Cent Eur J Nurs Midw 2021, 12(1):295-305 | DOI: 10.15452/cejnm.2020.11.0026

Mirror therapy in adult stroke patients: a review of possible applications and effectiveness with an emphasis on activities of daily living

Jan Chrastina, Hana Svízelová
Institute of Special Education Studies, Faculty of Education, Palacký University Olomouc, Olomouc, Czech Republic

Aim:  To present the current knowledge about possible applications, effectiveness, and other aspects of mirror therapy in adult stroke clients, with an emphasis on the performance of Activities of Daily Living (ADL), or on supporting independence and self-care, including limitations.

Design:  A descriptive mapping study.

Methods:  A systematic literature search and an interpretative content analysis (according to predetermined criteria) of 34 identified relevant studies (2000–2017) and conceptualization of findings in relation to ADL performance / limitation among adult stroke clients.

Results:  Mirror Therapy (MT) is a simple and undemanding approach which improves the function of extremities with respect to performance of ADL. However, due to smaller research samples, it is impossible to clearly confirm its effectiveness and extrapolate the conclusions. MT is also used to complement other therapeutic approaches, or various approaches can be combined with it (e.g., micro-sensory electrical stimulation or observation imitation). Assessment of ADL was primarily performed with the Barthel Index, Modified Barthel Index, and Functional Independence Measures, Functional Ambulation Categories, and Foot and Ankle Ability Measure tests.

Conclusion:  It seems desirable to apply task-oriented MT – an approach that includes functional tasks to prevent clients from becoming bored during therapy. The performance of MT tasks need not always be supervised by a physiotherapist. Good cooperation between nurses from clinical practice and physiotherapy is desirable. In order to be able to widen the conclusions and clearly confirm the effectiveness of MT in the context of ADL, other randomized controlled (pilot) studies are desirable.

Keywords: activities of daily living, adult stroke patients, mirror therapy, stroke, task-oriented mirror therapy

Received: April 6, 2020; Revised: May 6, 2020; Accepted: September 16, 2020; Prepublished online: December 28, 2020; Published: March 5, 2021  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Chrastina J, Svízelová H. Mirror therapy in adult stroke patients: a review of possible applications and effectiveness with an emphasis on activities of daily living. Central European Journal of Nursing and Midwifery. 2021;12(1):295-305. doi: 10.15452/cejnm.2020.11.0026.
Download citation

