The official journal of the Korean Society for Neurorehabilitation (KSNR), and Asia-Oceanian Soceity for Neurorehabilitation (AOSNR)
pISSN 1976-8753 eISSN 2383-9910
Open Access, Peer-reviewed
Indexed in PubMed, PubMed Central, DOAJ and Korea Citation Index (KCI)
    Brain Neurorehabil. 2016 Mar;9(1):48-55. Korean.
    Published online Mar 31, 2016.
    https://doi.org/10.12786/bn.2016.9.1.48
    Copyright © 2016 Korean Society for Neurorehabilitation
    Original Article

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

    Seung Won Choi, M.D., Ph.D.,1 Suncheol Heo,2 Chang Ho Hwang, M.D., Ph.D.,3 and 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, Email: 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, Email: kikoo@ulsan.ac.kr
    Received November 18, 2015; Revised December 15, 2015; Accepted March 30, 2016.

    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 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.

    Keywords
    analgesia; rheumatoid arthritis; virtual reality therapy; wrist

    Figures

    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.

    Tables

    Table 1
    Interval Changes of Functional and Surrogate Ends

    Table 2
    Validity of the Virtual Reality

    Appendix

    Validation of virtual reality

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    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
    Metrics
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