Rehabilitation of brain injuries. Discuss mirror therapy

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A brain injury is the sort of damage that a blow to the brain caused by an external force but is not of congenital or degenerative nature. It might lead to temporary or permanent impairment of the physical, cognitive and psychological functions. An injury to the brain might generate an altered or diminished state of consciousness to cause these effects that prevent normal functioning as before the injury:

  • Impairment of physical functioning and cognitive abilities
  • Profound disturbances of emotional, cognitive and behavior functioning
  • Permanent impairments that cause partial or full functional disability as well as psychosocial maladjustment

The Brain Injury Association Board adopted the definition of acquired brain injury to add the definition of a brain injury to include other causes that occur because of other nontrauma causes. An acquired brain injury (ABI): An injury to the brain that occurs after birth. It commonly causes a change in neuronal activities that affect physical, metabolic or functional ability of a cell. The causes of ABI include an application of external forces to the head or neck without causing a fracture.

The severity of Traumatic Brain Injury

Moderate traumatic brain injury–Trauma to the head causing a loss of consciousness that lasts 30 minutes to 24 hours. Posttraumatic amnesia can last 24 hours to a week.

Severe traumatic brain injury-this injury is a trauma to the head that causes a loss of consciousness lasting more than 24 hours and an initial Glasgow Coma scale of 3-8. It also creates a posttraumatic amnesia period that goes beyond seven days.

Traumatic Brain Injury (TBI)- TBI IS an insult to the brain occurring after an external physical force to produce an altered and diminished state of consciousness interfering with physical or cognitive abilities. TBI can cause altering or diminishing state of consciousness.TBI might cause permanent impairments resulting in partial or full functional disability as well as psychosocial maladjustment.

Head injuries that cause brain injury might be open or closed. A closed head injury is that which does not break the skull. An open or penetrating head injury is that which cracks the scalp o skull to enter the brain. Assessing the severity of the head injury by observation is hard. Some of the injuries on the head can cause much bleeding while other does not cause any bleeding. Head injuries are dangerous, and nobody should take them lightly. It is essential to go for assessment by a doctor quickly.

What is Rehabilitation of Brain Injuries

Brain injuries can affect the way of doing everything from walking, talking or even entire thinking. Brain healing is a process occurring after brain damage. The brain has the resilience to adapt but when cells within can cause significant damage or die for instance after a stroke, there might be formation on those cells or repair might be impossible.

Some TBIs increase the risk of a stroke. The necessity to start healing is the reason for rehabilitation of brain injuries which is a term referring to different types of specialized support and services that attempt at making an emergency or early phase intervention. Some brain injury rehab is a program within a hospital or other clinical settings. Some of them can take place on an outpatient basis. Every patient benefits from rehabilitation after a brain injury with the specific type depending on the unique needs by a person and challenges they face.

Mirror therapy

Mirror therapy is a type of motor imagery therapy that involves using a mirror to convey visual stimuli to the brain through observation of the body part that is still intact after the injury as it performs setoff movements. The underlying principle behind mirror therapy is that visual cues from the functional side of the body will stimulate the action of an affected limb. The thinking behind the therapy is that might be useful among the patients who lose movement or a limb after a brain injury or after suffering a stroke.

Mirror therapy involves using a tabletop mirror for creating a reflection of the unaffected part of the body such as an arm in place of the one that is affected during the therapy. A mirror should stand in line with the middle of the patient’s body. The position allows reflection of the unaffected half. It creates an optical illusion that the week part suck as a leg or hand has regained the ability to move. The initial use of this technique was to help in the rehabilitation of the patients suffering from chronic pain, but now those who are recovering from brain injury and stroke can also benefit. An advantage is that someone can set it up without challenges even when having some form of disability. A patient can even perform the therapy alone at home.

The mirror becomes a tool for performing various rehab exercises by just using the healthy side or part of the body.

Why Use Mirror Therapy for Rehabilitation of Brain Injuries

A reason for therapists, physicians as well as patients or their families to use a mirror to consider using mirror therapy is its ability to fire the neurons. The movement takes place after firing of the motor neurons in the brain that communicate to the muscles to move. Every time a person talks, walk or stands, it is a result of motor neurons in the brain. These motor neurons are in the same area of the brain as the mirror neurons. The difference between motor and mirror neurons is that the former fire up after a person sees the occurrence of a movement. In simple terms, the mirror neuron fire off after watching someone to move. The use of the word mirror is not a coincidence. Mirror therapy triggers firing of mirror neurons after a patient notices an illusion of affected arm as it moves in the mirror. Even though it is a mere reflection of a natural body part such as an arm, studies show that the brain perceives it as an affected part. The mobility improves after moving the affected area to inspire to move the affected.

