Monday, November 28, 2011
Final reflection
It was interesting to have a go with one of my own arms (right arm) in the mirror box; when I looked in the mirror at the image of left arm my immediate thought was that I was looking at my right arm. I found it very interesting that even knowing the purpose and concept of the mirror box it still was able to trick my brain into thinking that the image of my left arm was my right arm. Through the education and experience I have gained about mirror therapy, I will continue to follow research and see what possibilities mirror therapy could be used for in my future practice.
Research
Two studies that I looked at regarding mirror therapy following a stroke were 1. Systematic review of the effectiveness of mirror therapy in upper extremity function. Written by Ezendam, Bongers & Jannink, 2009; and 2. Mirror therapy improves hand function in sub-acute stroke: a randomized controlled trial.
Article one state its findings as “All studies showed a positive result of mirror therapy. The positive result was based on a combination score given by two neurologists and subjective comments.”(Ezendam, Bongers & Jannink, 2009)
Article two state its findings as “Mirror therapy, in addition to conventional therapy, improved hand function in patients with severe hemiparesis both post-treatment and at six month follow-up.” (Yavuzer et al, 2008)
Both of these studies show that mirror therapy has the potential to be an effective tool used to increase function for people with hemiparesis following a stroke. We also need to be mindful that mirror therapy is a relatively new concept which requires more research to be certain of its effectiveness.
Ezendam, D., Bongers, R. M., & Jannink, M. J. (2009). Systematic review of the effectiveness of mirror therapy in upper extremity function. Disability and Rehabilitation, 31(26), 2135-2149.
Yavuzer, G., Selles, R., Sezer, N., Sütbeyaz, S., Bussmann, J. B., Köseoglu, F., & Atay, M. (2008). Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 393-398.
Article one state its findings as “All studies showed a positive result of mirror therapy. The positive result was based on a combination score given by two neurologists and subjective comments.”(Ezendam, Bongers & Jannink, 2009)
Article two state its findings as “Mirror therapy, in addition to conventional therapy, improved hand function in patients with severe hemiparesis both post-treatment and at six month follow-up.” (Yavuzer et al, 2008)
Both of these studies show that mirror therapy has the potential to be an effective tool used to increase function for people with hemiparesis following a stroke. We also need to be mindful that mirror therapy is a relatively new concept which requires more research to be certain of its effectiveness.
Ezendam, D., Bongers, R. M., & Jannink, M. J. (2009). Systematic review of the effectiveness of mirror therapy in upper extremity function. Disability and Rehabilitation, 31(26), 2135-2149.
Yavuzer, G., Selles, R., Sezer, N., Sütbeyaz, S., Bussmann, J. B., Köseoglu, F., & Atay, M. (2008). Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 393-398.
Sunday, November 27, 2011
Check out this website!
http://www.ireflex.co.uk/mirrorboxtherapy.com/
Above is a fantastic link that has lots of information about mirror box therapy. You can also see what the box looks like and also visit links to research that has been completed.
Above is a fantastic link that has lots of information about mirror box therapy. You can also see what the box looks like and also visit links to research that has been completed.
My Experience
While on my placement I was fortunate to be able to have a look at the mirror therapy box and be able to learn about its use and how it works. I was fortunate to end up with a patient on my caseload that was appropriate to use mirror therapy as part of her rehabilitation programme. This patient had experienced a stroke resulting in right sided hemiplegia and inattention, apraxia, dyspraxia and dressing apraxia.
Before and after completing mirror therapy I assessed the patient’s functional ability of her right arm (affected arm). In comparing the two assessments the patient had increased her functional ability of her right hand. It surprised me how much the clients function changed with only one session. During the session when the patient’s affected right arm was placed within the box the patient had no active movement of the arm so was passively moved by myself.
This opportunity enabled me to experience on some of the strengths and limitations of the mirror box. During the mirror box intervention I observed ideomotor apraxia as a symptom of my patients following her stroke. Ideomotor apraxia is “the inability to imitate gestures or perform a purposeful motor task on command even though the patient fully understands the idea or concept of the task” (Zoltan, 1996) the patient’s symptom of ideomotor apraxia made the mirror box therapy very hard to facilitate as she had difficulty in imitating the movements requested.
Overall I feel that mirror therapy would be difficult to facilitate for this patient but also be very successful.
Zoltan, B. (1996). Vision, perception, and cognition: a manual for the evaluation and treatment of the neurologically impaired adult (3rd ed., pp. 53-68). N.p.: Slack Incorporated.
Before and after completing mirror therapy I assessed the patient’s functional ability of her right arm (affected arm). In comparing the two assessments the patient had increased her functional ability of her right hand. It surprised me how much the clients function changed with only one session. During the session when the patient’s affected right arm was placed within the box the patient had no active movement of the arm so was passively moved by myself.
This opportunity enabled me to experience on some of the strengths and limitations of the mirror box. During the mirror box intervention I observed ideomotor apraxia as a symptom of my patients following her stroke. Ideomotor apraxia is “the inability to imitate gestures or perform a purposeful motor task on command even though the patient fully understands the idea or concept of the task” (Zoltan, 1996) the patient’s symptom of ideomotor apraxia made the mirror box therapy very hard to facilitate as she had difficulty in imitating the movements requested.
