Mirror Therapy May Facilitate Recovery in Hemiplegic Stroke Patients

Susan Jeffrey

October 15, 2008

October 15, 2008 (Vienna, Austria) — Mirror therapy, a strategy that has been used successfully to treat phantom pain after amputation, may promote recovery from hemiplegia after a stroke, a new study suggests.

In mirror therapy, patients place a mirror beside the unaffected limb, blocking their view of the affected limb, creating the illusion that both limbs are working normally. In a study of 14 hemiplegic patients, those who practiced ankle dorsiflexion using the mirror had more recovery of function in the affected limb than those who underwent direct conditioning.

"If such change can be brought about purely through visual input of movement by the healthy body half, then it stands to reason that the cognitive, which is to say the mental, aspect of rehabilitation, has far greater importance than previously understood and should be paid far more attention," said Kazu Amimoto, MD, from Tokyo Metropolitan University, in Japan, in a statement.

The results were presented here at the 6th World Stroke Congress.

Reflection of Movement

Mirror therapy has now been used in a number of settings, including the treatment of phantom-limb pain after amputation and complex regional pain syndrome, as well as in stroke rehabilitation. The idea is to use the mirror to produce the illusion for the patient that both limbs are intact.

Conventional therapies for hemiplegic limbs use active or passive physical exercise in an attempt to stimulate new neural connections that lead to recovery, the authors note. The addition of mirror therapy might enhance recovery by enlisting direct visual stimulation showing the affected limb working properly, rather than relying on mental imagery alone.

In this study, Dr. Amimoto and colleagues examined the addition of mirror therapy to direct conditioning in 14 right-handed patients with lower-limb hemiplegia. All enrolled were in the chronic phase, 4 months or longer after their stroke. The study used a crossover design: patients were randomized to start with direct conditioning with or without the addition of mirror therapy and then cross over to the other treatment.

A mirror was set up in the sagittal plane. Subjects sat on a chair with the lower limbs placed in the mirrored box. For the movement task, subjects stepped over a 3-cm-high columnar step 10 times. The angle of the ankle joint and the time required to complete the task were calculated using 2-dimensional motion-analysis software.

Dr. Amimoto and colleagues report that the time required to complete the task was significantly shortened by the mirror conditioning, from 3.19 to 2.80 seconds. Direct conditioning was associated with a change in the ankle dorsal flexion angle by 0.8°, but this was not significantly different from the mirror conditioning group.

The changes associated with mirror conditioning using visual stimulation from the sound side underline the importance of the cognitive aspect of recovery as well as the physical, they conclude.

6th World Stroke Congress: Abstract PO-02-274. Presented September 26, 2008.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.