Brain Neurorehabil.  2016 Mar;9(1):48-55. 10.12786/bn.2016.9.1.48.

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

• Choi SW
• Heo S
• Hwang CH
• Koo KI

• KMID: 2161461
• DOI: http://doi.org/10.12786/bn.2016.9.1.48

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 1st 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.

Keyword

analgesia; rheumatoid arthritis; virtual reality therapy; wrist

MeSH Terms

Activities of Daily Living
Analgesia
Arthritis
Arthritis, Rheumatoid*
Hand
Humans
Michigan
Range of Motion, Articular
Virtual Reality Exposure Therapy
Weights and Measures
Wrist

Figure

• 

  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.

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