Mirror Therapy for Hemiparesis Following Stroke: A Review
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Purpose of Review
Ramachandran (Nature 377:489–490, 1995) showed that in amputees, phantom limb pain described as a spasming or immobile phantom limb can be alleviated by watching their reflection of the intact limb in a parasagittally placed mirror while moving the intact limb and the phantom simultaneously. This suggested that therapy via mirror visual feedback—mirror therapy—might be considered for other diseases and conditions characterized by poor mobility. We were the first to show that mirror therapy might be beneficial for hemiparesis following stroke. There have now been numerous case reports and studies of mirror therapy for hemiparesis following stroke.
Overall, the majority of studies done thus far on patients with hemiparesis in the subacute or chronic phase following stroke find mirror therapy to be more beneficial than control treatments. Even when mirror therapy is not superior to control therapy, the reason for this is there are similar improvements in both groups. There have not been adverse effects in patients that perform mirror therapy for hemiparesis following stroke.
There appears to be a benefit of mirror therapy for hemiparesis following stroke in the subacute and chronic phase. Trial of mirror therapy for hemiparesis may be warranted. Further study of mirror therapy for hemiparesis following stroke will be welcomed; in particular, it would be important to study different groups of patients given the heterogeneity of stroke.
KeywordsMirror therapy Stroke rehabilitation Visual feedback Physical rehabilitation Hemiparesis Review
Compliance with Ethics Guidelines
Conflict of Interest
Kasondra Hartman and Eric L. Altschule declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Recently published papers of particular interest have been highlighted as: • Of importance •• Of major importance
- 2.•• Ramachandran VS, Rogers-Ramachandran D, Cobb S. Touching the phantom limb. Nature. 1995;377:489–90. This paper reports the discovery and the first use of mirror therapy. Google Scholar
- 5.• Chan BL, Witt R, Charrow AP, Magee A, Howard R, Pasquina PF, et al. Mirror therapy for phantom limb pain. N Engl J Med. 2007;357:2206–7. The first randomized controlled trial of mirror therapy for phantom limb pain. Google Scholar
- 6.The Centers for Disease Control and Prevention. Stroke (2015). Retrieved from http://www.cdc.gov/stroke/index.htm.
- 7.Altschuler EL. Motor rehabilitation in a stroke patient using a mirror. Poster session (24.1408) presented at the annual meeting of the Society for Neurosciences, Los Angeles, CA (1998).Google Scholar
- 8.• Altschuler EL, Wisdom SB, Stone L, Foster C, Galasko D, Llewellyn DME, et al. Rehabilitation of hemiparesis after stroke with a mirror. Lancet. 1999;353:2035–6. The first study of the use of mirror therapy for hemiparesis following stroke. Google Scholar
- 9.• Sathian K, Greenspan AI, Wolf SL. Doing it with mirrors: a case study of a novel approach to neurorehabilitation. Neurorehabil Neural Repair. 2000;14:73–6. A case report of significant benefit of mirror therapy in a patient with hemiparesis following stroke. Google Scholar
- 12.∙ Sütbeyaz S, Yavuzer G, Sezer N, Koseoglu BF. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2007;88:555–9. The first randomized controled trial of mirror therapy for the lower extremity in patients with hemiparesis following stroke. Google Scholar
- 13.∙ Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseoğlu F, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2008;89:393–8. The first randomzied controled trial of mirror therapy for the upper extremity in patients with hemiparesis following stroke. Google Scholar
- 15.∙ Cacchio A, De Blasis E, Necozione S, di Orio F, Santilli V. Mirror therapy for chronic complex regional pain syndrome type 1 and stroke. N Engl J Med. 2009;361(6):634–6. A randomized controled trial of mirror therapy for patients with complex regional pain syndrome and hemiparesis following stroke. Google Scholar
- 21.∙ Holmes NP, Crozier G, Spence C. When mirrors lie: ‘visual capture’ of arm position impairs reaching performance. Cogn Aff Behav Neurosci. 2004;4:193–200. An excellent study in normal study which elucidates the mechanism of action of mirror visual feedback. Google Scholar
- 29.∙ Ng MJ, Singh P, Pandian JD, Arora R, Kaur P. Mirror therapy in unilateral neglect after stroke (MUST trial): a randomized controlled trial. Neurology. 2015;84(12):1286. A randomized controled trial demonstrating the benefit of mirror therapy in patients with hemineglect following stroke. Google Scholar
- 31.Schuster-Amft C, Henneke A, Hartog-Keisker B, Holper L, Siekierka E, Chevrier E, Pyk P, Kollias S, Kiper D, Eng K. Intensive virtual reality-based training for upper limb motor function in chronic stroke: a feasibility study using a single case experimental design and fMRI. Disabil Rehabil Assist Technol. 2015;10(5):385–92.CrossRefPubMedGoogle Scholar
- 34.Diers M, Kamping S, Kirsch P, Rance M, Bekrater-Bodmann R, Foell J, Trojan J, Fuchs X, Bach F, Maaß H, Cakmak H, Flor H. Illusion-related brain activations: a new virtual reality mirror box system for use during functional magnetic resonance imaging. Brain Res. 2015;12(1594):173–82.CrossRefGoogle Scholar
- 51.Michielsen ME, Selles RW, van der Geest JN, Eckhardt M, Yavuzer G, Stam HJ, Smits M, Ribbers GM, Bussmann JB. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil Neural Repair. 2011;25(3):223–33.CrossRefPubMedGoogle Scholar
- 55.Colomer C, Noè E, Llorens R. Mirror therapy in chronic stroke survivors with severely impaired upper limb function: a randomized controlled trial. Eur J Phys Rehabil Med. 2016.Google Scholar
- 59.Lee MM, Cho HY, Song CH. The mirror therapy program enhances upper-limb motor recovery and motor function in acute stroke patients. Am J Phys Med Rehabil. 2012;91(8):689–96, quiz 697–700.Google Scholar
- 66.Mirela Cristina L, Matei D, Ignat B, Popescu CD. Mirror therapy enhances upper extremity motor recovery in stroke patients. Acta Neurol Belg. 2015;115(4):597–603.Google Scholar
- 68.Radajewska A, Opara J, Biliński G, Kaczorowska A, Nawrat-Szołtysik A, Kucińska A, Lepsy E. Effectiveness of mirror therapy for subacute stroke in relation to chosen factors. Rehabil Nurs. 2016.Google Scholar
- 70.Mohan U, Babu SK, Kumar KV, Suresh BV, Misri ZK, Chakrapani M. Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: a randomized sham-controlled pilot trial. Ann Indian Acad Neurol. 2013;16(4):634–9.CrossRefPubMedPubMedCentralGoogle Scholar
- 77.de Almeida Oliveira R, Cintia Dos Santos Vieira P, Rodrigues Martinho Fernandes LF, Patrizzi LJ, Ferreira de Oliveira S, Pascucci Sande de Souza LA. Mental practice and mirror therapy associated with conventional physical therapy training on the hemiparetic upper limb in poststroke rehabilitation: a preliminary study. Top Stroke Rehabil. 2014;21(6):484–94.Google Scholar