Effect of mirror therapy on motor and sensory recovery from brachial plexus injury: Case report
Keywords:mirror therapy, peripheral nerve injury, brachial palsy, brachial plexus injury
Introduction: Brachial plexus injuries generate muscle weakness and altered sensitivity of the upper limb. When a peripheral nerve injury occurs, a reduction in afferences is generated, which alters the cortical representation of the segments involved, this generates poor motor and sensory recovery. Mirror therapy contributes to recovery from peripheral nerve injury by stimulating the somatosensory, primary motor, and premotor cortices, which in turn increases corticomuscular excitability having sensory and motor impact.
Clinical findings: This is a 35-year-old male patient with an axonotmesis-type brachial plexus injury with an evolution time of almost ten months. Patient presents total paralysis and anesthesia of the right upper limb.
Intervention: Task-based mirror therapy was applied twice a week for four weeks. Sensitivity, pain, muscle activation, muscle strength, range of motion, and level of disability of the upper limb were evaluated.
Outcomes: Improvement in neuropathic pain and sensitivity regulation was observed, as well as increased activation of the main muscles of the upper limb (Deltoids, biceps, triceps, extensor carpi radialis longus, flexor carpi ulnaris).
Conclusion: The application of mirror therapy can be suggested as an effective low-cost auxiliary tool with short-term results for the improvement of neuropathic pain and for the regulation of sensitivity in peripheral nerve injuries. Likewise, its use could be recommended to stimulate muscle activation of the upper limb.
Noland SS, Bishop AT, Spinner RJ, Shin AY. Adult Traumatic Brachial Plexus Injuries. J Am Acad Orthop Surg. 2019;27(19):705–16. doi: 10.5435/JAAOS-D-18-00433.
Zink PJ, Philip BA. Cortical plasticity in rehabilitation for upper extremity peripheral nerve injury: A scoping review. Am J Occup Ther. 2020;74(1). doi: 10.5014/ajot.2020.036665.
Gilcrease-Garcia BM, Deshmukh SD, Parsons MS. Anatomy, imaging, and pathologic conditions of the brachial plexus. Radiographics. 2020;40(6):1686–714. doi: 10.1148/rg.2020200012.
Thieme H, Morkisch N, Mehrholz J, Pohl M, Behrens J, Borgetto B, et al. Mirror therapy for improving motor function after stroke (Review). Cochrane Database Syst Rev. 2018;0(7):1–30. doi: 10.1002/14651858.CD008449.pub3.
Deconinck FJA, Smorenburg ARP, Benham A, Ledebt A, Feltham MG, Savelsbergh GJP. Reflections on mirror therapy: A systematic review of the effect of mirror visual feedback on the brain. Neurorehabil Neural Repair. 2015;29(4):349–61. doi: 10.1177/1545968314546134.
Sallés L, Gironès X, Lafuente JV. Organización motora del córtex cerebral y el papel del sistema de las neuronas espejo. Repercusiones clínicas para la rehabilitación. Med Clin (Barc). 2015;144(1):30–4. doi: 10.1016/j.medcli.2013.12.013.
Wittkopf PG, Johnson MI. Mirror therapy: A potential intervention for pain management. Rev Assoc Med Bras. el 1 de noviembre de 2017;63(11):1000–5. doi: 10.1590/1806-92220.127.116.110.
Paula MH, Barbosa RI, Marcolino AM, Elui VMC, Rosén B, Fonseca M de CR. Early sensory re-education of the hand after peripheral nerve repair based on mirror therapy: A randomized controlled trial. Brazilian J Phys Ther. 2016;20(1):58–65. doi: 10.1590/bjpt-rbf.2014.0130.
Ferreira CM, de Carvalho CD, Gomes R, Bonifácio de Assis ED, Andrade SM. Transcranial Direct Current Stimulation and Mirror Therapy for Neuropathic Pain After Brachial Plexus Avulsion: A Randomized, Double-Blind, Controlled Pilot Study. Front Neurol. el 11 de diciembre de 2020;11. doi: 10.3389/fneur.2020.568261.
Chen YH, Siow TY, Wang JY, Lin SY, Chao YH. Greater Cortical Activation and Motor Recovery Following Mirror Therapy Immediately after Peripheral Nerve Repair of the Forearm. Neuroscience. el 15 de enero de 2022;481:123–33. doi: 10.1016/j.neuroscience.2021.11.048.
How to Cite
Copyright (c) 2022 Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
September 2022-present © Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez. Open access articles under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. No commercial re-use is allowed.
January-September 2022 © The authors. Open access articles under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) license, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. No commercial re-use is allowed.
January 2014-December 2021 © Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez. Open access articles under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) license, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.