镜-像反馈-治-疗课件

1、OT心理语言科 柴丽,镜 像 治 疗 （Mirror Therapy）,镜像治疗(mirror therapy),又称镜像视觉反馈疗法（MVF）或平面镜疗法，最早由Ramachandran等于1995年提出,用于康复医学实践及神经科学研究.最初用于治疗截肢后的幻肢痛与脑卒中后的运动功能障碍，现在多用于单侧肢体受累的患者。,在镜像治疗中，患者看到完好侧肢体运动的镜像，就可以激活相应皮层的镜像神经元，脑电图证明，其放电形式与实际执行动作时的脑区电活动一致，因此有助于恢复受累侧肢体的运动功能。正是由于视觉反馈可以影响中枢感觉、运动区的皮质电活动，同时中枢又是具有部分可塑性，因此，通过视觉反馈达到康复治疗的目的也就有了可行性。 李欣怡 Chinese Journal of Rehabilition Aug.2014,Ramachandran（1994）最早应用镜子治疗于截肢后幻肢痛。 Ramachandran 教授在1996年公布了对镜子治疗的第一项研究，10例上肢截肢后患肢痛的病人，应用镜子治疗发生了惊人的改变：患肢痛的减轻或消除了。 Altschuler 在1999年对9位偏瘫恢复期患者使

2、用镜子治疗的研究证明了镜子治疗的作用。 McCabe 2003年公开了一项关于8个CRPS-I型早期病人的研究，得出的结论是：健侧的视觉输入使得在感觉反馈与运动活动之间的无痛联系重新建立。 Moseley 2004年做的一项临床随机研究得出了结论：包括镜子治疗的运动想象方案可以有效地减轻CRPS的疼痛和改善功能限制。 Rosen and Lundborg, 2005应用镜子治疗周围神经损伤后疼痛 Gruenert-Pluess et al., 2008年将镜子治疗应用于外科手术后治疗,镜像治疗的临床应用： 1.截肢，幻肢痛 2.脑损伤（脑卒中、脑外伤、CP） 3.不完全性脊髓损伤 4.周围神经损伤 5.CRPS（慢性区域性疼痛综合症） 6.感觉过敏或者是感觉迟钝的病人 7.复杂疼痛病人 8.手外伤术后治疗,Effect of Task-Based Mirror Therapy on MotorRecovery of the Upper Extremity in Chronic Stroke Patients: A Pilot Study A Mirror TherapyBased Ac

3、tionObservation Protocol to ImproveMotor Learning After Stroke Effect of Constraint-Induced MovementTherapy and Mirror Therapy for Patients WithSubacute StrokeJin A Yoon, MD, Bon Il Koo, MD, Myung Jun Shin, MD, Yong Beom Shin, MD,Hyun-Yoon Ko, MD, Yong-Il Shin, MD Effect of mirror therapy with tDCS on functionalrecovery of the upper extremity of stroke patients Mental Practice and Mirror TherapyAssociated with ConventionalPhysical Therapy Training on theHemiparetic Upper Limb in PoststrokeRehabi

4、litation: A Preliminary Study,Topics in Stroke Rehabilitation,Mirror Therapy Improves Hand Function in Subacute Strok :A Rondamized Controlled Trila DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. N=40 RESULTS: The scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P.01) and at the

5、6-month follow-up (by 0.16, 0.43, and 2.34, respectively; all P.05). No significant differences were found between the groups for the MAS. CONCLUSIONS:In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity. Yavuzer G, Selles R, Sezer N, Stbeyaz S, Bussmann

6、 JB, Kseolu F, Atay MB, Stam HJ.Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2008 Mar;89(3):393-8.,上肢功能,DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. N=40 RESULTS: The mean change score and 95% confidence interval (CI) of the Brunnstrom stages (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 0.8; 95% CI, 0.5-1.2; P=.002), as well as the FIM motor score (mean, 21.4; 95% CI, 18.2-24.7; vs mean, 12

7、.5; 95% CI, 9.6-14.8; P=.001) showed significantly more improvement at follow -up in the mirror group compared with the control group. Neither MAS (mean, 0.8; 95% CI, 0.4-1.2; vs mean, 0.3; 95% CI, 0.1-0.7; P=.102) nor FAC (walking ability ,Functional Ambulation Categories,FAC), (mean, 1.7; 95% CI, 1.2-2.1; vs mean, 1.5; 95% CI, 1.1-1.9; P=.610) showed a significant difference between the groups. CONCLUSIONS: Mirror therapy combined with a conventional stroke rehabilitation program enhances lowe

8、r-extremity motor recovery and motor functioning in subacute stroke patients. Stbeyaz S, Yavuzer G, Sezer N,et al. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2007 May;88(5):555-9.,下肢功能, (a) In one subset of patients the presence of the mirror seemed to enhance the patients awareness of the neglected field, so that they reached correctly for an object that was shown in the neglected field. Will r

9、epeated practice with this task accelerate recovery from neglect? (b) The second group of patients kept reaching into the mirror to grasp the reflection or kept groping behind the mirror(mirror agnosia). If the mirror was placed in the coronal position and the object placed behind their head, then some of these patients (from group B) reached correctly for the object. Quite apart from its obvious theoretical implications, we believe this technique might provide a new approach for the treatment of visual hemineglect. Ramachandran VS, Altschuler EL, Stone L, et al. Can mirrors alleviate visual hemineglect? Med Hypotheses. 1999 Apr;52(4):303-5.,空间忽略,2013-3-7黑龙江佳木斯大学附属第三医院脑瘫科李晓捷等 40例偏瘫型脑瘫儿随机分为两组，观察镜像疗法对于偏瘫型脑瘫儿童上肢功能康复的影响，患儿在3种不同视觉条件下进行双侧上肢连续的对称环形运动玻璃：看见双侧肢体屏幕：只看见健侧肢体：镜子：看见健侧肢体及其镜像。显示镜像疗法可以对偏瘫型脑瘫患儿的神经肌肉活动起到影响，镜像视觉反馈可以降低患侧肩部肌肉的紧张度，缩短患侧肘部肌肉向心收缩和离心收缩的持续时间文章结论为：对比目前其他康复方法，镜像疗法具有操作简便、设备简单、费用小等优点，值得临床推广，本研究亦有不足之处，每日训练时间约为半小时，不排除在治疗过程中，患儿疲乏，不配合等情况，影响研究结

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