Mirror Therapy in Stroke Rehabilitation: Current Perspectives

Figures & data

Figure 1 PRISMA flow chart.

Table 1 Summary of Included Studies

First Author/Year	Phase	Intervention Target	Duration of Therapy (Weeks)	Mode of MT	Sample
Harmsen, 2015^Citation40	Chronic	UL motor	1 session	Action-observation, u/l	37
Lin, 2014^Citation39	Chronic	UL motor, ambulation, ADL	4	MB, b/l	29
Amasyalı, 2016^Citation38	Chronic	Hand motor	3	MF, u/l	17
Gurbuz, 2016^Citation53	Sub-acute	UL motor	4	MF, u/l	31
Mohan, 2013^Citation50	Acute	LL motor, balance	2	MF	22
Xu, 2017^Citation43	Sub-acute	LL, ambulation, spasticity	4	MF	46
Vural, 2015^Citation28	Chronic	CRPS, UL motor, ADL, spasticity	4	MR, b/l	30
Wu, 2013^Citation29	Chronic	UL motor and sensory	4	MF, b/l	23
Rodrigues, 2015^Citation45	Chronic	UL motor	4	MB, b/l	16
Arya, 2018^Citation46	Chronic	UL sensory	6	MF, b/l	31
Samuelkamaleshkumar, 2014^Citation37	Sub-acute	Wrist and hand motor	3	MB, b/l	20
Cristina, 2015^Citation44	Sub-acute	UL motor	6	MF, b/l	15
Thieme, 2012^Citation52	Sub-acute	UL motor, ADLS, QOL, visuospatial neglect	5	MF, b/l	60
Colomer, 2016^Citation31	Chronic	UL motor and sensory	8	MB, b/l	31
Michielsen, 2011^Citation32	Chronic	UL motor, pain, QOL	6	MF, b/l	40
Pandian, 2014^Citation54	Acute	Unilateral neglect	4	MB, b/l	47
Antoniotti, 2019^Citation41	Acute	UL motor	4	MF, u/l	35
Tyson, 2015^Citation33	Acute	UL and LL, motor and sensory	1	MF	85
Chan, 2018^Citation42	Acute	UL motor	4	MF, b/l	35
Arya, 2015^Citation46	Chronic	UL motor	8	MB, u/l	33
Park, 2015^Citation47	Chronic	UL motor, ADL	4	MF, u/l	30
Radajewska, 2013^Citation51	Sub-acute	UL and hand motor, ADL	3	MF, b/l	60
Ji, 2015^Citation49	Sub-acute	Gait	4	MF, u/l	34
Park, 2015^Citation36	Chronic	UL motor, ADL	6	MF, u/l	30
Lee, 2012^Citation35	Acute and sub-acute	UL motor	4	MB, b/l	26
Invernizzi, 2013^Citation34	Sub-acute	UL motor, ADL	4	MF, u/l	26
In, 2016^Citation48	Chronic	Balance, gait	4	MB, VRRT	25
Yang, 2015^Citation55	Sub-acute	Pusher’s syndrome	3	MF	12

Abbreviations: UL, Upper Limb; u/l, Unilateral; ADL, Activities of Daily Living, MB, Mirror Box; b/l, bilateral; MF, Mirror Frame; LL, Lower Limb; CRPS, Complex Regional Pain Syndrome; QOL, Quality of Life; VRRT, Virtual Reality Reflection Therapy.

Table 2 Types of Outcome Measures

Category	Scales Used
	Impairment	Activity Limitation	Participation Restriction
Motor: upper and lower extremity	FMA Myoton 3 myometer PROM MCSI MAS Movement time Grip force Wrist extension Bhakta test Tardieu scale Motricity index Brunnstrom stages MSS	WMFT BBT 10-metre walk test MFT Upper extremity performance test for the elderly ARAT Stroke-ULAM	BI FIM
Sensory	FMA RNSA RASP TDT VAS	NA	NA
Unilateral neglect	SCT LBT PIT	NA	NA
Balance	Postural sway	BBS BBA	FRT TUG
Others	Scale for Contraversive Pushing	Motion analysis device FAC FAT	SIS ABILHAND mRS EQ 5D RFI

