MirrorTherapyforPost-StrokeRehabilitation镜子疗法对脑卒中后康复课件

1、Mirror Therapy for Post-Stroke RehabilitationBy: Kim Errico, OTR/LKristen Daniels, OTR/LMirror Therapy for Post-StrokePurpose of Mirror TherapyImprove motor recovery in upper and lower extremitiesIncrease the functional use of upper and lower extremitiesWork in conjunction with conventional therapyP

2、urpose of Mirror TherapyGoals for Mirror TherapyThe following are goals for OT and PT treatment of the affected extremitiesIncrease ROM Increase functionIncrease perception (neglect, inattention, awareness)Increase cortical reorganization of the brainIncrease processing speedIncrease strengthImprove

3、 a lack or change in sensationDecrease apraxiaDecrease painIncrease coordinationGoals for Mirror TherapyThe foPatient CriteriaMedically stableDiagnosis that has affected an extremity in strength, ROM, sensation and/or visual perceptionMust have intact/unaffected extremityTolerates upright positionFo

4、llows simple commands/directionsCan attend to task for at least 15 minutesPatient CriteriaMedically stabContraindicationsPrecautions or restrictions limiting ROM to the affected extremityie: DVT, sternal precautions, arthritis, contractures, toneAny visual impairments that will severely impact abili

5、ty to see image in the mirrorie: macular degeneration, cataracts, etc.ContraindicationsEquipmentMirror therapy requires very little for equipment and set-upEquipment includesMirror box or full length mirrorTable (for upper extremities)Mat or chair (for lower extremities)Quiet environment with limite

6、d visual and auditory distractionsSide tables (depending on activity)EquipmentMirror therapy requirUse of Mirror Therapy for Upper Extremity ImpairmentsA baseline of range of motion, strength, coordination, and sensation All identifiers are removed from unaffected extremity such as:RingsName bandsBr

7、acelets/watchesThe affected upper extremity is placed inside the box or behind the full length mirrorPatient sits with mirror at midline of face/bodySelected exercises are completed with unaffected upper extremity while patient watches motion in mirrorPatient should try to move both extremities toge

8、ther and coordinate throughoutUse of Mirror Therapy for UppeUse of Mirror Therapy for Lower Extremity ImpairmentsA baseline of range of motion, strength, coordination, and sensationPatient is positioned in appropriate position for desired ROM (supine with head elevated or seated in wheelchair/chair)

9、The affected lower extremity is placed behind the full length or rolling mirrorSelected exercises are completed with unaffected upper extremity while patient watches motion in mirrorPatient should try to move both extremities together and coordinate throughoutUse of Mirror Therapy for LoweSample Pro

10、tocolsUpper ExtremityProtocol 115 minutes, twice daily, 6 days a week for 4 weeksProximal to distal movementsBegin with movements patients can complete and move to more difficultProtocol 230 minutes, once a day, 5 days a week for 4 weeksFinger and wrist movementsLower Extremity30 minutes a day, 5 da

11、ys a week for 4 weeksAnkle dorsifelxion movementsSample ProtocolsUpper ExtremitAssessments Used to Collect DataThe following assessments and tests have been chosen by numerous researchers to look at the efficacy of mirror therapyUpper ExtremityFugl Meyer AssessmentAction Research Arm Test Motor Asse

12、ssment ScaleWolf Motor Function TestBox and Block TextBrunnstrom StagesLower ExtremityFugl Meyer AssessmentBrunnstrom StagesAssessments Used to Collect DaResearchYavuzer, Selles, Sezer, Sutbeyaz, Bussmann, Kseolu, Atay, & Stam (2008)Participants: 40 inpatients within 12 months post-strokePurpose: Ev

13、aluate effects of mirror therapy for motor recovery, spasticity, and upper extremity functionIntervention: 30 minutes a day, 5 days a week for 4 weeks in conjunction with conventional therapyResults: Hand function improved at end of intervention as well as 6 month follow-up; spasticity was not chang

14、edResearchYavuzer, Selles, SezerResearch ContinuedStbeyaz, Yavuzer, Sezer & Koseoglu (2007)Participants: 40 inpatients within 12 months post-strokePurpose: Evaluate using mirror therapy and motor imagery on lower extremity functioningIntervention: 30 minutes of mirror therapy a day, 5 days a week fo

15、r 4 weeks in conjunction with conventional therapyResults: Lower extremity recovery and functioning increases following mirror therapy combined with conventional therapyResearch ContinuedStbeyaz, YaResearch ContinuedDohle, Pullen, Nakaten, Kust, Rietz, & Karbe (2009) Participants: 36 patients no mor

16、e than 8 weeks post stroke all with severe hemiparesis Purpose: Evaluate affect of therapy including the use of a mirror to simulate the affected upper extremity with the unaffected upper extremity; this was a randomized controlled trialIntervention: 30 minutes of mirror therapy a day, 5 days a week

17、 for 6 weeks with random assignment to either mirror therapy or an equivalent control therapyResults: Mirror therapy is a promising method to improve sensory and attentional deficits and to support motor recoveryResearch ContinuedDohle, PulleResearch ContinuedCase studyStevens, & Stoykov (2004) Outl

18、ined a method for using simulation of movement to provide a means for experiancing a range of smooth and controlled movements completed by a paretic limb. The simulation provides perceptual experience of bilateral motion beyond the current capabilities of the affected limb. Technique was done for a

19、3 week course of treatment. Results showed improved hand function as demonstrated by increases in Fugl-Meyer scores and faster movement speeds as demonstrated by decreased movement times for the Jebsen Test of Hand Function.Research ContinuedCase studyConclusionMirror therapy is a relatively new tre

20、atment approach in the field of stroke rehabilitation which will require future research for efficacy. It is difficult to discriminate gains in relation to just mirror therapy due to the fact that mirror therapy is rarely completed without conventional treatment. ConclusionMirror therapy is a Video

21、ExampleVideo ExampleReferencesDohle, C., Pullen, J., Nakaten, A., Kust, J., Rietz, C., & Karbe, H. (2009). Mirror therapy promotes recovery from severe hemiparesis: A randomized controlled trial. Neurorehabilitation and Neural Repair, 23, 209-217.Laybourne, D. & Carrigan, P. “Doug and mirror box therapy in action” (2009). Online video clip. /watch?v=MIucuMWOdKE. Accessed on May 1, 2011.Stevens, J.A. & Stoykov, M.E.P. (2004). Simulation o