鏡像治療的臨床應用及腦部機制探討之文獻回顧

Effects of Mirror Therapy in Clinical Practice and Possible Brain Mechanisms: A Literature Review

羅敏文(Min-Wen Lo) ； 黃淑桂(Shu-Kuei Huang) ； 林克忠(Keh-Chung Lin) ； 吳菁宜(Ching-Yi Wu)

《臺灣職能治療研究與實務雜誌》 6卷1期 (2010/06) Pp. 37-49

https://doi.org/10.6534/jtotrp.2010.6(1).37

摘要

目的：鏡像治療為近期一種新的臨床復健治療方法，可用在疼痛減緩、感覺、知覺、與動作回復。本篇目的在分析歸納鏡像治療療效之實證研究，以供臨床研究之參考。方法：經由PubMed、Medline及Scopus等文獻搜尋引擎，從1996 年至2009年3月，關鍵字為：mirror therapy、stroke、rehabilitation，篩選條件為（1）以鏡像治療為介入方案（2）排除只用動作想像或是心像想像、無使用鏡子介入之文章。結果：鏡像治療主要療效適用於損傷層級，在感覺缺失方面，應用在截肢、中風及手部手術病人上，有減緩疼痛、回復手部觸覺、深壓覺及區辨覺之療效；減輕中風病人知覺缺失的情況；動作方面，關節活動度、抓握力量、動作時間、日常生活活動表現及動作功能皆有所進步。在腦部活化實驗中，研究證實，看鏡中影像確實比其他觀看情況的腦部活化量較大，活化區較多。結論：鏡像治療是個節省經費及醫療人力的輔助療法，應用範圍廣，從不同類型的病人到不同症狀缺損都可能應用。鏡像治療能協助臨床上訓練治療難度高的病人，如疼痛或感覺知覺缺失。對初期沒有上肢遠端動作的中風病人，鏡像治療是個有效的治療方法。鏡像治療所提供的良好動作視覺刺激，徵召了前動作皮質區、主動作皮質區及體感覺皮質區，可達到改善病患感覺、知覺和動作的進步。

關鍵字

鏡像治療 ； 中風 ； 神經復健 ； 上肢

並列摘要

Objective: Mirror therapy has become one of the innovative intervention approaches in neurorehabilitation. It was applied for reducing pain and improving sensorimotor function. The objective of this review was to summarize and analyze the effects of mirror therapy to provide the basis for evidence-based mirror therapy practice. Methods: We searched the key words ”mirror　therapy”, ”stroke”, ”rehabilitation” in PubMed, Medline and Scopus databases and retrieved the relevant articles from January 1996 to March 2009. We included studies that used a mirror as a tool of intervention and excluded studies that used only motor or mental imagery without mirror. Results: The intervention gains were obtained primarily at the impairment level. Mirror therapy might reduce pain; improve tactile, deep pressure and discrimination sensations in amputee, stroke and hand surgery patients; diminish hemineglect in stroke patients; and improve range of motion, grip strength, movement time, ADL performance and motor function. In some studies of brain activation, compared to control conditions, the level of brain activation was increased and involving more brain regions after interventions with a mirror. Conclusion: Mirror therapy is an intervention that is cost- and manpower-efficient. It can be widely applied to various types of patients and deficits. Mirror therapy showed beneficial effects in patients with sensory deficits for whom interventions are difficult to be implemented. Mirror therapy is feasible for early-stage stroke patients without distal hand movements. The motor-visual input from mirror therapy facilitates the activations in the premotor, primary motor, and somatosensory areas, which may have in turn enhanced sensory, perception and motor abilities.

並列關鍵字

Mirror therapy ； Stroke ； Neurorehabilitation ； Upper extremity