Corbetta Davide, Sarasso Elisabetta, Agosta Federica, Filippi Massimo, Gatti Roberto
Laboratory of Analysis and Rehabilitation of Motor Function, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milan, Italy.
2Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy.
Arch Physiother. 2018 Feb 23;8:4. doi: 10.1186/s40945-018-0047-y. eCollection 2018.
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.
Five 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.
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.
丘脑-内囊卒中后中枢性卒中后疼痛（CPSP）的治疗通常基于药物治疗，因为其对物理治疗反应不佳。在本病例报告中，介绍了在一名丘脑卒中患者中使用镜像疗法（MT）减轻CPSP的情况。
一名50岁女性在右侧豆状核-内囊丘脑卒中五年后，尽管自主运动恢复良好，能够保证日常生活活动的独立性，但仍出现左侧上肢轻度无力和痉挛、严重感觉丧失以及灼痛。为减轻手臂疼痛，进行了镜像疗法，每周五天，每次45分钟，连续进行两周。镜像疗法包括在观看矢旁镜反射到患侧肢体上的健全肢体影像时，双侧前臂和手部进行对称运动。在干预前、干预后以及一年随访时，使用视觉模拟量表（VAS）评估疼痛严重程度。经过两周的镜像疗法后，患者休息时手部VAS疼痛评分降低了4.5分，左手最大收缩力挤压时降低了3.9分。在一年随访时，疼痛减轻得以维持，且疼痛减轻范围还扩展到了肩部。
本病例报告显示了一种具有感觉混淆条件的运动训练（镜像疗法）在减轻慢性丘脑卒中患者CPSP方面的成功应用。
