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Stonsaovapak C, Koonalinthip N, Kitisomprayoonkul W. Efficacy of mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions: A systematic review and meta-analysis. PM R 2024. [PMID: 39051506 DOI: 10.1002/pmrj.13239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 05/05/2024] [Accepted: 05/16/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis is to assess the efficacy of mirror neuron system-based therapy for managing pain and improving motor and upper limb function in patients with upper limb orthopedic conditions. LITERATURE SURVEY Systematic bibliographical searches of the PubMed, SCOPUS, and CENTRAL registries and databases up to September 2023 were conducted to find randomized controlled trials (RCTs) assessing the efficacy of mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions. METHODOLOGY Two reviewers assessed the RCTs using a Cochrane risk-of-bias tool and extracted data from studies with similar outcome measures in the domains of pain, motor function, or functional score, which were pooled into meta-analyses. SYNTHESIS The review included 13 studies to compare the efficacy of mirror neuron system-based therapy with that of conventional rehabilitation programs. The therapy reduced pain intensity (mean difference [MD] 2.04, 95% confidence interval [CI] 1.46-2.63) and kinesiophobia (MD 8.43, 95% CI 6.98 to 9.88), and increased grip strength (MD 1.86, 95% CI 0.28-3.45). The therapy also improved upper limb functional outcomes as assessed by the 30-item Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score (MD 13.52, 95% CI 10.63-16.41). However, the outcomes as assessed by the 11-item QuickDASH questionnaire and the Shoulder Pain and Disability Index (SPADI) were not superior to conventional rehabilitation. CONCLUSIONS Mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions may reduce pain intensity and kinesophobia, and improve grip strength and DASH scores compared with conventional rehabilitation programs. However, this interpretation is limited by the heterogeneity and various quality of the RCTs included in our meta-analysis.
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Affiliation(s)
- Chernkhuan Stonsaovapak
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nantawan Koonalinthip
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wasuwat Kitisomprayoonkul
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Muñoz-Gómez E, Aguilar-Rodríguez M, Mollà-Casanova S, Sempere-Rubio N, Inglés M, Serra-Añó P. A randomized controlled trial on the effectiveness of mirror therapy in improving strength, range of movement and muscle activity, in people with carpal tunnel syndrome. J Hand Ther 2024:S0894-1130(24)00008-5. [PMID: 38458950 DOI: 10.1016/j.jht.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/07/2024] [Accepted: 02/09/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND There is little information on the potential effects of mirror therapy (MT) on motor recovery in individuals with Carpal Tunnel Syndrome (CTS). PURPOSE To compare the effectiveness of a MT protocol versus a therapeutic exercise (TE) protocol, in improving strength, range of motion (ROM), muscle activity, pain, and functionality in patients with CTS. STUDY DESIGN Randomized clinical trial. METHODS Thirty-nine participants with unilateral CTS were divided into two groups: (i) MT group (n = 20) that followed an exercise protocol applied to the unaffected hand reflected in a mirror, and (ii) TE group (n = 19) that followed the same exercise protocol using the unaffected hand but without a mirror. Strength, wrist ROM, muscle activity, pain and functionality, were assessed at baseline (T0), after treatment (T1) and one month after treatment (T2). RESULTS At T1, the MT group showed significantly higher wrist flexion-extension ROM compared to TE (p = 0.04, d = 0.8), maintained at T2 (p = 0.02, d = 0.8). No significant changes were observed in ulnar-radius deviation, pronosupination, or fatigue following either MT or TE (p > 0.05). MT exhibited enhanced handgrip strength at T1 (p = 0.001, d = 0.7), as well as an increase in the extensor carpi radialis (ECR) and flexor carpi radialis (FCR) maximum muscle activity (p = 0.04, d = 1.0; p = 0.03, d = 0.4). At T1, both groups decreased pain (p = 0.002, d = 1.1; p = 0.02, d = 0.7), and improved functionality (p < 0.001, d = 0.8; p = 0.01, d = 0.5) (MT and TE respectively). DISCUSSION MT led to enhancements in wrist flexion-extension movement, handgrip strength and functionality unlike TE. MT notably increased muscle activity, particularly in the ECR and FCR muscles. CONCLUSIONS MT is a favorable strategy to improve wrist flexion-extension ROM, handgrip strength, ECR and FCR muscle activity, and functionality in people with unilateral CTS.