Abbreviations: FMA, Fugl Meyer Assessment; PROM, Passive Range Of Motion; MCSI, Modified Composite Spasticity Index; MSS, Motor Status Score; MFT, Manual Function Test; ULAM, Upper Limb Activity Monitor; BI, Barthel Index; FIM, Functional Independence Measure; RNSA, Revised Nottingham Sensory Assessment; NSA, Nottingham Sensory Assessment; RASP, Rivermead Assessment Of Sensory Perception; TDT, Tactile Discrimination Test; SMT, Semmes-Weinstein Monofilament Test; VAS, Visual Analog Scale; SCT, Star Cancellation Test; LBT, Line Bisection Test; PIT, Picture Identification Task; BBS, Berg Balance Scale; BBA, Brunel Balance Assessment; FRT, Functional Reach Test; TUG, Timed Up and Go Test; FAC, Functional Ambulation Categories; FAT, Frenchay Arm Test; MAL, Motor Activity Log; mRS, Modified Rankin Score; EQ-5D, EuroQOL-5 Domains; RFI, Repty Functional Index.

Figure 2 The risk of bias scored on the Cochrane tool.

Harmsen WJ, Bussmann JB, Selles RW, Hurkmans HL, Ribbers GM. A mirror therapy–based action observation protocol to improve motor learning after stroke. Neurorehabil Neural Repair. 2015;29(6):509–516. doi:10.1177/1545968314558598

 PubMed Web of Science ®Google Scholar

Lin KC, Huang PC, Chen YT, Wu CY, Huang WL. Combining afferent stimulation and mirror therapy for rehabilitating motor function, motor control, ambulation, and daily functions after stroke. Neurorehabil Neural Repair. 2014;28(2):153–162. doi:10.1177/1545968313508468

 PubMed Web of Science ®Google Scholar

Amasyali SY, Yaliman A. Comparison of the effects of mirror therapy and electromyography-triggered neuromuscular stimulation on hand functions in stroke patients: a pilot study. Int J Rehabil Res. 2016;39(4):302–307. doi:10.1097/MRR.0000000000000186

 PubMed Web of Science ®Google Scholar

Gurbuz N, Afsar SI, Ayaş S, Cosar SN. Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial. J Phys Ther Sci. 2016;28(9):2501–2506. doi:10.1589/jpts.28.2501

 PubMedGoogle Scholar

Mohan U. 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. doi:10.4103/0972-2327.120496

 PubMed Web of Science ®Google Scholar

Xu Q, Guo F, Salem HM, Chen H, Huang X. Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled study. Clin Rehabil. 2017;31(12):1583–1591. doi:10.1177/0269215517705689

 PubMed Web of Science ®Google Scholar

Vural SP, Yuzer GFN, Ozcan DS, Ozbudak SD, Ozgirgin N. Effects of mirror therapy in stroke patients with complex regional pain syndrome type 1: a randomized controlled study. Arch Phys Med Rehabil. 2016;97(4):575–581. doi:10.1016/j.apmr.2015.12.008

 PubMed Web of Science ®Google Scholar

Wu CY, Huang PC, Chen YT, Lin KC, Yang HW. Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2013;94(6):1023–1030. doi:10.1016/j.apmr.2013.02.007

 PubMed Web of Science ®Google Scholar

Rodrigues LC, Farias NC, Gomes RP, Michaelsen SM. Feasibility and effectiveness of adding object-related bilateral symmetrical training to mirror therapy in chronic stroke: a randomized controlled pilot study. Physiother Theory Pract. 2016;32(2):83–91. doi:10.3109/09593985.2015.1091872

 PubMed Web of Science ®Google Scholar

Arya KN, Pandian S, Kumar D, Puri V. Task-based mirror therapy augmenting motor recovery in poststroke hemiparesis: a randomized controlled trial. J Stroke Cerebrovascular Dis. 2015;24(8):1738–1748. doi:10.1016/j.jstrokecerebrovasdis.2015.03.026

 PubMed Web of Science ®Google Scholar

Samuelkamaleshkumar S, Reethajanetsureka S, Pauljebaraj P, Benshamir B, Padankatti SM, David JA. Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial. Arch Phys Med Rehabil. 2014;95(11):2000–2005. doi:10.1016/j.apmr.2014.06.020

 PubMed Web of Science ®Google Scholar

Cristina LM, Matei D, Ignat B, Popescu CD. Mirror therapy enhances upper extremity motor recovery in stroke patients. Acta Neurologicabelgica. 2015;115(4):597–603.