References

  1. Baek, N. Y. (2009). Effects of mirror therapy on hemiplegia in the function of lower extremity [Unpublished master's thesis]. Department of Physical Therapy, Graduate School of Rehabilitation Science, Daegu University.
  2. Bowering, K. J., OʼConnell, N. E., Tabor, A., Catley, M. J., Leake, H. B., Moseley, G. L., & Stanton, T. R. (2013). The effects of graded motor imagery and its components on chronic pain: a systematic review and meta-analysis. The Journal of Pain, 14(1), 3-13. https://doi.org/10.1016/j.jpain.2012.09.007 Go to original source... Go to PubMed...
  3. Colomer, C., Noé, E., & Llorens, R. (2016). Mirror therapy in chronic stroke survivors with severely impaired upper limb function: a randomized controlled trial. European Journal of Physical and Rehabilitation Medicine, 52(3), 271-278. Go to PubMed...
  4. Cooper, D. (2016). What is a "mapping study?ˮ Journal of the Medical Library Association, 104(1), 76-78. https://dx.doi.org/10.3163%2F1536-5050.104.1.013 Go to original source... Go to PubMed...
  5. Cortez, B. V., Coêlho, C. K. S., Silva, D. R. C., Oliveira, M. C. B., Oliveira, G. B. V. P., Sousa e Silva, F. M., Frederico, É. H. F. F., Sá-Caputo, D. C., Bernardo-Filho, M., & Silva, J. M. (2016). Effects of mirror therapy on the lower limb functionality hemiparesis after stroke. Health, 8(14), 1442-1452. http://dx.doi.org/10.4236/health.2016.814144 Go to original source...
  6. Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26(2), 91-108. https://doi.org/10.1111/j.1471-1842.2009.00848.x Go to original source... Go to PubMed...
  7. Grünert-Plüss, N., Hufschmid, U., Santschi, L., & Grünert, J. (2008). Mirror therapy in hand rehabilitation: a review of the literature, the St Gallen Protocol for mirror therapy and evaluation of a case series of 52 patients. The British Journal of Hand Therapy, 13(1), 4-11. https://doi.org/10.1177%2F175899830801300101 Go to original source...
  8. Hung, G. K. N., Li, C. T. L., Yiu, A. M., & Fong, K. N. K. (2015). Systematic review: effectiveness of mirror therapy for lower extremity post-stroke. Hong Kong Journal of Occupational Therapy, 26(1), 51-59. https://doi.org/10.1016/j.hkjot.2015.12.003 Go to original source...
  9. Invernizzi, M., Negrini, S., Carda, S., Lanzotti, L., Cisari, C., & Baricich, A. (2013). The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients: a randomized controlled trial. European Journal of Physical and Rehabilitation Medicine, 49(3), 311-317. Go to PubMed...
  10. Ji, S. G., & Kim, M. K. (2015). The effects of mirror therapy on the gait of subacute stroke patients: a randomized controlled trial. Clinical Rehabilitation, 29(4), 348-354. https://doi.org/10.1177/0269215514542356 Go to original source... Go to PubMed...
  11. Jönsson, A. C., Lindgren, I., Hallström, B., Norrving, B., & Lindgren, A. (2006). Prevalence and intensity of pain after stroke: a population based study focusing on patients' perspectives. Journal of Neurology, Neurosurgery, and Psychiatry, 77(5), 590-595. https://dx.doi.org/10.1136%2Fjnnp.2005.079145 Go to original source... Go to PubMed...
  12. Lan, M., Huiling, L., Yuhong, F., Jun, W., Jun, Y., Weixiang, Y., & Liping, Z. (2016). Study on construction scheme of mirror therapy rehabilitation nursing in patients with severed finger reunion on the basis of Delphi method. Chinese Journal of Modern Nursing, 22(29), 4193-4196. http://dx.chinadoi.cn/10.3760/cma.j.issn.1674-2907.2016.29.012
  13. Lee, Y. Y., Lin, K. C., Wu, C. Y., Liao, C. H., Lin, J. C., & Chen, C. L. (2015). Combining afferent stimulation and mirror therapy for improving muscular, sensorimotor, and daily functions after chronic stroke: a randomized, placebo-controlled study. American Journal of Physical Medicine & Rehabilitation, 94(10), 859-868. https://doi.org/10.1097/phm.0000000000000271 Go to original source... Go to PubMed...
  14. Lim, K. B., Lee, H. J., Yoo, J., Yun, H. J., & Hwang, H. J. (2016). Efficacy of Mirror Therapy Containing Functional Tasks in Poststroke Patients. Annals of Rehabilitation Medicine, 40(4), 629-636. https://dx.doi.org/10.5535%2Farm.2016.40.4.629 Go to original source... Go to PubMed...
