作者：Susan Jeffrey
出處：WebMD醫學新聞
October 15, 2008 (奧地利維也納) — 一篇新研究認為，鏡像治療─用來成功治療截肢後幻肢現象的方法─可以促進中風後的偏癱恢復。
在鏡像治療中，病患在健側肢的床邊放一面鏡子，阻斷他們對患側肢的視線，建立兩側肢體都功能正常的假象；研究中的14名偏癱病患，患側肢利用鏡子練習踝關節背曲的功能恢復比直接練習者佳。
東京Metropolitan大學的Kazu Amimoto醫師在聲明中表示，如果可以透過健側身體動作的視覺輸出，而達到此類改變，就有理由相信會影響認知，也就是影響到心靈、恢復等方面，比之前所瞭解的更重要，且應多專注於此。
研究結果發表於第6屆世界中風研討會。
【動作反射】
鏡像治療現在已經應用在許多方面，包括治療截肢後幻肢現象，複雜的區域性疼痛症狀，以及中風復健；觀念是使用鏡子產生病患兩側肢體都完整的幻象。
作者指出，傳統的偏癱肢治療是使用主動或被動體能活動，來刺激新的神經元連結而獲得恢復；加入鏡像治療可以藉由患側肢體適當運作的視覺刺激而促進恢復，而非僅僅依賴心中的想像。
該研究中，Amimoto醫師等人檢視將鏡像治療加入14個下肢偏癱右撇子病患後的直接制約，這些病患都是慢性期，中風後4個月以上；該研究使用交叉設計：病患隨機分派，併用或不併用鏡像治療與直接制約，之後交換治療方式。
鏡子設定在一個矢狀平面；研究對象坐在椅子上，下肢放在鏡子盒內。至於動作，研究對象跨越一個3公分高的欄狀階梯10次；使用二次元動作分析軟體計算腳踝關節的角度與完成這個動作的時間。
Amimoto等人報告指出，鏡像制約下完成動作的時間顯然比較短，從3.19秒減少到2.80秒；直接制約也改變腳踝背曲角度達0.8°，不過，與鏡像制約組沒有顯著差異。
他們結論表示，使用健側的視覺刺激產生的鏡像制約變化，顯示出認知恢復與體能恢復有一樣的重要性。
第6屆世界中風研討會：摘要PO-02-274。發表於2008年9月26日。
Mirror Therapy May Facilitate Recovery in Hemiplegic Stroke Patients
By Susan Jeffrey
Medscape Medical News
October 15, 2008 (Vienna, Austria) — Mirror therapy, a strategy that has been used successfully to treat phantom pain after amputation, may promote recovery from hemiplegia after a stroke, a new study suggests.
In mirror therapy, patients place a mirror beside the unaffected limb, blocking their view of the affected limb, creating the illusion that both limbs are working normally. In a study of 14 hemiplegic patients, those who practiced ankle dorsiflexion using the mirror had more recovery of function in the affected limb than those who underwent direct conditioning.
"If such change can be brought about purely through visual input of movement by the healthy body half, then it stands to reason that the cognitive, which is to say the mental, aspect of rehabilitation, has far greater importance than previously understood and should be paid far more attention," said Kazu Amimoto, MD, from Tokyo Metropolitan University, in Japan, in a statement.
The results were presented here at the 6th World Stroke Congress.
Reflection of Movement
Mirror therapy has now been used in a number of settings, including the treatment of phantom-limb pain after amputation and complex regional pain syndrome, as well as in stroke rehabilitation. The idea is to use the mirror to produce the illusion for the patient that both limbs are intact.
Conventional therapies for hemiplegic limbs use active or passive physical exercise in an attempt to stimulate new neural connections that lead to recovery, the authors note. The addition of mirror therapy might enhance recovery by enlisting direct visual stimulation showing the affected limb working properly, rather than relying on mental imagery alone.
In this study, Dr. Amimoto and colleagues examined the addition of mirror therapy to direct conditioning in 14 right-handed patients with lower-limb hemiplegia. All enrolled were in the chronic phase, 4 months or longer after their stroke. The study used a crossover design: patients were randomized to start with direct conditioning with or without the addition of mirror therapy and then cross over to the other treatment.
A mirror was set up in the sagittal plane. Subjects sat on a chair with the lower limbs placed in the mirrored box. For the movement task, subjects stepped over a 3-cm-high columnar step 10 times. The angle of the ankle joint and the time required to complete the task were calculated using 2-dimensional motion-analysis software.
Dr. Amimoto and colleagues report that the time required to complete the task was significantly shortened by the mirror conditioning, from 3.19 to 2.80 seconds. Direct conditioning was associated with a change in the ankle dorsal flexion angle by 0.8°, but this was not significantly different from the mirror conditioning group.
The changes associated with mirror conditioning using visual stimulation from the sound side underline the importance of the cognitive aspect of recovery as well as the physical, they conclude.
6th World Stroke Congress: Abstract PO-02-274. Presented September 26, 2008.
[ 本帖最後由 goodcat1111 於 2008-10-24 01:04 編輯 ] |
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