Original article
Mirror Therapy Improves Hand Function in Subacute Stroke: A Randomized Controlled Trial

https://doi.org/10.1016/j.apmr.2007.08.162Get rights and content

Abstract

Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseoğlu F, Atay MB, Stam HJ. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial.

Objective

To evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke.

Design

Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months.

Setting

Rehabilitation education and research hospital.

Participants

A total of 40 inpatients with stroke (mean age, 63.2y), all within 12 months poststroke.

Interventions

Thirty minutes of mirror therapy program a day consisting of wrist and finger flexion and extension movements or sham therapy in addition to conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks.

Main Outcome Measures

The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), and hand-related functioning (self-care items of the FIM instrument).

Results

The scores of the Brunnstrom stages for the hand and upper extremity and the FIM self-care score improved more in the mirror group than in the control group after 4 weeks of treatment (by 0.83, 0.89, and 4.10, respectively; all P<.01) and at the 6-month follow-up (by 0.16, 0.43, and 2.34, respectively; all P<.05). No significant differences were found between the groups for the MAS.

Conclusions

In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity.

Section snippets

Participants

Patients recruited in this study were referred from all over Turkey for inpatient rehabilitation. Generally, in Turkey, an estimated 50% of the stroke population is referred to a rehabilitation center if they cannot return home directly after discharge from the hospital. Two physiatrists (SS, NS) assessed potential participants to determine eligibility and to collect written informed consent. The trial included 40 inpatients with hemiparesis after stroke (mean age, 63.2y; mean time since

Results

Initial and final evaluations were made 1 to 3 days before and 1 to 3 days after the treatment period. None of the patients missed more than 1 scheduled session during the study, and all of them finished the treatment period. However, 3 patients from the mirror group and 1 patient from the control group could not come to the follow-up clinic for final evaluation because of economic reasons. We did not observe any adverse events.

Demographic and clinical characteristics of the 2 groups are

Discussion

This study shows that mirror therapy in addition to a conventional rehabilitation program was more beneficial in terms of motor recovery and hand-related functioning than a similar treatment without mirroring. The beneficial effect on hand functioning started at posttreatment and continued during the 6-month follow-up evaluation. However, we found no effect on spasticity.

Several underlying mechanisms for the effect of mirror therapy on motor recovery after stroke have been proposed. For

Conclusions

In our group of subacute stroke patients, hand function improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment directly after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy does not affect spasticity.

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