Mirror Therapy for Improving Motor Function After Stroke

Erste Europäische Schule für Physiotherapie, Ergotherapie und Logopädie, Klinik Bavaria Kreischa, Kreischa, Sachen, Germany. .
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 12/2012; 3(1):CD008449. DOI: 10.1002/14651858.CD008449.pub2
Source: PubMed

ABSTRACT Objectives:
This systematic review summarizes the effectiveness of mirror therapy for improving motor function, activities of daily living, pain, and visuospatial neglect in patients after stroke.

We searched the Cochrane Stroke Group’s Trials Register (June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1950 to June 2011), EMBASE (1980 to June 2011), CINAHL (1982 to June 2011), AMED (1985 to June 2011), PsycINFO (1806 to June 2011), and PEDro (June 2011). We also handsearched relevant conference proceedings, trials, and research registers; checked reference lists; and contacted trialists, researchers, and experts in our field of study. We included randomized controlled trials and randomized crossover trials comparing mirror therapy with any control intervention for patients after stroke. Two review authors independently selected trials based on the inclusion criteria, documented the methodological quality of studies, and extracted data. The primary outcome was motor function. We analyzed the results as standardized mean differences (SMDs) for continuous variables.

We included 14 studies with a total of 567 participants, which compared mirror therapy with other interventions. When compared with all other interventions, mirror therapy was found to have a significant effect on motor function (postintervention data: SMD 0.61; 95% CI 0.22 to 1.0; P=0.002; change scores: SMD 1.04; 95% CI 0.57 to 1.51; P<0.0001) ; Figure). However, effects on motor function are influenced by the type of control intervention. Additionally, mirror therapy was found to improve activities of daily living (SMD 0.33; 95% CI 0.05 to 0.60; P=0.02). We found a significant positive effect on pain (SMD −1.10; 95% CI −2.10 to −0.09; P=0.03), which is influenced by patient population. We found limited evidence for improving visuospatial neglect (SMD 1.22; 95% CI 0.24 to 2.19; P=0.01). The effects on motor function were stable at follow-up assessment after 6 months.

