Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis

Broderick, Patrick; Horgan, Frances; Blake, Catherine; Ehrensberger, Monika; Simpson, Daniel; Monaghan, Kenneth

doi:10.1016/j.gaitpost.2018.05.017

Cited by 58 publications

(56 citation statements)

References 29 publications

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“…Post-stroke hemiplegic patients have drag step, drop foot and asymmetric gait [29,42] . Evaluating and correcting the gait parameters, such as improving hip joint angle, toe-ground clearance and gait symmetry, help improve hemiplegic gait, thus promote rehabilitation [43][44][45] . The phenomenon of hemiplegic gait results from post-stoke nervous system damage, which will seriously affect patients' daily life [46] .…”

Section: Discussionmentioning

confidence: 99%

Clinical research of lower extremity exoskeleton robot In post-stroke hemiplegic patients

Wang¹,

Yu²,

Hui-min³

et al. 2020

Preprint

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Background In recent years, the number of people suffering from stroke-induced motor function lost increased considerably. Recovery of motility is essential in improving their quality of life. However, the existing rehabilitation methods cannot fulfill patients’ training requirements. As a new rehabilitation technology, exoskeleton robot provides a new treatment scheme for post-stroke hemiplegic patients. Objective To explore the safety and effectiveness of exoskeleton-assisted gait training for post-stroke hemiplegic patients. Methods A lower extremity hip joint exoskeleton robot was designed by the cooperation team, and 9 post-stroke hemiplegic patients were included for exoskeleton-assisted gait training. The three-dimensional gait parameters, plantar pressure and surface electromyography were used to validate the effectiveness of the exoskeleton robot in post-stroke hemiplegic patients. Results Exoskeleton-assisted ambulation training for post-stroke hemiplegic patients can correct the asymmetry of gait and abnormal phase of gait cycle, increase the toe-ground clearance and the angle of hip joint, reduce the pressure of non-paretic plantar and the impulse of bilateral feet, which help balance the plantar pressure distribution. It can also improve the integral electromyography value of specific muscle, which means that corresponding muscles are stimulated to generate activities. Conclusions The exoskeleton robot designed by our team can correct the hemiplegic gait and foot drop phenomenon of post-stroke patients, protecting them from damage caused by long-term abnormal gait, which contributes to the recovery of lower extremity motor function in hemiplegic patients. The results also provide important information for the design of lower extremity exoskeleton robot. In the future, we should further explore the rehabilitation function of exoskeleton robot in post-stroke hemiplegic patients, as well as the ambulation and rehabilitation function in other lower extremity motor dysfunction patients.

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Section: Discussionmentioning

confidence: 99%

Clinical research of lower extremity exoskeleton robot In post-stroke hemiplegic patients

Wang¹,

Yu²,

Hui-min³

et al. 2020

Preprint

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“…However, there is evidence of the effectiveness of first-generation mirror therapy for some indications [3–5]. Second-generation therapies are also more expensive.…”

Section: Discussionmentioning

confidence: 99%

“…It does not seem reasonable to develop new devices given the costs, time, and resources required, but rather to assess existing devices, especially in the case of public funding. On the other hand, research on mirror therapy with a real mirror or mirror box should continue to emerge given the good quality of evidence already available for certain indications [3–5]. If a new literature review is conducted on second-generation mirror therapy, search engine queries to identify studies should use comprehensive keywords (see Table S3 in Supplementary Materials).…”

Section: Discussionmentioning

confidence: 99%

“…This standard mirror therapy has been used in rehabilitation for multiple indications since the 1990s [2]. A good level of evidence supports some of these indications, particularly for cerebrovascular accidents in adults [3, 4] and cerebral palsy in children [5]. Cost is very low, because a simple little and not specifically dedicated mirror can be used [1].…”

Section: Introductionmentioning

confidence: 99%

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Do Robotics and Virtual Reality Add Real Progress to Mirror Therapy Rehabilitation? A Scoping Review

