Mirror Therapy For Stroke Survivors

A new kind of physical therapy called mirror therapy is helping stroke patients who suffer from post-stroke weakness. 

What is mirror therapy? 

Mirror therapy was initially developed to treat 'phantom pain,' a condition in which people experience pain in an arm or a leg that they have lost. Someone who suffers from phantom pain feels pain in a ‘missing arm’ or a ‘missing leg ‘even when the arm or leg was amputated or lost, often due to an injury.

 

In mirror therapy, patients place the affected arm behind a mirror so that it is hidden from the patient’s view. Patients then move the healthy arm and, because of the placement of the mirror, the brain is 'tricked' into thinking that the injured arm has moved. This exercise has been shown to help decrease pain symptoms for people who suffer from phantom pain, and now researchers have begun to use mirror therapy with stroke survivors who are weak or paralyzed. The same overall principle is used for mirror therapy in stroke rehabilitation. 

How is mirror therapy used for stroke?

Stroke survivors who have arm weakness or arm paralysis are instructed to hide the weak arm under a triangular box that has a mirrored cover. Then, the patients are asked to move the stronger arm and to observe it moving in the mirror. This gives the brain the incorrect message that the weak arm is actually moving.

Even though participants know what they are doing and why they are doing it- the brain still has a way of registering the incorrect message and ‘thinking’ that the weak arm is stronger than it actually is. Over time, consistently participating in the mirror therapy sessions can help strengthen the weaker arm by directly stimulating the corresponding area in the brain.

 

Does it work?

The largest evaluation of mirror therapy comes from the Cochrane database, which is a large database of stroke patients worldwide. The authors of the Cochrane report on a mirror therapy study including 564 stroke survivors who had participated in mirror therapy in different places throughout the world. The stroke survivors who had participated in mirror therapy had a measurable improvement in activities of daily living when compared to the outcomes of stroke survivors who participated in other types of post stroke rehabilitation. 

Another, more recent study in Turkey assessed 30 stroke patients for 4 weeks. One group of recovering stroke survivors received standard physical therapy for 4 weeks, 5 days/week for 2-4 hours per day and another group received the standard therapy but also had an additional 30 minutes of mirror therapy each day. Both groups improved over the course of the 4-week rehabilitation, but the mirror therapy group had significantly better measures of strength, a marked decrease in post-stroke pain and better levels of independence as measured by objective criteria.

The measurement scales used to measure improvement were the Functional Independence Measure (FIM motor), the Visual Analog Scale (VAS) for pain severity, the Brunnstrom Recovery Stages of arm (BRS arm) and hand (BRS hand) for motor recovery and the Fugl- Meyer assessment (FMA).

The future of mirror therapy 

These preliminary results of using mirror therapy for stroke rehabilitation look promising. Adding mirror therapy to standard physical therapy after a stroke is relatively simple. There have not been any documented side effects or negative outcomes from mirror therapy.

Physical therapy and rehabilitation after a stroke require a great deal of active participation and hard work on the part of the stroke survivor. If you are recovering from a stroke, make sure that you take advantage or all of your resources for post-stroke recovery so that you can regain as much of your physical and cognitive abilities as possible.

Sources:

The Effects of Mirror Therapy in Stroke Patients with Complex Regional Pain Syndrome Type 1: A Randomized Controlled Study, Vural SP, Nakipoglu Yuzer GF, Ozcan DS, Ozbudak SD, Ozgirgin N, Archives of Physical Medicine and Rehabilitation, December 2015

Task-Based Mirror Therapy Augmenting Motor Recovery in Poststroke Hemiparesis: A Randomized Controlled Trial, Arya KN, Pandian S, Kumar D, Puri V, Journal of Stroke and Cerebrovascular Disease, August 2015

Mirror therapy for improving motor function after stroke, Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C., Cochrane Database of Systemic Reviews, March 2012

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