Background. Rehabilitation of the severely affected paretic arm after stroke represents a major challenge, especially in the presence of sensory impairment. Objective. To evaluate the effect of a therapy that includes use of a mirror to simulate the affected upper extremity with the unaffected upper extremity early after stroke. Methods. Thirty-six patients with severe hemiparesis because of a first-ever ischemic stroke in the territory of the middle cerebral artery were enrolled, no more than 8 weeks after the stroke. They completed a protocol of 6 weeks of additional therapy (30 minutes a day, 5 days a week), with random assignment to either mirror therapy (MT) or an equivalent control therapy (CT). The main outcome measures were the Fugl-Meyer subscores for the upper extremity, evaluated by independent raters through videotape. Patients also underwent functional and neuropsychological testing. Results. In the subgroup of 25 patients with distal plegia at the beginning of the therapy, MT patients regained more distal function than CT patients. Furthermore, across all patients, MT improved recovery of surface sensibility. Neither of these effects depended on the side of the lesioned hemisphere. MT stimulated recovery from hemineglect. Conclusions. MT early after stroke is a promising method to improve sensory and attentional deficits and to support motor recovery in a distal plegic limb.

A low profile prosthesis was designed using a flexible liner in conjunction with a rigid shell, with a toe extension. Thus far, two paediatric patients have been fitted with the device, at the University of Virginia Medical Center. One patient is a five year old with a Lisfranc level amputation and the other, a sixteen year old with a Chopart level amputation. Both patients have successfully worn their prostheses, full time, for over two years. The prostheses these children have been wearing are comfortable, functional and cosmetic. The prostheses provide excellent suspension, a good weight-bearing surface and an anterior lever arm for push-off during late stance phase.

No abstract