學院

醫學院

系所

職能治療學系

題名

Research development of occupational therapy for stroke in Taiwan: The example of mirror therapy

作者

Li, Y-C., Lin, K-C.^*, & Cheng, H-J.

期刊名稱

Journal of Zhong Guo Kang Fu.（中國康復雜誌，非SCI/SSCI）(Chn)

發表日期

2015

著作性質

原著

語文

中文

關鍵字

mirror therapy, stroke, rehabilitation intervention

摘要

Stroke is one of the leading causes of long-term disability, and impairment of the arm explains approximately 50% of the variance in functional limitation after stroke. Therefore, we should tackle the issue that effective training approaches to promote motor recovery and activities of daily living are needed to reduce the burden of stroke. Since the 1990s, contemporary task-oriented treatment approaches have emerged and received increasing popularity in stroke rehabilitation. The contemporary approaches include constraint-induced therapy (CIT), bilateral arm training (BAT), robot-assisted therapy (RT), and mirror therapy (MT). MT is defined as an intervention that uses a mirror to create a reflection of the non-paretic upper or lower limb, thus giving the patient visual feedback of normal movement of the paretic limb. As an alternative treatment approach, MT is based on the theory of neuroplasticity and has been proposed as beneficial. The patients’ severity of impairments might range from mild to severe. Besides, other advantages of mirror therapy are also apparent, such as less labor-intensive, comparatively low cost and simplicity. When counting the number of clinical trials for improving upper limb function after stroke, the study published last year by the Cochrane Library showed that mirror therapy was one of the top two treatment approaches. And in recent years, there is growing evidence supporting the effects of MT for neurorehabilitation. This article summaries the treatment principles and possible mechanisms of MT as well as provides systematic reviews of MT and an overview of our published clinical trials. The possible mechanism of MT may be that when the visual image of the paretic limb is perceived by the patients, the activity of their cortical areas related to attention may be increased to resolve the perceptual incongruence between visual and somatosensory areas. Later, the mirror illusion may rebalance interhemispheric excitability, activate areas within the primary, somatosensory cortex as well as the mirror neuron system, and then reverse the functions of the paretic limb. The review of our published clinical trials also pointed to the enormous promise of MT for using alone or in combination with other regimens. The trials provide findings indicating that MT assists motor and sensory recovery. Furthermore, combined with the use of sensory afferent stimulation, the manual dexterity, ambulation and activity of daily function can be improved also. To extend the utility of MT, the authors have been studying the effects of MT combined with regimens such as transcranial direct current stimulation (tDCS) and the implementation of MT in home settings. Such efforts may contribute to evolution of the research and practice of stroke rehabilitation.