  15. Lin, K. C., Huang, P. C., Chen, Y. T., Wu, C. Y., & Huang, W. L. (2014a). Combining afferent stimulation and mirror therapy for rehabilitating motor function, motor control, ambulation, and daily functions after stroke. Neurorehabilitation and Neural Repair, 28(2), 153-162. https://doi.org/10.1177/1545968313508468 Go to original source... Go to PubMed...
  16. Lin, K. C., Chen, Y. T., Huang, P. C., Wu, C. Y., Huang, W. L., Yang, H. W., Lai, H. T., & Lu, H. J. (2014b). Effect of mirror therapy combined with somatosensory stimulation on motor recovery and daily function in stroke patients: a pilot study. Journal of the Formosan Medical Association, 113(7), 422-428. https://doi.org/10.1016/j.jfma.2012.08.008 Go to original source... Go to PubMed...
  17. Lindgren, I., Jönsson, A. C., Norrving, B., & Lindgren, A. (2007). Shoulder pain after stroke: a prospective population-based study. Stroke, 38(2), 343-348. https://doi.org/10.1161/01.str.0000254598.16739.4e Go to original source... Go to PubMed...
  18. Louie, D. R., Lim, S. B., & Eng, J. J. (2019). The Efficacy of Lower Extremity Mirror Therapy for Improving Balance, Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis. Journal of Stroke and Cerebrovascular Diseases, 28(1), 107-120. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.09.017 Go to original source... Go to PubMed...
  19. Mathieson, S., Parsons, J., Kaplan, M., & Parsons, M. (2018). Combining functional electrical stimulation and mirror therapy for upper limb motor recovery following stroke: a randomised trial. European Journal of Physiotherapy, 20(4), 244-249. https://doi.org/10.1080/21679169.2018.1472635 Go to original source...
  20. Michielsen, M. E., Selles, R. W., van der Geest, J. N., Eckhardt, M., Yavuzer, G., Stam, H. J., Smits, M., Ribbers, G. M., & Bussmann, J. B. (2011). Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabilitation and Neural Repair, 25(3), 223-233. https://doi.org/10.1177/1545968310385127 Go to original source... Go to PubMed...
  21. Mohan, U., Babu, S. K., Kumar, K. V., Suresh, B. V., Misri, Z. K., & Chakrapani, M. (2013). Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: a randomized sham-controlled pilot trial. Annals of Indian Academy of Neurology, 16(4), 634-639. https://doi.org/10.4103/0972-2327.120496 Go to original source... Go to PubMed...
  22. Moseley, G. L., Gallace, A., & Spence, C. (2008). Is mirror therapy all it is cracked up to be? Current evidence and future directions. Pain, 138(1), 7-10. https://doi.org/10.1016/j.pain.2008.06.026 Go to original source... Go to PubMed...
  23. Najiha, A., Alagesan, J., Rathod, V. J., & Paranthaman, P. (2015). Mirror therapy: a review of evidences. International Journal of Physiotherapy and Research, 3(3), 1086-1090. http://dx.doi.org/10.16965/ijpr.2015.148 Go to original source...
  24. Paik, Y-R., Kim, S-K., Lee, J-S., & Jeon, B-J. (2014). Simple and task-oriented mirror therapy for upper extremity function in stroke patients: a pilot study. Hong Kong Journal of Occupational Therapy, 24(1), 6-12. https://doi.org/10.1016%2Fj.hkjot.2014.01.002 Go to original source...
  25. Park, J. Y., Chang, M., Kim, K. M., & Kim, H. J. (2015). The effect of mirror therapy on upper-extremity function and activities of daily living in stroke patients. Journal of Physical Therapy Science, 27(6), 1681-1683. https://dx.doi.org/10.1589%2Fjpts.27.1681 Go to original source... Go to PubMed...
  26. Radajewska, A., Opara, J. A., Kucio, C., Błaszczyszyn, M., Mehlich, K., & Szczygiel, J. (2013). The effects of mirror therapy on arm and hand function in subacute stroke in patients. International Journal of Rehabilitation Research, 36(3), 268-274. https://doi.org/10.1097/mrr.0b013e3283606218 Go to original source... Go to PubMed...
  27. Rajappan, R., Abudaheer, S., Selvaganapathy, K., & Gokanadason, D. (2015). Effect of mirror therapy on hemiparetic upper extremity in subacute stroke patients. International Journal of Physiotherapy, 2(6), 1041-1046. https://doi.org/10.15621/ijphy/2015/v2i6/80766 Go to original source...
  28. Ramachandran, V. S., & Rogers-Ramachandran, D. (1996). Synaesthesia in phantom limbs induced with mirrors. Proceedings of the Royal Society B: Biological Sciences, 263(1369), 377-386. https://doi.org/10.1098/rspb.1996.0058 Go to original source... Go to PubMed...
