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一篇新研究认为，镜像治疗─用来成功治疗截肢后幻肢现象的方法─可以促进中风后的偏瘫恢复。
在镜像治疗中，病患在健侧肢的床边放一面镜子，阻断他们对患侧肢的视线，建立两侧肢体都功能正常的假象；研究中的14名偏瘫病患，患侧肢利用镜子练习踝关节背曲的功能恢复比直接练习者佳。
东京Metropolitan大学的Kazu Amimoto医师在声明中表示，如果可以透过健侧身体动作的视觉输出，而达到此类改变，就有理由相信会影响认知，也就是影响到心灵、恢复等方面，比之前所了解的更重要，且应多专注于此。
研究结果发表于第6届世界中风研讨会。
【动作反射】
镜像治疗现在已经应用在许多方面，包括治疗截肢后幻肢现象，复杂的区域性疼痛症状，以及中风复健；观念是使用镜子产生病患两侧肢体都完整的幻象。
作者指出，传统的偏瘫肢治疗是使用主动或被动体能活动，来刺激新的神经元连结而获得恢复；加入镜像治疗可以藉由患侧肢体适当运作的视觉刺激而促进恢复，而非仅仅依赖心中的想像。
该研究中，Amimoto医师等人检视将镜像治疗加入14个下肢偏瘫右撇子病患后的直接制约，这些病患都是慢性期，中风后4个月以上；该研究使用交叉设计：病患随机分派，并用或不并用镜像治疗与直接制约，之后交换治疗方式。
镜子设定在一个矢状平面；研究对象坐在椅子上，下肢放在镜子盒内。至于动作，研究对象跨越一个3公分高的栏状阶梯10次；使用二次元动作分析软体计算脚踝关节的角度与完成这个动作的时间。
Amimoto等人报告指出，镜像制约下完成动作的时间显然比较短，从3.19秒减少到2.80秒；直接制约也改变脚踝背曲角度达0.8°，不过，与镜像制约组没有显著差异。
他们结论表示，使用健侧的视觉刺激产生的镜像制约变化，显示出认知恢复与体能恢复有一样的重要性。
第6届世界中风研讨会：摘要PO-02-274。发表于2008年9月26日。
Mirror Therapy May Facilitate Recovery in Hemiplegic Stroke Patients
By Susan Jeffrey
Medscape Medical News
Mirror therapy, a strategy that has been used successfully to treat phantom pain after amputation, may promote recovery from hemiplegia after a stroke, a new study suggests.
In mirror therapy, patients place a mirror beside the unaffected limb, blocking their view of the affected limb, creating the illusion that both limbs are working normally. In a study of 14 hemiplegic patients, those who practiced ankle dorsiflexion using the mirror had more recovery of function in the affected limb than those who underwent direct conditioning.
"If such change can be brought about purely through visual input of movement by the healthy body half, then it stands to reason that the cognitive, which is to say the mental, aspect of rehabilitation, has far greater importance than previously understood and should be paid far more attention," said Kazu Amimoto, MD, from Tokyo Metropolitan University, in Japan, in a statement.
The results were presented here at the 6th World Stroke Congress.
Reflection of Movement
Mirror therapy has now been used in a number of settings, including the treatment of phantom-limb pain after amputation and complex regional pain syndrome, as well as in stroke rehabilitation. The idea is to use the mirror to produce the illusion for the patient that both limbs are intact.
Conventional therapies for hemiplegic limbs use active or passive physical exercise in an attempt to stimulate new neural connections that lead to recovery, the authors note. The addition of mirror therapy might enhance recovery by enlisting direct visual stimulation showing the affected limb working properly, rather than relying on mental imagery alone.
In this study, Dr. Amimoto and colleagues examined the addition of mirror therapy to direct conditioning in 14 right-handed patients with lower-limb hemiplegia. All enrolled were in the chronic phase, 4 months or longer after their stroke. The study used a crossover design: patients were randomized to start with direct conditioning with or without the addition of mirror therapy and then cross over to the other treatment.
A mirror was set up in the sagittal plane. Subjects sat on a chair with the lower limbs placed in the mirrored box. For the movement task, subjects stepped over a 3-cm-high columnar step 10 times. The angle of the ankle joint and the time required to complete the task were calculated using 2-dimensional motion-analysis software.
Dr. Amimoto and colleagues report that the time required to complete the task was significantly shortened by the mirror conditioning, from 3.19 to 2.80 seconds. Direct conditioning was associated with a change in the ankle dorsal flexion angle by 0.8°, but this was not significantly different from the mirror conditioning group.
The changes associated with mirror conditioning using visual stimulation from the sound side underline the importance of the cognitive aspect of recovery as well as the physical, they conclude.
6th World Stroke Congress: Abstract PO-02-274. Presented September 26, 2008.