Mirror Therapy Using Virtual Reality on the Wrsit of Rheumatoid Arthritis; Pilot Trial

Seung Won Choi; Suncheol Heo; Chang Ho Hwang; Kyo-in Koo

doi:10.12786/bn.2016.9.1.48

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Choi, Heo, Hwang, and Koo: Mirror Therapy Using Virtual Reality on the Wrsit of Rheumatoid Arthritis; Pilot Trial

Original Article

Brain & Neurorehabilitation 2016; 9(1): 48-55.

Published online: 31 March 2016

DOI: https://doi.org/10.12786/bn.2016.9.1.48

Mirror Therapy Using Virtual Reality on the Wrsit of Rheumatoid Arthritis; Pilot Trial

Seung Won Choi, M.D., Ph.D.¹, Suncheol Heo², Chang Ho Hwang, M.D., Ph.D.³, Kyo-in Koo, Ph.D.²

¹Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Korea.

²Department of Biomedical Engineering, University of Ulsan, Korea.

³Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, Korea.

Correspondence to: Chang Ho Hwang, Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Korea. Tel: 052-250-7210, Fax: 052-250-7211, chhwang1220ciba@yahoo.co.kr

Co-Correspondence to: Kyo-in Koo, Department of Biomedical Engineering, University of Ulsan, 93 Deahak-ro, Nam-gu, Ulsan 44610, Korea. Tel: 052-259-1408, Fax: 052-259-1306, kikoo@ulsan.ac.kr

Received 18 November 2015 Revised 15 December 2015 Accepted 30 March 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Authors conducted the pilot trial to evaluate whether the virtual reality using mirror therapy induces analgesia and functional improvement to the patients of rheumatoid wrist arthritis.

Method

Three patients with no symptom or sign of active phase at both wrists were recruited. Voluntary range of motion (ROM) of each wrist over as far as possible was recorded and then the same movement was recorded only over 60% of the previous one after break of 5 minutes. For the virtual reality treatment, the second recorded motion was reconstructed into the another one of as same ROM and spent time as the first one, providing confusing visual information to the patients while patients were instructed to reach only the red flags (60% ROM of 1^st one). This exercise was repeated for 5 days. Numerous scales such as VAS, ROM, Michigan Hand Outcomes Questionaire (MHQ), Performance and Satisfaction in Activities of Daily Living (PS-ADL), patient-rated wrist evaluation (PRWE) were evaluated before and after repetition.

Results

The increased satisfaction with their hands (satisfaction score of MHQ; 5.8 ± 2.3, [6-30]), improved ADL performances (PS-ADL score: 5.0 ± 3.5, [0-117]), and no side effect were noticed.

Conclusion

The virtual reality using mirror therapy may be safe and has some analgesic effect, which warrants a clinical trial in the future for the patients of rheumatoid wrist arthritis.

Keywords: analgesia, rheumatoid arthritis, virtual reality therapy, wrist

Figures and Tables

Fig. 1

Diagram of virtual reality. Patients were instructed to took a seat upright in a chair opposite to the table on which a monitor of virtual reality was placed, stretche their either of arm out into the support for the elbow, replace their wrist and hand in an anatomical neutral position under a camera to be seen fully in the center of the monitor, and their forearm and wrist were immobilized to the supports using Velcro strap.

Fig. 2

Preparation of virtual reality. Patients were instructed to grip a white poles using the palm surface so that the tip of the while pole was protruded beyond the ulnar border. Two red- colored round stickers of 1 cm in diameter were affixed to the center of wrist strap and the tip of the white pole respectively.

Fig. 3

Process of virtual reality. Patients were instructed to do flexion-extension wrist exercise again up- and down-ward to two red frags the location of which in a monitor was seen as the same as during the former exercise of full range. But virtual reality let the real-time movement of the wrist (white spot; 60% of previous range of motion) be seen to reach to the red flag in the pace of the same angular velocity.

Table 1

Interval Changes of Functional and Surrogate Ends

		PRWE (0~50)			PS-ADL (0~117)	MHQ								Active ROM		VAS (0~100)
		Pain	Specific activity	Routine activity		Function (5~25)		Function of both hands (7~35)	Normal work (5~25)	Pain (3~15)		Satisfaction (6~30)		Active ROM		Resting		Moving
		Pain	Specific activity	Routine activity		Rt.	Lt.	Function of both hands (7~35)	Normal work (5~25)	Rt.	Lt.	Rt.	Lt.	Rt.	Lt.	Rt.	Lt.	Rt.	Lt.
Patient A	Before	17	28	14	23	13	10	24	17	15	15	20	20	35	40	10	20	15	25
Patient A	After	14	32	13	22	14	14	21	15	15	15	13	13	35	45	10	5	10	5
Patient B	Before	13	21	17	6	5	13	10	10	15	13	5	11	50	50	0	0	35	35
Patient B	After	6	9	2	0	5	5	16	25	15	13	5	11	55	55	0	0	35	35
Patient C	Before	46	57	39	81	20	29	30	5	3	3	27	30	0	25	80	80	100	100
Patient C	After	46	55	40	73	20	24	34	5	3	3	24	24	0	30	70	70	100	100

( ); normal range of corresponding scale.

The improved satisfaction with each hand or ADL was noticed after the virtual reality treatment for 5 days. Interval changes in others were variable. PRWE: patient-rated wrist evaluation, PS-ADL: performance & satisfaction in activities of daily living, MHQ: Michigan Hand Outcomes Questionnaire.