  29. Rodrigues, L. C., Farias, N. C., Gomes, R. P., & Michaelsen, S. M. (2016). Feasibility and effectiveness of adding object-related bilateral symmetrical training to mirror therapy in chronic stroke: a randomized controlled pilot study. Physiotherapy Theory and Practice, 32(2), 83-91. https://doi.org/10.3109/09593985.2015.1091872 Go to original source... Go to PubMed...
  30. Salem, A. H. M., & Huang, X. (2015). The effects of mirror therapy on clinical improvement in hemiplegic lower extremity rehabilitation in subjects with chronic stroke. International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering, 9(2), 163-166. https://doi.org/10.5281/zenodo.1099406 Go to original source...
  31. Sciusco, A., Ditrenta, G., Rahinò, A., Damiani, S., Megna, M., Ranieri, M., & Megna, G. (2008). Mirror therapy in the motor recovery of upper extremities. Europa Medicophysica, 44(3), 1-5.
  32. Selles, R. W., Michielsen, M. E., Bussmann, J. B. J., Stam, H. J., Hurkmans, H. L., Heijnen, I., de Groot, D., & Ribbers, G. M. (2014). Effects of a mirror-induced visual illusion on a reaching task in stroke patients: implications for mirror therapy training. Neurorehabilitation and Neural Repair, 28(7), 652-659. https://doi.org/10.1177/1545968314521005 Go to original source... Go to PubMed...
  33. Sütbeyaz, S., Yavuzer, G., Sezer, N., & Koseoglu, B. F. (2007). Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 88(5), 555-559. https://doi.org/10.1016/j.apmr.2007.02.034 Go to original source... Go to PubMed...
  34. Thieme, H., Mehrholz, J., Pohl, M., Behrens, J., & Dohle, C. (2012). Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews, 14(3), CD008449. https://doi.org/10.1002/14651858.cd008449.pub2 Go to original source... Go to PubMed...
  35. Thieme, H., Bayn, M., Wurg, M., Zange, C., Pohl, M., & Behrens, J. (2013). Mirror therapy for patients with severe arm paresis after stroke - a randomized controlled trial. Clinical Rehabilitation, 27(4), 314-324. https://doi.org/10.1177/0269215512455651 Go to original source... Go to PubMed...
  36. Toh, S. F. M., & Fong, K. N. K. (2012). Systematic Review on the Effectiveness of Mirror Therapy in Training Upper Limb Hemiparesis after Stroke. Hong Kong Journal of Occupational Therapy, 22(2), 84-95. https://doi.org/10.1016/j.hkjot.2012.12.009 Go to original source...
  37. Wada, Y., Kondo, I., Sonoda, S., Yamada, K., Narukawa, A., Kawakami, K., Nonoyama, S., Miyasaka, H., Teranishi, T., Nagai, S., & Takeshima, N. (2011). Mirror therapy for severely affected ankle joints of stroke patients. Japanese Journal of Comprehensive Rehabilitation Science, 2, 71-76. https://doi.org/10.11336/jjcrs.2.71 Go to original source...
  38. Yavuzer, G., Selles, R., Sezer, N., Sütbeyaz, S., Bussmann, J. B., Köseoğlu, F., Atay, M. B., & Stam, H. J. (2008). Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 89(3), 393-398. https://doi.org/10.1016/j.apmr.2007.08.162 Go to original source... Go to PubMed...
  39. Yeldan, I., Huseyinsinoglu, B. E., Akinci, B., Tarakci, E., Baybas, S., & Ozdincler, A. R. (2015). The effects of very early mirror therapy on functional improvement of the upper extremity in acute stroke patients. Journal of Physical Therapy Science, 27(11), 3519-3524. https://doi.org/10.1589/jpts.27.3519 Go to original source... Go to PubMed...
  40. Yildirim, M., & Kanan, N. (2016). The effect of mirror therapy on the management of phantom limb pain. Aǧri: Ağri (Algoloji) Derneği'nin Yayin organidir, 28(3), 127-134. https://doi.org/10.5505/agri.2016.48343 Go to original source... Go to PubMed...
  41. Yoo, S. J. (2010). An effect of mirror therapy on upper extremity function and activities of daily living in patients with poststroke hemiplegia [Unpublished masterʼs thesis]. Department of Occupational Therapy, Graduate School of Rehabilitation Science, Daegu University.
  42. Zhang, X., Liang, J., & Huang, R. (2018a). Effect of acupuncture combined with mirror therapy on functional recovery of posterior lower limb after stroke and observation on nursing effect. Journal of Sichuan Traditional Chinese Medicine, 3, 208-210.
  43. Zhang, R., Liu, B., Chen, W., Zheng, Y., Huang, W., Yu, Y., Wu, L., & Zhu, M. (2018b). Effects of mirror therapy combined with 'Tong Du Xing Shen' acupuncture therapy on function recovery of upper limbs after stroke. Medical Exploration, 3(1), 16-26.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.