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Affiliation(s)
- Elena Muñoz-Gómez
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain.
| | - Sara Mollà-Casanova
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Nuria Sempere-Rubio
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Marta Inglés
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Pilar Serra-Añó
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
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Yalçın G, Mülkoğlu C, Gülmez S, Genç H. The effect of mirror therapy in the rehabilitation of flexor tendon injuries after primary surgical repair. HAND SURGERY & REHABILITATION 2024; 43:101612. [PMID: 37918714 DOI: 10.1016/j.hansur.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of mirror therapy and to provide a clinical basis for better functional recovery in the rehabilitation of patients with flexor tendon injury. MATERIALS AND METHODS Thirty patients were included and randomly divided between two groups: mirror therapy and conventional treatment. A physical therapy program consisting of whirlpool, ultrasound and transcutaneous electrical nerve stimulation was applied to both groups. In the mirror therapy group, flexor tendon gliding, blocking exercises, joint range of motion and resistance exercises were performed with the healthy hand via a mirror. In the conventional treatment group, the same exercises were performed with the affected hand without mirror. This treatment was continued for 12 sessions over 4 weeks. Joint range of motion, handgrip strength, pain, functionality, dexterity and kinesiophobia were evaluated before and after treatment. RESULTS More improvement was observed in the mirror therapy group in terms of pain on visual analog scale, Patient-Rated Wrist Evaluation, Hand Function Index and Disabilities of the Arm, Shoulder and Hand scores (p = 0.025, p = 0.004, p < 0.001 and p < 0.001, respectively). There was no significant difference between groups for the other parameters (Tampa Kinesiophobia Scale, Purdue Pegboard test, total active range movement, or handgrip strength: p > 0.05). CONCLUSION This study shows that mirror therapy in postoperative rehabilitation of flexor tendon injuries is more effective than conventional in terms of reducing the severity of pain and restoring hand function.
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Affiliation(s)
- Gözde Yalçın
- Department of Physical Medicine and Rehabilitation, Ankara Research and Training Hospital, Ankara, Turkey.
| | - Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Research and Training Hospital, Ankara, Turkey
| | - Semanur Gülmez
- Department of Physical Medicine and Rehabilitation, Ankara Research and Training Hospital, Ankara, Turkey
| | - Hakan Genç
- Department of Physical Medicine and Rehabilitation, Ankara Research and Training Hospital, Ankara, Turkey
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Tofani M, Santecchia L, Conte A, Berardi A, Galeoto G, Sogos C, Petrarca M, Panuccio F, Castelli E. Effects of Mirror Neurons-Based Rehabilitation Techniques in Hand Injuries: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5526. [PMID: 35564920 PMCID: PMC9104298 DOI: 10.3390/ijerph19095526] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023]
Abstract
Background: Hand trauma requires specific rehabilitation protocol depending on the different structures involved. According to type of surgical intervention, and for monitoring pain and edema, post-operative rehabilitation of a hand that has experienced trauma involves different timings for immobilization. Several protocols have been used to reduce immobilization time, and various techniques and methods are adopted, depending on the structures involved. Objective: To measure the effects of mirror neurons-based rehabilitation techniques in hand injuries throughout a systematic review and meta-analysis. Methods: The protocol was accepted in PROSPERO database. A literature search was conducted in Cinahl, Scopus, Medline, PEDro, OTseeker. Two authors independently identified eligible studies, based on predefined inclusion criteria, and extracted the data. RCT quality was assessed using the JADAD scale. Results: Seventy-nine suitable studies were screened, and only eleven were included for qualitative synthesis, while four studies were selected for quantitative analysis. Four studies were case reports/series, and seven were RCTs. Nine investigate the effect of Mirror Therapy and two the effect of Motor Imagery. Quantitative analyses revealed Mirror Therapy as effective for hand function recovery (mean difference = −14.80 95% Confidence Interval (CI) = −17.22, −12.38) (p < 0.00001) in the short term, as well as in long follow-up groups (mean difference = −13.11 95% Confidence Interval (CI) = −17.53, −8.69) (p < 0.00001). Clinical, but not statistical, efficacy was found for manual dexterity (p = 0.15), while no benefit was reported for range of motion. Conclusions: Mirror neurons-based rehabilitation techniques, combined with conventional occupational and physical therapy, can be a useful approach in hand trauma. Mirror therapy seems to be effective for hand function recovery, but, for motor imagery and action observation, there is not sufficient evidence to recommend its use. Further research on the efficacy of the mirror neurons-based technique in hand injury is recommended.
