Aplicación móvil de realidad virtual para el entrenamiento de la mano espástica

Antecedentes: La mano es una estructura con una compleja organización neuromuscular que en la hemiparesia se ve comprometida afectando la función. Objetivo: Determinar los cambios en la función motora de la mano espástica de un adulto con hemiparesia a través el uso de una aplicación móvil de realidad virtual. Método: Reporte de caso de un adulto de 29 años con hemiparesia, evaluado con las escala Fugl Meyer miembro superior (FMA-ES), Test Trail Making y el test de dinamometría de fuerza; se realizó una intervención terapéutica con gafas de realidad virtual usando la aplicación móvil Mirror box Therapy VR®. Resultados: La terapia de realidad virtual aplicada a través de la aplicación móvil Mirror box Therapy VR®, muestra a corto tiempo cambios favorables en la función motora y sensitiva del paciente. Discusión: La realidad virtual proporciona una interacción funcional, haciéndola una herramienta eficaz para motivar a los pacientes durante las sesiones. Conclusión: La intervención a través de la realidad virtual genera cambios en la función motora y sensitiva de la mano en la hemiparesia después de 12 sesiones.

When Right Goes Left: Phantom Touch Induced by Mirror Box Procedure in Healthy Individuals

In the present article, we investigated the possibility of inducing phantom tactile sensations in healthy individuals similar to those that we observed in patients after stroke. On the basis of previous research, we assumed that manipulating visual feedbacks may guide and influence, under certain conditions, the phenomenal experience of touch. To this aim, we used the Tactile Quadrant Stimulation (TQS) test in which subjects, in the crucial condition, must indicate whether and where they perceive a double tactile stimulation applied simultaneously in different quadrants of the two hands (asymmetrical Double Simultaneous Stimulation trial, Asym-DSS). The task was performed with the left-hand out of sight and the right-hand reflected in a mirror so that the right-hand reflected in the mirror looks like the own left-hand. We found that in the Asym-DSS trial, the vision of the right-hand reflected in the mirror and stimulated by a tactile stimulus elicited on the left-hand the sensation of having been touched in the same quadrant as the right-hand. In other words, we found in healthy subjects the same phantom touch effect that we previously found in patients. We interpreted these results as modulation of tactile representation by bottom-up (multisensory integration of stimuli coming from the right real and the right reflected hand) and possibly top-down (body ownership distortion) processing triggered by our experimental setup, unveiling bilateral representation of touch.

Mirror Therapy and Action Observation Therapy to Increase the Affected Upper Limb Functionality in Children with Hemiplegia: A Randomized Controlled Trial Protocol

The movements of the affected upper limb in infantile hemiplegia are slower and clumsy. This leads to a decrease in the use of the affected hand. The visual effect obtained using the mirror box and the observation of actions in another individual can activate the same structural neuronal cells responsible for the execution of these actions. This research will study the affected upper limb functionality in hemiplegia infantile from 6 to 12 years old after the application of two intervention protocols: observation action therapy and mirror therapy combined with observation action therapy. Children with a diagnose of congenital infantile hemiplegia will be recruited to participate in a randomized controlled trial with two intervention protocols during four weeks (1 h per/day; 5 sessions per/week): Mirror Therapy Action Observation (MTAO) or Action Observation Therapy (AOT). The study variables will be: spontaneous use, measured with the Assisting Hand Assessment (AHA); manual ability measured with the Jebsen Taylor Hand Function Test (JTHFT); surface electromyography of the flexors and extensors muscles of the wrist and grasp strength through a grip dynamometer. Four assessments will be performed: At baseline situation, at the end of treatment, 3 and 6 months after treatment (follow-up assessments). This study will study the effects of these therapies on the use of the affected upper limb in children with hemiplegia.