Effects of camera-based mirror visual feedback therapy for patients who had a stroke and the neural mechanisms involved: protocol of a multicentre randomised control study

Abstract

IntroductionAs a combination of visual stimulation and motor imagery, mirror visual feedback (MVF) is an effective treatment for motor impairment after stroke; however, few studies have investigated its effects on relevant cognitive processes such as visual perception and motor imagery. Camera-based MVF (camMVF) overcomes the intrinsic limitations of real mirrors and is recognised as an optimal setup. This study aims to investigate the effects of camMVF as an adjunct treatment for stroke patients, compare camMVF outcomes with those of conventional therapy and elucidate neural mechanisms through which MVF influences cognition and brain networks.Methods and analysisThis will be a multicentre, single-blinded, randomised controlled trial including 90 patients randomised into three groups: camera-based mirror visual feedback intervention group (30), shielded mirror visual feedback intervention group (30) and conventional group (30). Patients in each group will receive a 60 min intervention 5 days per week over 4 weeks. The primary outcome will be the Fugl-Meyer Assessment Upper Limb subscale measurement. Secondary outcomes include the modified Ashworth Scale, Grip Strength test, Modified Barthel Index, Functional Independence Measure, Berg Balance Scale, 10-metre walking test, hand-laterality task and electroencephalography .Ethics and disseminationEthics approval was granted by the Huashan Hospital Institutional Review Board on 15 March (KY2017-230). We plan to submit the results to a peer-reviewed journal and present them at conferences, rehabilitation forums and to the general public.Trial registration numberChiCTR-INR-17013644; Pre-results.

Mirror Visual Feedback Prior to Robot-Assisted Training Facilitates Rehabilitation After Stroke: A Randomized Controlled Study

“…Patients in the control group received 1.5 h dosage-equivalent (intensity and duration) exercises as the experimental group, which comprised 0.5 h sham-MVF ( 31 ) training ( Figure 2B ) prior to 1 h RT. During sham-MVF, the reflection of the affected side will be shielded to restrain the development of mirror illusion, which related to subjective embodiment experience.…”

Mirror Visual Feedback Combining Vibrotactile Stimulation Promotes Embodiment Perception: An Electroencephalogram (EEG) Pilot Study

“…Mirror visual feedback (MVF) is widely used in the field of upper limb and hand rehabilitation as a low laborintensive, affordable, and convenient method (Wu et al, 2013;Samuelkamaleshkumar et al, 2014;Hebert et al, 2016). Recent studies reported that MVF was an evidence-based effective treatment to promote the recovery of motor functions, especially for upper limbs, and enhance the abilities of daily life in stroke patients (Pollock et al, 2014;Ding et al, 2018Ding et al, , 2019bThieme et al, 2018) from the reflection of the unaffected hand movements. MVF could prompt the multisensory integration of patients and contribute to balance the conflict between motor output and visual/proprioceptive feedback, whereby it makes patients embody the reflection, especially through experiencing the kinesthesia illusion (Ramachandran and Rodgers-Ramachandran, 1996;Altschuler et al, 1999).…”

Associated Mirror Therapy Enhances Motor Recovery of the Upper Extremity and Daily Function after Stroke: A Randomized Control Study

“…We speculated that the primary outcome (FMA-UL) had a group × time interaction. Based on the previous camera technique-based MVF studies [ 21 , 25 , 26 ], an effect size of 0.27 to 0.45 was expected to detect the differences in the improvements between groups. Given the reliability and safety margin, an effect size of 0.27 was anticipated for repeated analysis of variance (ANOVA).…”