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Affiliation(s)
- Marco Tofani
- Professional Development, Continuous Education and Research Service, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (A.B.); (G.G.); (C.S.)
| | - Luigino Santecchia
- Orthopedic Unit, Department of Surgery, Bambino Gesù Children’s Hospital, 00100 Rome, Italy;
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (A.B.); (G.G.); (C.S.)
- Neuromed IRCCS, 86077 Pozzili, Italy
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (A.B.); (G.G.); (C.S.)
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (A.B.); (G.G.); (C.S.)
- Neuromed IRCCS, 86077 Pozzili, Italy
| | - Carla Sogos
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (A.C.); (A.B.); (G.G.); (C.S.)
| | - Maurizio Petrarca
- Department of Intensive Neurorehabilitation and Robotics, Bambino Gesù Children’s Hospital, 00100 Rome, Italy; (M.P.); (E.C.)
| | | | - Enrico Castelli
- Department of Intensive Neurorehabilitation and Robotics, Bambino Gesù Children’s Hospital, 00100 Rome, Italy; (M.P.); (E.C.)
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Ferreira CM, de Carvalho CD, Gomes R, Bonifácio de Assis ED, Andrade SM. Transcranial Direct Current Stimulation and Mirror Therapy for Neuropathic Pain After Brachial Plexus Avulsion: A Randomized, Double-Blind, Controlled Pilot Study. Front Neurol 2020; 11:568261. [PMID: 33362687 PMCID: PMC7759497 DOI: 10.3389/fneur.2020.568261] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/20/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: Although transcranial direct current stimulation (tDCS) and mirror therapy (MT) have benefits in combating chronic pain, there is still no evidence of the effects of the simultaneous application of these techniques in patients with neuropathic pain. This study aims to assess the efficacy of tDCS paired with MT in neuropathic pain after brachial plexus injury. Methods: In a sham controlled, double-blind, parallel-group design, 16 patients were randomized to receive active or sham tDCS administered during mirror therapy. Each patient received 12 treatment sessions, 30 min each, during a period of 4 weeks over M1 contralateral to the side of the injury. Outcome variables were evaluated at baseline and post-treatment using the McGill questionnaire, Brief Pain Inventory, and Medical Outcomes Study 36-Item Short-Form Health Survey. Long-term effects of treatment were evaluated at a 3-month follow-up. Results: An improvement in pain relief and quality of life were observed in both groups (p ≤ 0.05). However, active tDCS and mirror therapy resulted in greater improvements after the endpoint (p ≤ 0.02). No statistically significant differences in the outcome measures were identified among the groups at follow-up (p ≥ 0.12). A significant relationship was found between baseline pain intensity and outcome measures (p ≤ 0.04). Moreover, the results showed that state anxiety is closely linked to post-treatment pain relief (p ≤ 0.05). Conclusion: Active tDCS combined with mirror therapy has a short-term effect of pain relief, however, levels of pain and anxiety at the baseline should be considered. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT04385030.
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Affiliation(s)
| | | | - Ruth Gomes
- Neuroscience and Aging Laboratory, Federal University of Paraíba, João Pessoa, Brazil
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Civi Karaaslan T, Berkoz O, Tarakci E. The effect of mirror therapy after carpal tunnel syndrome surgery: A randomised controlled study. HAND SURGERY & REHABILITATION 2020; 39:406-412. [DOI: 10.1016/j.hansur.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
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