Table 2

Validity of the Virtual Reality

	Validity of virtual reality (−5 to 5)	Validity of reconstructed virtual reality (−5 to 5)	Validity of control question of reconstructed virtual reality (−5 to 5)
Patient A	5	4.2	0.6
Patient B	5	5	0
Patient C	5	3.6	1

Appropriate score of validity was reported.

Appendix

Validation of virtual reality

References

1. Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci. 1996; 263:377–386.

2. Ramachandran VS, Altschuler EL. The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain. 2009; 132:1693–1710.

3. Moseley GL. Using visual illusion to reduce at-level neuropathic pain in paraplegia. Pain. 2007; 130:294–298.

4. Karmarkar A, Lieberman I. Mirror box therapy for complex regional pain syndrome. Anaesthesia. 2006; 61:412–413.

5. Ramachandran VS, Seckel EL. Using mirror visual feedback and virtual reality to treat fibromyalgia. Med Hypotheses. 2010; 75:495–496.

6. Yavuzer G, Selles R, Sezer N, Sutbeyaz S, Bussmann JB, Koseoglu F. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2008; 89:393–398.

7. Lee HM, Li PC, Fan SC. Delayed mirror visual feedback presented using a novel mirror therapy system enhances cortical activation in healthy adults. J Neuroeng Rehabil. 2015; 12:56.

8. Waljee JF, Chung KC, Kim HM, Burns PB, Burke FD, Wilgis EF. Validity and responsiveness of the Michigan Hand Questionnaire in patients with rheumatoid arthritis: a multicenter, international study. Arthritis Care Res (Hoboken). 2010; 62:1569–1577.

9. Holmes NP, Crozier G, Spence C. When mirrors lie: visual capture of arm position impairs reaching performance. Cogn Affect Behav Neurosci. 2004; 4:193–200.

10. Romano D, Bottini G, Maravita A. Perceptual effects of the mirror box training in normal subjects. Restor Neurol Neurosci. 2013; 31(4):373–386.

11. Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am. 1998; 23:575–587.

12. Archenholtz B, Dellhag B. Validity and reliability of the instrument Performance and Satisfaction in Activities of Daily Living (PS-ADL) and its clinical applicability to adults with rheumatoid arthritis. Scand J Occup Ther. 2008; 15:13–22.

13. MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma. 1998; 12:577–586.

14. Norkin C WJ. Measurement of joint motion: a guide to goniometry. Philadelphia, PA: Davis Company;1995. p. 89–90.

15. Darnall BD, Li H. Home-based self-delivered mirror therapy for phantom pain: a pilot study. J Rehabil Med. 2012; 44:254–260.

16. Botvinick M, Cohen J. Rubber hands feel touch that eyes see. Nature. 1998; 391:756.

17. Garry MI, Loftus A, Summers JJ. Mirror, mirror on the wall: viewing a mirror reflection of unilateral hand movements facilitates ipsilateral M1 excitability. Exp Brain Res. 2005; 163:118–122.

18. Harris AJ. Cortical origin of pathological pain. Lancet. 1999; 354:1464–1466.

19. Flor H, Elbert T, Knecht S, Wienbruch C, Pantev C, Birbaumer N. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature. 1995; 375:482–484.

20. Flor H, Denke C, Schaefer M, Grusser S. Effect of sensory discrimination training on cortical reorganisation and phantom limb pain. Lancet. 2001; 357:1763–1764.

21. Maihofner C, Handwerker HO, Neundorfer B, Birklein F. Cortical reorganization during recovery from complex regional pain syndrome. Neurology. 2004; 63:693–701.

22. Pleger B, Tegenthoff M, Ragert P, Forster AF, Dinse HR, Schwenkreis P. Sensorimotor retuning [corrected] in complex regional pain syndrome parallels pain reduction. Ann Neurol. 2005; 57:425–429.

23. Kolb B, Whishaw IQ. Brain plasticity and behavior. Annu Rev Psychol. 1998; 49:43–64.

24. Funase K, Tabira T, Higashi T, Liang N, Kasai T. Increased corticospinal excitability during direct observation of self-movement and indirect observation with a mirror box. Neurosci Lett. 2007; 419:108–112.

25. Touzalin-Chretien P, Ehrler S, Dufour A. Dominance of vision over proprioception on motor programming: evidence from ERP. Cereb Cortex. 2010; 20:2007–2016.

26. Schaefer M, Flor H, Heinze HJ, Rotte M. Morphing the body: illusory feeling of an elongated arm affects somatosensory homunculus. Neuroimage. 2007; 36:700–705.

27. Schaefer M, Heinze HJ, Rotte M. My third arm: shifts in topography of the somatosensory homunculus predict feeling of an artificial supernumerary arm. Hum Brain Mapp. 2009; 30:1413–1420.

28. Egsgaard LL, Petrini L, Christoffersen G, Arendt-Nielsen L. Cortical responses to the mirror box illusion: a high-resolution EEG study. Exp Brain Res. 2011; 215:345–357.

29. Liepert J, Miltner WH, Bauder H, Sommer M, Dettmers C, Taub E. Motor cortex plasticity during constraint-induced movement therapy in stroke patients. Neurosci Lett. 1998; 250:5–8.

30. Kang YJ, Ku J, Han K, Kim SI, Yu TW, Lee JH. Development and clinical trial of virtual reality-based cognitive assessment in people with stroke: preliminary study. Cyberpsychol Behav. 2008; 11:329–339.

31. Keshavarz B, Hecht H. Validating an efficient method to quantify motion sickness. Hum Factors. 2011; 53:415–426.

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