantly better score in the “bodily pain” domain of SF-36 (p = 0.012). Both groups significantly (p < 0.05) improved in other domains of SF-36 and ambulatory potential with no significant (p > 0.05) between-group differences. Conclusions The Addition of phantom exercises resulted in significantly better pain management in lower limb amputees treated with mirror therapy and routine physiotherapy. Trial registration This study is registered in the U.S National Library of Medicine. The clinical trials registration number for this study is NCT04285138 (ClinicalTrials.gov Identifier) (Date: 26/02/2020).

Download Full-text

The use of brain stimulation in the rehabilitation of walking disability in patients with multiple sclerosis: A randomized double-blind clinical trial study

Iranian Journal of Neurology ◽

10.18502/ijnl.v18i2.1289 ◽

2019 ◽

Cited By ~ 1

Author(s):

Shahram Oveisgharan ◽

Zahra Karimi ◽

Siamak Abdi ◽

Hajir Sikaroodi

Keyword(s):

Multiple Sclerosis ◽

Clinical Trial ◽

Motor Cortex ◽

Lower Limb ◽

Primary Motor Cortex ◽

Double Blind ◽

The Real ◽

Sham Stimulation ◽

Double Blind Clinical Trial ◽

Disability Status

Background: Transcranial direct current stimulation (tDCS) of the primary motor cortex of the lower limb has been exploited in the treatment of patients with stroke and spastic lower limb paresis. We examined this stimulation efficacy in the treatment of multiple sclerosis (MS)-related walking disability. Methods: In a single-center randomized doubleblind clinical trial study, 13 patients with MS and walking disability and Expanded Disability Status Scale (EDSS) score of 3 to 6 were randomized to the real and sham stimulation groups. In the real tDCS stimulation, 7 patients received anodal 2.5 mA stimulation at 1 cm anterior to the Cz point for 30-minute daily sessions in 7 consecutive days. The other group received sham stimulation with the same protocol. The primary outcome of the trial was change in the Timed 25-Foot Walk (T25-FW) from before to after the stimulation. We also assessed the Multiple Sclerosis Walking Scale-12 (MSWS-12). We employed linear mixed effects model to examine the efficacy of tDCS stimulation on changing the outcomes. Results: On average, patients who received real tDCS stimulation walked faster after 7 sessions of stimulation [Estimate = -2.7, standard error (SE) = 1.3, P = 0.049], while walking speed of sham stimulation recipients did not change. For every session of stimulation, recipients of real tDCS stimulation spent 2.7 seconds less for walking the 25 feet. Real tDCS stimulation was not effective in improving MSWS-12 scores. Conclusion: tDCS stimulation of the lower limb motor cortex speeded up patients with MS in walking, but without improvement in patients’ mobility in daily activities.

Download Full-text

Effect of Mirror Therapy on Human Primary Motor Cortex Function in Motor Learning

Journal of the Japanese Physical Therapy Association ◽

10.1298/jjpta.vol16_013 ◽

2013 ◽

Vol 16 (1) ◽

pp. 44

Author(s):

Ippei NOJIMA ◽

Toshio KAWAMATA ◽

Tatsuya MIMA

Keyword(s):

Motor Cortex ◽

Motor Learning ◽

Primary Motor Cortex ◽

Mirror Therapy

Download Full-text

Intradiploic encephalocele of the primary motor cortex in an adult patient: electrophysiological implications during surgery

Journal of Neurosurgery ◽

10.3171/2016.11.jns162426 ◽

2018 ◽

Vol 128 (3) ◽

pp. 871-874 ◽

Cited By ~ 2

Author(s):

Luca Valci ◽

Martina Dalolio ◽

Dominique Kuhlen ◽

Emanuele Pravatà ◽

Claudio Gobbi ◽

...

Keyword(s):

Motor Cortex ◽

Evoked Potentials ◽

Motor Function ◽

Lower Limb ◽

Primary Motor Cortex ◽

Brain Mri ◽

Brain Parenchyma ◽

Transcranial Electrical Stimulation ◽

Precentral Gyrus ◽

Left Lower Limb

Encephaloceles are herniations of brain parenchyma through congenital or acquired osseous-dural defects of the skull base or cranial vault. Different types of symptoms, due to CSF fistulas, meningitis, or seizures, are often associated with this condition. The authors present a rare case of spontaneous right frontal parasagittal encephalocele in a 70-year-old man who was experiencing a spastic progressive paresis of his left lower limb. Results of routine electrophysiological workup (motor evoked potentials, somatosensory evoked potentials, and electroneuromyography), as well as those of MRI of the spinal cord, were normal. A brain MRI study detected a partial herniation of the right precentral gyrus through a meningeal defect into the diploe, embedding corticospinal fibers. The patient underwent navigated craniotomy. Intraoperative neuromonitoring of motor function with transcranial electrical stimulation and direct cortical stimulation indicated the presence of motor cortex inside the encephalocele. Thus, the brain parenchyma was carefully released without resection to preserve motor function and, finally, a cranioplasty was performed. After a few months, the patient demonstrated considerable improvement in his left lower-limb function and, after 1 year, he had fully recovered. Intraoperative electrophysiological monitoring and mapping allowed for the determination of the best surgical strategy for the isolation of the encephalocele and correlated well with preoperative multimodal MRI.

Download Full-text