Can mirror visual feedback improve sensory relearning outcomes following median/ulnar nerve repair?

Abstract

Background/Aims: Mirror visual feedback is an intervention that focuses on watching the movements of the intact hand in the mirror to restore the movements of the injured hand. This method is developed based on the concept of the central reflection of the amputated or injured limb. This study aims to determine the effect of mirror visual feedback as a complementary method on the outcomes of sensory relearning in patients following median/ulnar nerve repair. Methods: This randomised clinical trial was conducted on 20 patients with median/ulnar nerve damage who were selected through convenience sampling and were then randomly assigned to a treatment and a control group. Both groups received traditional rehabilitation in three 40-minute sessions a week. In addition, the treatment group received mirror visual feedback 15 minutes a day, 5 days a week, for 8 weeks. The patients' sensory status was assessed using Semmes-Weinstein Monofilaments and two-point discrimination tests and their sensory function was assessed using stereognosis both before and after the intervention. Findings: The final analysis was performed on a total of 20 patients. The Semmes-Weinstein Monofilaments test and two-point discrimination scores obtained showed significant improvements following therapy in both groups. The changes in Semmes-Weinstein Monofilaments test (P=0.000], two-point discrimination (P=0.000) and stereognosis (active: P=0.001, passive: P=0.000) scores were significantly greater in the mirror therapy group compared to the controls. Conclusions: Mirror visual feedback in conjunction with traditional sensory retraining programmes led to greater improvements in superficial sensation and touch discrimination of the hand in the first phase of the sensory relearning programme. This may be due to the use of the neuroplasticity potential, the stimulation of the somatosensory areas and motor networks, the adjustment of early cortical reorganisation and the prevention of further changes.

A Systematic Review of Registered Clinical Trials for Peripheral Nerve Injuries

“…The main secondary outcome measure was 2-point discriminator reported by (n = 38, Seventeen studies (17.7%) included patient-reported outcomes (PROs) as their primary outcome. [14][15][16][17][18][19][20][21] Patient-reported outcomes provided crucial data regarding functional limitations, pain levels, treatment satisfaction, and overall quality of life. Furthermore, at least 1 PRO measure was used as a secondary outcome in 38 studies (39.5%), 13,16,[18][19][20][22][23][24][25][26][27][28] suggesting a considerable potential for emphasizing patient-focused evaluations in both primary and secondary outcomes.…”

“…19,30 Mirror therapy was evaluated in 4 studies, 3 of which are completed and 1 is still actively recruiting. 15,18,25,32 However, one of the completed studies did not meet their enrollment goals. 18 Chen et al enrolled 8 of 65 patients before closing the study.…”

“…38,94 Thirteen studies provided inadequate reporting practices. 13,15,20,21,23,24,28,30,36,37 The descriptions of interventions for 2 studies were incomplete, making it challenging to evaluate the treatment approaches accurately. 23,24 Thirteen studies had unknown status.…”