the aim of the current research project is to investigate the effect of the mirror box illusion on movement performance, neuromuscular activation and proprioception in children with SHCP. The following objectives are: to determine the effect of the…
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Brief title
Condition
- Musculoskeletal and connective tissue disorders congenital
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Research involving
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Intervention
Outcome measures
Primary outcome
Experiment 1 *Judging and Matching*: During the judging task, the smallest
detectable difference between the two hands will be determined. This smallest
detectable difference is the threshold. In the matching task the difference at
endpoint position (distance) and the difference in the elbow angle (measured
with a goniometer) between both arms will be determined. The threshold of the
judging tasks and the differences on the matching tasks will be taken as main
study parameters.
Experiment 2 *One-way mirror*: While performing the slit movement, the distance
that is covered by the handle will be determined by means of the Optotrak
system. This is called the movement deflection. In addition the relative phase
will be calculated which indicates the symmetry between the two arms at each
moment in time. Moreover, neuromuscular activation (i.e., mean neuromuscular
activity, relative durations of eccentric, concentric, and isometric activity)
will be measured by means of EMG. The main study parameters for this experiment
are the movement deflection during the slit movement for the different
conditions (mirror/glass) and the neuromuscular activation in the different
conditions.
Experiment 3 *Learning*: The movement deflection of the handle during the slit
movement and the relative phase (measured with the Optotrak system) in the
screen condition will be the main study parameters for the pre- and
post-measurement. In addition the neuromuscular activation (i.e., mean
neuromuscular activity, relative durations of eccentric, concentric, and
isometric activity) while performing the slit movement in the screen condition
and the error on the proprioceptive tasks (equal to experiment 1) for the pre-
and post-measurement will be taken as main study parameters.
Experiments 1, 2 & 3: The scores of the QUEST (Quality of Upper Extremity
Skills Test).
Secondary outcome
Experiment 2: The time it takes before the hypothesized changes in relative
phase and movement deflection are seen after the transition from mirror to
glass or the other way around.
Experiments 1, 2 & 3: The scores of the MACS and the WeeFIM.
Background summary
Cerebral palsy (CP) is an umbrella term for a group of permanent disorders of
movement and posture hampering daily activities.(1) Spastic Hemiparetic
Cerebral Palsy (SHCP) is a common form of CP (33%) (1, 2) caused by
non-progressive brain damage in one hemisphere of the fetal or infant brain (3)
resulting in movement impairments on one side of the body (contralateral to the
lesion). Patients with SHCP have an increased muscle tone, reduced strength,
and proprioceptive disturbances.(4) A recent method to improve the
functionality of the impaired hand is mirror therapy.(5) Ramachandran and
Rogers-Ramachandran(6) first described the mirror-box illusion for the
treatment of amputees with phantom pain.(6) However, nowadays the application
has expanded to stroke patients and patients with complex regional pain
syndrome and the majority of the studies show promising results in the recovery
of motor function or reduction of pain in the affected limb.(7, 8) It is
thought that, by replacing the absent or disturbed visual information of the
affected (amputated, paretic etc.) limb with a mirror reflection of the not
affected, healthy body side (by use of a mirror), the sensory afferent (visual)
information is *normalized*. This *restoration* of the afferent inflow of
information, although manipulated, is suggested to be crucial to reverse the
negative effects on movement performance and pain experience.(6) Recently,
Feltham et al. (9-11) investigated the effects of the mirror box illusion on
movement coordination and neuromuscular activation in children with SHCP during
a bimanual circle drawing task. It was found that the mirror could reduce the
variability of the intermanual coordination and the high EMG intensity that is
usually found in CP children. While these results suggest a positive effect of
the mirror box illusion on the motor behaviour in children with SHCP, further
research is needed in order to investigate its potential application for
intervention. Three important unanswered questions trigger our current
research: 1) What is the exact working mechanism of the mirror box? This
question will be explored by testing the hypothesis that the mirror enhances
movement performance by restoring the afferent visual feedback. Further we will
examine what happens with movement performance and neuromuscular activation
when normal visual feedback is suddenly replaced by mirror feedback. 2) What is
the effect of the mirror box illusion on the proprioceptive ability of the
impaired hand in children with SHCP? Feltham et al.(9) focused on bimanual
coordination and muscle activation but no attention was paid to proprioception
which plays an important role in the control of movement. Proprioception is the
sensory feedback that contributes to the conscious sensation of movement,
posture and segmental posture and is mediated by proprioceptors in the skin,
muscles, tendons, ligaments and joint capsules.(12) It is known that during
motor learning or skill acquisition process, a shift in reliance from vision to
proprioception takes place.(13) In children with SHCP this shift is
considerably hampered due to the disturbed proprioception. Therefore, any
therapeutic intervention that aims to improve motor function in children with
SHCP depends on its effect on proprioception. 3) What is the effect of a short
training programme with the mirror box on the movement performance of the
impaired arm in children with SHCP? So far, only the immediate effect of the
mirror box has been tested in lab studies, using exposure times of
approximately 5 minutes. It is expected that longer interventions will shed
more light into the potential outcome of the mirror box and its effectiveness
as a therapeutic device. Based on these unanswered questions
Study objective
the aim of the current research project is to investigate the effect of the
mirror box illusion on movement performance, neuromuscular activation and
proprioception in children with SHCP. The following objectives are: to
determine the effect of the mirror box illusion on movement performance and
neuromuscular activation when seeing the impaired arm and its mirror
reflection; to examine the proprioceptive ability in children with SHCP and the
effect of the mirror box illusion on this ability; to explore the effect of (a
perturbation of) the visual feedback on movement performance in children with
SHCP; and to investigate the effect of a short mirror box training on movement
performance of the impaired hand in children with SHCP.
Study design
The study consists of 3 separate experiments which aim to gain more insight
into the effect of the mirror box illusion in children with SHCP and into the
working mechanisms of the mirror box illusion. Experiment 1 will focus on the
proprioceptive ability of children with SHCP and the effect of the mirror box
illusion on this proprioceptive ability. In experiment 2 the effect of a
perturbation of the visual feedback on movement coordination and neuromuscular
activation will be determined. Finally, in experiment 3 the effect of a short
mirror box training on movement coordination, neuromuscular activation and
proprioception will be examined.
Study burden and risks
We do not expect any specific risks for the participants. The methods used are
non-invasive (mirror box, goniometer, and EMG) and do not represent any
particular risk. It will be secured that the mirror and the perspex glass will
be well tied. In addition, in case an allergic reaction to the EMG electrodes
in noticed, the electrodes will be removed immediately and no EMG measurement
will be performed.
Van der Boechorststraat 9
1081 BT Amsterdam
NL
Van der Boechorststraat 9
1081 BT Amsterdam
NL
Listed location countries
Age
Inclusion criteria
Clinical diagnosis of Spastic Hemiparetic Cerebral Palsy (SHCP; either left or right hemispheric damage)
Age between 10 and 18 years
IQ>80
Exclusion criteria
Any neuromuscular disorders other than SHCP
Pain in any of the upper extremities
Neglect or visual impairments not corrected to normal
Parents/guardians and/or child who do not speak Dutch or English well enough to participate
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL30632.029.10 |