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Available from: Jan Mehrholz, Nov 18, 2014
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    • "A complementary approach to that discussed above may also involve combining TMS measurements with non-invasive brain stimulation techniques to up-or down-regulate specific motor regions of interest and investigating the impact upon the neural mechanisms (e.g., PMd-M1 connectivity) and how these are subsequently affected by alterations in visual feedback. Indeed, if net excitability (as investigated by traditional TMS measurements) is not the driving factor underlying the beneficial effect of mirror feedback (see Ramachandran & Altschuler, 2009; Thieme et al., 2012), this approach could give further insight into the underlying neurological mechanisms of MT. "
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    ABSTRACT: Provision of a mirror image of a hand undertaking a motor task (i.e., mirror therapy) elicits behavioural improvements in the inactive hand. A greater understanding of the neural mechanisms underpinning this phenomenon is required to maximise its potential for rehabilitation across the lifespan, e.g., following hemiparesis or unilateral weakness. Young and older participants performed unilateral finger abductions with no visual feedback, with feedback of the active or passive hands, or with a mirror image of the active hand. Transcranial magnetic stimulation was used to assess feedback-related changes in two neurophysiological measures thought to be involved in inter-manual transfer of skill, namely corticospinal excitability (CSE) and intracortical inhibition (SICI) in the passive hemisphere. Task performance led to CSE increases, accompanied by decreases of SICI, in all visual feedback conditions relative to rest. However, the changes due to mirror feedback were not significantly different to those observed in the other (more standard) visual conditions. Accordingly, the unimanual motor action itself, rather than modifications in visual feedback, appears more instrumental in driving changes in CSE and SICI. Therefore, changes in CSE and SICI are unlikely to underpin the behavioural benefits of mirror therapy. We discuss implications for rehabilitation and directions of future research.
    Neuropsychological Rehabilitation 06/2014; 24(6):1-22. DOI:10.1080/09602011.2014.922889 · 1.96 Impact Factor
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    • "These examples show that under some conditions, the brain can be “fooled” by multisensory stimulation in a way that stimulations are perceived that do not actually exist. This may elicit visuo- tactile illusions with regard to a person’s self-body schema [14,18,21]. "
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    ABSTRACT: The goal of this study was to test whether central mechanisms of scratching-induced itch attenuation can be activated by scratching the limb contralateral to the itching limb when the participant is made to visually perceive the non-itching limb as the itching limb by means of mirror images. Healthy participants were asked to assess the intensity of an experimentally induced itch at their right forearm while they observed externally guided scratch movements either at their right (itching) or left (non-itching) forearm which were either mirrored or not mirrored. In the first experiment, a mirror placed between the participant's forearms was used to create the visual illusion that the participant's itching (right) forearm was being scratched while in fact the non-itching (left) forearm was scratched. To control visibility of the left (non-mirrored) forearm, a second experiment was performed in which unflipped and flipped real-time video displays of the participant's forearms were used to create experimental conditions in which the participant visually perceived scratching either on one forearm only, on both forearms, or no scratching at all. In both experiments, scratching the non-itching limb attenuated perceived itch intensity significantly and selectively in the mirror condition, i.e., when the non-itching forearm was visually perceived as the itching limb. These data provide evidence that the visual illusion that an itching limb is being scratched while in fact the non-itching limb contralateral to the itching limb is scratched, can lead to significant itch relief. This effect might be due to a transient illusionary intersensory perceptual congruency of visual, tactile and pruriceptive signals. "Mirror scratching" might provide an alternative treatment to reduce itch perception in focal skin diseases with persistent pruritus without causing additional harm to the affected skin and might therefore have significant clinical impact.
    PLoS ONE 12/2013; 8(12):e82756. DOI:10.1371/journal.pone.0082756 · 3.23 Impact Factor
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    • "Mirror training (Ramachandran, Rogers-Ramachandran, & Cobb, 1995) consists in having patients watch movements of a mirror image of their existing/unaffected limb appearing in the position of their amputated/affected limb. Training over the course of several weeks—partly in combination with additional motor imagery training—has been shown to effectively reverse pain and/or motor disability (Chan et al., 2007; McCabe, Haigh, & Blake, 2008; Mercier & Sirigu, 2009; Moseley, 2004; Thieme, Mehrholz, Pohl, Behrens, & Dohle, 2012), along with a reversal of putatively maladaptive brain changes (Giraux & Sirigu, 2003; MacIver, Lloyd, Kelly, Roberts, & Nurmikko, 2008). "
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    ABSTRACT: Mirror training and movement imagery have been demonstrated to be effective in treating several clinical conditions, such as phantom limb pain, stroke-induced hemiparesis, and complex regional pain syndrome. This article presents an augmented reality home-training system based on the mirror and imagery treatment approaches for hand training. A head-mounted display equipped with cameras captures one hand held in front of the body, mirrors this hand, and displays it in real time in a set of four different training tasks: (1) flexing fingers in a predefined sequence, (2) moving the hand into a posture fitting into a silhouette template, (3) driving a “Snake” video game with the index finger, and (4) grasping and moving a virtual ball. The system records task performance and transfers these data to a central server via the Internet, allowing monitoring of training progress. We evaluated the system by having 7 healthy participants train with it over the course of ten sessions of 15-min duration. No technical problems emerged during this time. Performance indicators showed that the system achieves a good balance between relatively easy and more challenging tasks and that participants improved significantly over the training sessions. This suggests that the system is well suited to maintain motivation in patients, especially when it is used for a prolonged period of time. Electronic supplementary material The online version of this article (doi:10.3758/s13428-013-0412-4) contains supplementary material, which is available to authorized users.
    Behavior Research Methods 12/2013; 46(3). DOI:10.3758/s13428-013-0412-4 · 2.12 Impact Factor
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