Neuroplasticity effect

The mirror image tricks the brain into thinking that the affected body side but the truth is that the image is of the healthy part. The conscious mind knows it is a reflection, but the illusion helps the brain to rewire through a phenomenon called neuroplasticity. Plasticity is the ability of a cell to change. Each time a person makes a movement or the brain assumes that there is mobility, it is building connections.

If the brain injury was extremely severe to cause stroke, parts of it might have more damage, and it will begin to form new connections. Damage to the brain that hinders an ability to move a part of the body, the area requires repopulation with healthy connecting neurons to regain a full movement. The brain has a role in repurposing cells that control the other parts and trains them to learn new tasks.

Therapists can harness neuroplasticity to the advantage of a patient in rehabilitation. Approaches like mirrors or visualization utilize neuroscientific principles for rehabilitating areas of the brain for survivors to regain new control of their thinking as well as an independent ability to complete the daily tasks.

A developer of mirror box for use in mirror therapy therapeutic approach to regenerate neural networks that control the limbs as well as other body parts Vilayanur S. Ramachandran had the intention to address phantom limb pain. A mirror box uses mirrors to create an impression in the brain of a user that the movement of an affected body part is taking place whereas it is the one that is not suffering the effects of brain injury. The reflective surfaces in a box trigger patients to perform exercises using the unaffected limbs as the appearance seems as if the exercise is on the affected limb.

A study on the efficiency of the mirror therapy supports confirms that it a supports motor recovery even in post-stroke hemiparesis. The theory behind mirror therapy is that positive visual feedback encourages a neuroplastic change leading to quicker recovery for the survivors. Mirror boxes are on sale, but those with a specific preference might ask for customization.

Mirror therapy works in an almost similar way to another rehab technique whose basis of performance is on the science of visualization. Information on rehabilitation after brain injury and stroke show that visualizing or mental rehearsal of a task can cause the same effects as performing a task. A study on visualization showed that it increases the efficiency of brain recovery when someone performs it together with physical activity rather than rely on conventional rehabilitation or practice on its own. Visualization can boost mirror therapy for rehabilitation of brain injuries because it has powerful effects with richness in sensory details. They show the effect of sights, feelings, and smells. Visualization, for instance, helps a patient who is unable to walk after a brain injury or stroke can have a vivid imagination of strolling in a part while doing rehabilitative exercises.

Does Mirror Therapy Work

Mirror therapy is an efficient way of rehabilitation the brain and helping a patient to achieve the normal functionality of the body after a brain injury. It is more efficient when the injury affects one side of the brain than the other in a similar way to a stroke. It can leave the patient feeling weaker and off-balance on one side. Sometimes the patients are unable to stand upright or use an arm or leg on the affected side. Exercises and physical therapy helps much in the recovery. Mirror therapy still plays some role because they will fire the neurons.

An example is a study by a team of researchers in Germany who undertook 62 studies on mirror therapy as way brain rehabilitation. The study was on 1892 patients, and the outcomes showed that the mirror therapy led to the moderate improvement of the motor action. It also helped in the daily activities. Mirror therapy also helped in the management of complex regional pain syndrome a form of chronic pain that occurs after damage to the nerves usually after complications of brain injury such as stroke. However, the scope of research did not include studying whether mirror therapy helps with neglect that occurs when the people have hard times noticing the things in a visual field of the bad side.

It does not hurt to try mirror therapy for those who want to test means that will help in rehabilitation from brain injury. However, it is not a reason to replace all the efforts of physical therapy and activity.

Mirror therapy is not a replacement to other standard therapies but should be a supplement to what they achieve. It is as a good as other treatments but one of the varieties to try along the recovery training that a patient gets from a therapist. Mirror therapy is a non-pharmacological and alternate treatment strategy that some therapists propose as a way of managing PLP. It is a neuron-rehabilitation technique with a design to re-modulate the cortical mechanisms. MT is a technique that enables patients to perform movements with the unaffected limb while watching a mirror reflection superimposed over the affected limb that is out of the picture in the instance. It provides positive feedback and creates a visual illusion to motor cortex by creating an impression of a movement of the affected limb. This approach offers potential relief through the ocular dominance of the motor and the sensory processes.

Since PLP is very important as well its management, mirror therapy offers clinicians a low cost and a simple to implement rehabilitation technique. The higher weight of evidence about the efficiency of this process show that it has more benefit when in use as a sequential or combined therapy like graded motor imagery but not as a stand-alone modality.

Nonetheless, Mirror Therapy is not something to disregard. A crossover study on the effects of MT -Garry, Loftus & Summers (2004)-on healthy individuals shows that viewing a mirror image of an active hand makes the neurons in the ipsilateral primary motor cortex to be excited more than a direct view without using the mirror. The trend to view a mirror image shows that the patients undergoing rehabilitation of brain injuries will also favor watching their limb or body part move on the mirror. The movement prompts the brain to attempt to start moving the side with mobility difficulties.

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