Abstract
Background Treatment of central post-stroke pain (CPSP) after a thalamic-capsular stroke is generally based on pharmacological approach as it is low responsive to physiotherapy. In this case report, the use of mirror therapy (MT) for the reduction of CPSP in a subject after a stroke involving thalamus is presented.Case presentationFive years after a right lenticular-capsular thalamic stroke, despite a good recovery of voluntary movement that guaranteed independence in daily life activities, a 50-year-old woman presented with mild weakness and spasticity, an important sensory loss and a burning pain in the left upper limb. MT for reducing arm pain was administered in 45-min sessions, five days a week, for two consecutive weeks. MT consisted in performing symmetrical movements of both forearms and hands while watching the image of the sound limb reflected by a parasagittal mirror superimposed to the affected limb. Pain severity was assessed using visual analogue scale (VAS) before and after the intervention and at one-year follow-up. After the two weeks of MT, the patient demonstrated 4.5 points reduction in VAS pain score of the hand at rest and 3.9 points during a maximal squeeze left hand contraction. At one-year follow-up, pain reduction was maintained and also extended to the shoulder.ConclusionThis case report shows the successful application of a motor training with a sensory confounding condition (MT) in reducing CPSP in a patient with a chronic thalamic stroke.
Highlights
Treatment of central post-stroke pain (CPSP) after a thalamic-capsular stroke is generally based on pharmacological approach as it is low responsive to physiotherapy
This case report shows the successful application of a motor training with a sensory confounding condition (MT) in reducing CPSP in a patient with a chronic thalamic stroke
This technique was described for the first time in 1995 in studies reporting the reduction of phantom limb pain in arm amputees [13]; more recently, its use was described for recovery of motor function after stroke [14, 15], for the Corbetta et al Archives of Physiotherapy (2018) 8:4 treatment of complex regional pain syndrome type I [12] and other painful conditions [16, 17]
Summary
Stroke often causes impairment in movement control but can affect perception [1, 2]. Mirror therapy (MT), defined as the use of a mirror reflection of unaffected limb movements superimposed on the affected extremity, is often used to treat motor and perception problems [11, 12] This technique was described for the first time in 1995 in studies reporting the reduction of phantom limb pain in arm amputees [13]; more recently, its use was described for recovery of motor function after stroke [14, 15], for the Corbetta et al Archives of Physiotherapy (2018) 8:4 treatment of complex regional pain syndrome type I [12] and other painful conditions (e.g., brachial plexus avulsion and after surgery) [16, 17]. VAS was used to assess pain severity at the hand and at the shoulder [22] in two separate conditions: at rest and during a maximal squeeze left hand contraction [23]
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