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Mirror Therapy

Introduction

Mirror therapy is a form of motor imagery in which a mirror is used to convey visual stimuli to the brain through observation of one's unaffected body part as it carries out a set of movements. The underlying principle is that movement of the affected limb can be stimulated via visual cues originating from the opposite side of the body. Hence, it is thought that this form of therapy can prove useful in patients who have lost movement of an arm or leg including those who have had a stroke.

NOTE: Some of the effects of mirror therapy on the brain have already been demonstrated. In a crossover study on healthy individuals, Garry, Loftus & Summers (2004) showed that viewing the mirror image of one's active hand increased the excitability of neurons in the ipsilateral primary motor cortex (pictured below in yellow) significantly more than viewing the inactive hand directly (no mirror). As well, a trend toward significance was found in favour of viewing a mirror image of the active hand compared to viewing the active hand directly (no mirror). This study was not included in the in depth review below as it involved only neurologically healthy patients (non-stroke).

 

Authors*: Adam Kagan, B.Sc.; Samuel Harvey-Vaillancourt, PT U3; Shahin Tavakol, PT U3; Dan Moldoveanu, PT U3; Phonesavanh Cheang, PT U3; Elissa Sitcoff, BA BSc; Nicol Korner-Bitensky, PhD OT

 

NOTE: *The authors have no direct financial interest in any tools, tests or interventions presented in StrokEngine.

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*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

 

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

 

*high quality = PEDro score 6-10

*fair quality = PEDro score 4-5

*poor quality = PEDro score ≤ 3

The PEDro scale was developed by the Physiotherapy Evidence Database to determine the quality of clinical trials. The PEDro scale consists of a checklist of 10 scored yes-or-no questions pertaining to the internal validity and the statistical information provided. Please click on the link for more information: http://www.pedro.org.au/english/downloads/pedro-scale/

A randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.

 

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

Patients between 1-6 months post-stroke are identified as in sub-acute stage of recovery.

 

1a (Strong) Well-designed meta-analysis, or 2 or more high quality RCTs (PEDro ≥ 6) showing similar findings
1b(Moderate) 1 RCT of high quality (PEDro ≥ 6)
2a (Limited) At least 1 fair quality RCT (PEDro = 4-5)
2b (Limited) At least one poor quality RCT (PEDro < 4) or well-designed non-experimental study (non-randomized controlled trial, quasi-experimental studies, cohort studies with multiple baselines, single subject series with multiple baselines, etc.)
3(Consensus) Agreement by an expert panel or a group of professionals in the field or a number of pre-post studies all with similar results
4 (Conflicting) Conflicting evidence of 2 or more equally well-designed studies
5 (No evidence) No well-designed studies - only case studies/case descriptions or cohort studies/single subject series with no multiple baselines)

Patients longer than 6 months post-stroke are identified as in chronic stage of recovery.