 Google Scholar

Thieme H, Bayn M, Wurg M, Zange C, Pohl M, Behrens J. Mirror therapy for patients with severe arm paresis after stroke–a randomized controlled trial. Clin Rehabil. 2013;27(4):314–324. doi:10.1177/0269215512455651

 PubMed Web of Science ®Google Scholar

Colomer C, Noe E, Llorens Rodríguez R. Mirror therapy in chronic stroke survivors with severely impaired upper limb function: a randomized controlled trial. Eur J Phys Rehabil Med. 2016;52(3):271–278.

 PubMed Web of Science ®Google Scholar

Michielsen ME, Selles RW, van der Geest JN, et al. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a Phase II randomized controlled trial. Neurorehabil Neural Repair. 2011;25(3):223–233. doi:10.1177/1545968310385127

 PubMed Web of Science ®Google Scholar

Pandian JD, Arora R, Kaur P, Sharma D, Vishwambaran DK, Arima H. Mirror therapy in unilateral neglect after stroke (MUST trial): a randomized controlled trial. Neurology. 2014;83(11):1012–1017. doi:10.1212/WNL.0000000000000773

 PubMed Web of Science ®Google Scholar

Antoniotti P, Veronelli L, Caronni A, et al. No evidence of effectiveness of mirror therapy early after stroke: an assessor-blinded randomized controlled trial. Clin Rehabil. 2019;33(5):885–893. doi:10.1177/0269215518824737

 PubMed Web of Science ®Google Scholar

Tyson S, Wilkinson J, Thomas N, et al. Phase II pragmatic randomized controlled trial of patient-led therapies (mirror therapy and lower-limb exercises) during inpatient stroke rehabilitation. Neurorehabil Neural Repair. 2015;29(9):818–826. doi:10.1177/1545968314565513

 PubMed Web of Science ®Google Scholar

Chan WC, Au-Yeung SS. Recovery in the severely impaired arm post-stroke after mirror therapy: a randomized controlled study. Am j Phys Med Rehabil. 2018;97(8):572–577. doi:10.1097/PHM.0000000000000919

 PubMed Web of Science ®Google Scholar

Park Y, Chang M, Kim KM, An DH. The effects of mirror therapy with tasks on upper extremity function and self-care in stroke patients. J Phys Ther Sci. 2015;27(5):1499–1501. doi:10.1589/jpts.27.1499

 PubMedGoogle Scholar

Radajewska A, Opara JA, Kucio C, Blaszczyszyn M, Mehlich K, Szczygiel J. The effects of mirror therapy on arm and hand function in subacute stroke in patients. Int J Rehabil Res. 2013;36(3):268–274. doi:10.1097/MRR.0b013e3283606218

 PubMed Web of Science ®Google Scholar

Ji SG, Kim MK. The effects of mirror therapy on the gait of subacute stroke patients: a randomized controlled trial. Clin Rehabil. 2015;29(4):348–354. doi:10.1177/0269215514542356

 PubMed Web of Science ®Google Scholar

Park JY, Chang M, Kim KM, Kim HJ. The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients. J Phys Ther Sci. 2015;27(6):1681–1683. doi:10.1589/jpts.27.1681

 PubMedGoogle Scholar

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):689–700. doi:10.1097/PHM.0b013e31824fa86d

 PubMed Web of Science ®Google Scholar

Invernizzi M, Negrini S, Carda S, Lanzotti L, Cisari C, Baricich A. The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: a randomized controlled trial. Eur J Phys Rehabil Med. 2013;49(3):311–317.

 PubMed Web of Science ®Google Scholar

In T, Lee K, Song C. Virtual reality reflection therapy improves balance and gait in patients with chronic stroke: randomized controlled trials. Med Sci Monitor. 2016;22:4046. doi:10.12659/MSM.898157

 PubMed Web of Science ®Google Scholar

Yang YR, Chen YH, Chang HC, Chan RC, Wei SH, Wang RY. Effects of interactive visual feedback training on post-stroke pusher syndrome: a pilot randomized controlled study. Clin Rehabil. 2015;29(10):987–993. doi:10.1177/0269215514564898

 PubMed Web of Science ®Google Scholar