Darbois

Guillaud

Pinsault

2018

Rehabilitation Research and Practice

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Background Mirror therapy has been used in rehabilitation for multiple indications since the 1990s. Current evidence supports some of these indications, particularly for cerebrovascular accidents in adults and cerebral palsy in children. Since 2000s, computerized or robotic mirror therapy has been developed and marketed. Objectives To map the extent, nature, and rationale of research activity in robotic or computerized mirror therapy and the type of evidence available for any indication. To investigate the relevance of conducting a systematic review and meta-analysis on these therapies. Method Systematic scoping review. Searches were conducted (up to May 2018) in the Cochrane Library, Google Scholar, IEEE Xplore, Medline, Physiotherapy Evidence Database, and PsycINFO databases. References from identified studies were examined. Results In sum, 75 articles met the inclusion criteria. Most studies were publicly funded (57% of studies; n = 43), without disclosure of conflict of interest (59% of studies; n = 44). The main outcomes assessed were pain, satisfaction on the device, and body function and activity, mainly for stroke and amputees patients and healthy participants. Most design studies were case reports (67% of studies; n = 50), with only 12 randomized controlled trials with 5 comparing standard mirror therapy versus virtual mirror therapy, 5 comparing second-generation mirror therapy versus conventional rehabilitation, and 2 comparing other interventions. Conclusion Much of the research on second-generation mirror therapy is of very low quality. Evidence-based rationale to conduct such studies is missing. It is not relevant to recommend investment by rehabilitation professionals and institutions in such devices.

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“…Because contralateral strength gains are facilitated via neural pathways damaged during stroke, cross-education seems appropriately suited to stroke rehabilitation (Zult, Howatson, Kadar, Farthing, & Hortobagyi, 2014). Mirror therapy has also been shown to aid motor recovery and improve walking velocity and passive range of motion for ankle dorsiflexion after stroke (Broderick et al, 2018;Thieme et al, 2018). Based on visual stimulation, mirror therapy has demonstrated to activate the mirror neuron system (Carvalho et al, 2013) and enhance bilateral M1 excitability (Rossiter et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Unilateral dorsiflexor strengthening with mirror therapy to improve motor function after stroke: A pilot randomized study

Simpson

Ehrensberger

Horgan

et al. 2019

Physiotherapy Res Intl

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Background Independently, cross‐education, the performance improvement of the untrained limb following unilateral training, and mirror therapy have shown to improve lower limb functioning poststroke. Mirror therapy has shown to augment the cross‐education effect in healthy populations. However, this concept has not yet been explored in a clinical setting. Objectives This study set out to investigate the feasibility and potential efficacy of applying cross‐education combined with mirror therapy compared with cross‐education alone for lower limb recovery poststroke. Methods Thirty‐one chronic stroke participants (age 61.7 ± 13.3) completed either a unilateral strength training (ST; n = 15) or unilateral strength training with mirror‐therapy (MST; n = 16) intervention. Both groups isometrically strength trained the less‐affected ankle dorsiflexors three times per week for 4 weeks. Only the MST group observed the mirror reflection of the training limb. Patient eligibility, compliance, treatment reliability, and outcome measures were assessed for feasibility. Maximal voluntary contraction (MVC; peak torque, rate of torque development, and average torque), 10‐m walk test, timed up and go (TUG), Modified Ashworth Scale (MAS), and the London Handicap Scale (LHS) were assessed at pretraining and posttraining. Results Treatment and assessments were well tolerated without adverse effects. No between group differences were identified for improvement in MVC, MAS, TUG, or LHS. Only the combined treatment was associated with functional improvements with the MST group showing an increase in walking velocity. Conclusion Cross‐education plus mirror therapy may have potential for improving motor function after stroke. This study demonstrates the feasibility of the combination treatment and the need for future studies with larger sample sizes to investigate the effectiveness of the treatment.

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Mirror therapy for improving lower limb motor function and mobility after stroke: A systematic review and meta-analysis

Cited by 58 publications

References 29 publications

Clinical research of lower extremity exoskeleton robot In post-stroke hemiplegic patients

Clinical research of lower extremity exoskeleton robot In post-stroke hemiplegic patients

Do Robotics and Virtual Reality Add Real Progress to Mirror Therapy Rehabilitation? A Scoping Review

Unilateral dorsiflexor strengthening with mirror therapy to improve motor function after stroke: A pilot randomized study

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