Overall I feel that mirror therapy would be difficult to facilitate for this patient but also be very successful.
Zoltan, B. (1996). Vision, perception, and cognition: a manual for the evaluation and treatment of the neurologically impaired adult (3rd ed., pp. 53-68). N.p.: Slack Incorporated.
Mirror Therapy
The following is one of four videos that will give you an excellent overview of mirror therapy. Watch them and discover this interesting treatment option.
Hemiplegia
Hemiplegia
So hemiplegia is a weakness or paralysis of one side of the body. A major concern for the therapists working with a patient with hemiplegia is not only the functional implications that a hemiplegia has but also the effects of hemiplegia on the shoulder joint. Hemiplegia can cause subluxation of the shoulder.
Shoulder subluxation: “Incomplete dislocation of humerus out of glenohumeral joint caused by weakness, stretch, or abnormal tone in the scapulohumeral and/or scapular muscles.” (Woodson, 2008)
Woodson, A. M. (2008). Stroke. In M. V. Radomski, & C. A. Trombly Latham (Eds.), Occupational Therapy for Physical Dysfunction (pp. 1002). London: Lippincott Williams & Wilkins.
So hemiplegia is a weakness or paralysis of one side of the body. A major concern for the therapists working with a patient with hemiplegia is not only the functional implications that a hemiplegia has but also the effects of hemiplegia on the shoulder joint. Hemiplegia can cause subluxation of the shoulder.
Shoulder subluxation: “Incomplete dislocation of humerus out of glenohumeral joint caused by weakness, stretch, or abnormal tone in the scapulohumeral and/or scapular muscles.” (Woodson, 2008)
Woodson, A. M. (2008). Stroke. In M. V. Radomski, & C. A. Trombly Latham (Eds.), Occupational Therapy for Physical Dysfunction (pp. 1002). London: Lippincott Williams & Wilkins.
Friday, November 25, 2011
What is a stroke and hemiplegia?
To start off I will provide you with definitions of what a Stroke and Hemiplegia are.
Stroke
“Stroke, or cerebrovascular accident (CVA), describes a variety of disorders characterised by the sudden onset of neurological deficits caused by vascular injury to the brain. Vascular damage in the brain disrupts blood flow, limits oxygen supply to the surrounding cells, and location, and extent of the lesion determine the symptoms and prognosis for the patient.” (Woodson, 2008)
Hemiplegia
Hemiplegia is just one of the many possible symptoms following a stroke.
Hemiplegia definition: “Paralysis of one side of the body, usually caused by a brain lesion, such as tumor, or a cerebrovascular accident. Paralysis occurs on the side opposite the lesion, or infarct, because of decussation of most of the fibres in the motor tracts of the brain.” (Atchison & Dirette, 2007)
Atchison, B. J., & Dirette, D. K. (Eds.). (2007). Conditions in Occupational Therapy (3rd ed., p. 361). Baltimore: Lippincott Williams & Wilkins.
Woodson, A. M. (2008). Stroke. In M. V. Radomski, & C. A. Trombly Latham (Eds.), Occupational Therapy for Physical Dysfunction (pp. 1002). London: Lippincott Williams & Wilkins.
Stroke
“Stroke, or cerebrovascular accident (CVA), describes a variety of disorders characterised by the sudden onset of neurological deficits caused by vascular injury to the brain. Vascular damage in the brain disrupts blood flow, limits oxygen supply to the surrounding cells, and location, and extent of the lesion determine the symptoms and prognosis for the patient.” (Woodson, 2008)
Hemiplegia
Hemiplegia is just one of the many possible symptoms following a stroke.
Hemiplegia definition: “Paralysis of one side of the body, usually caused by a brain lesion, such as tumor, or a cerebrovascular accident. Paralysis occurs on the side opposite the lesion, or infarct, because of decussation of most of the fibres in the motor tracts of the brain.” (Atchison & Dirette, 2007)
Atchison, B. J., & Dirette, D. K. (Eds.). (2007). Conditions in Occupational Therapy (3rd ed., p. 361). Baltimore: Lippincott Williams & Wilkins.
Woodson, A. M. (2008). Stroke. In M. V. Radomski, & C. A. Trombly Latham (Eds.), Occupational Therapy for Physical Dysfunction (pp. 1002). London: Lippincott Williams & Wilkins.
My name is Megan Brandham and i am a third year Occupational Therapy Student. Throughout my degree I participated in many fieldwork placements. The latest placement being on an Assessment Treatment & Rehabilitation (AT&R) ward for people over the age of 65. Prior to attending my AT&R placement I had very limited knowledge about the intervention options for hemiplegia following a stroke and got introduced to an intervention called mirror therapy. I became very interested in this intervention option and wanted to increase my knowledge about the therapy and its use with people experiencing hemiplegia following a stroke.
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