Background: Mirror visual feedback (mirror therapy) is practiced worldwide in very different ways to alleviate phantom pain; no study has compared these variations yet or researched the associated risk and harm. Objectives: To establish use and justification of a generally accepted mirror visual feedback treatment plan after amputation; to explore the occurrence and handling of adverse effects; and to increase knowledge about contributing factors. Methods: Experiential knowledge of 13 experienced practitioners from 6 countries and 5 professions was explored with a 3-round Delphi technique. Results: Experience with the use of 5 different treatment plans was described, of which 1 has never been mentioned in the literature: an intense 1-off plan in which the illusion was carefully set up before the patient was left to the experience with no interference, resolving pain as well as adverse effects. In the 4 known treatment plans, the expectations of response time varied, which influenced the definition of responders/nonresponders; the set-ups, control, and use of material reflected the professional background of the practitioners. Contraindications also were defined according to the professional confidence to deal with the adverse effects. Adverse effects were reported, including emotional reactions, pain increase, sensory changes, freezing of the phantom limb, dizziness, and sweating. The attitude toward, and the handling of, adverse effects varied in patients as in practitioners according to their professional background. A tool to fine tune the experience was reported with covering of the limb during therapy. Full consensus was reached on several treatment modalities. Conclusion: Analysis of the results suggests that the different treatment plans suit different patients and practitioners. Matching these could enhance effectiveness and compliance. Knowledge about adverse effects needs to inform treatment decisions. These findings triggered the development of a mirror visual feedback gateway to guide patients to the treatment plan for their needs, and to collect data from the practitioners to enhance neuroscientific understanding and inform practice.
Background/Aims: To explore patients', with mild to moderate stroke, and their carers' experiences after a stroke and to explore their perceptions of healthy lifestyles. Methods: A qualitative study using semi-structured interviews was undertaken with 20 people (12 males and 8 females) with mild to moderate stroke or transient ischaemic attack (1 week to 6 months' post event) and seven of their carers. Each interview was transcribed and a thematic analysis approach guided the analytic process. Results: Patients with sub-acute, mild to moderate stroke were positive about healthy lifestyles and their ability to achieve them post stroke. Three core themes were identified: perceptions related to exercise; perceptions related to other lifestyle factors; and understanding of stroke and healthy lifestyles. Conclusions: In the sub-acute phase of stroke recovery, barriers to exercise such as lack of motivation do not appear to be an issue. People with stroke have a lack of understanding of healthy guidelines, risk factors and cause of their stroke. It is not clear if this is due to a lack of information provision or a lack of recall. They also do not appear to make the link between lifestyle choices and the cause of their stroke.
In this paper we report the results of a web-based survey that was aimed at improving our understanding of therapists' attitudes towards -and adoption of -technologies designed to support medical documentation. 310 valid responses from 28 countries were analysed. The PATCH scale was used to measure attitudes towards computers in healthcare. Significant differences in PATCH scores across the included countries were identified. 36% of the respondents used only paper for notetaking whereas 52% used both paper-and software-based approaches. Negative and positive experiences of employing the software tools were analysed together with the respondents' suggestions for enhancing those tools. Overall, clinicians' attitudes towards technology-supported notetaking were encouraging, although a number of technical issues remain to be solved.
Notetaking. Paper. Affordances. Clinician. Mirror therapy. P.A.T.C.H.
Objective
Perception of touch is expected at the location where it is applied. However, there are indications that being touched may be perceived on the contralateral side when seen as a reflection in a mirror at midline. Such inter-lateral referral of sensation (RS) lacks evidence, as mirror therapy research usually focusses on movement-based techniques. This study aimed to map out existing research across disciplines regarding the effect of RS in health and disease, and to understand whether there is rehabilitation potential in RS.
Method
A scoping review was conducted to map out concepts and keywords across disciplines interested in this topic, using keywords in several languages, and a wide range of databases and additional sources.
Results
The review revealed mostly cross-sectional experiments and included over 486 participants: healthy, or with stroke, complex regional pain syndrome, amputation, nerve graft surgery or radial fracture. Procedures varied regarding stimulation tool, time and location, with two stimulating replacements, one the face and one a variety of areas. Response rates ranged from 0 to 100%.
In general, RS was regarded as a phenomenon or even as a predictor of maladaptive neuroplasticity. There was little research into using RS stimulation as a modulatory tool to improve sensory perception.
Conclusions
RS challenges the understanding of touch perception and elicits a range of questions regarding neuro-processing. A modulatory approach using RS has not been described, requires investigation and, if promising, development as an intervention.
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