http://nnr.sagepub.com/content/23/3/209.abstract
Abstract
Background. Rehabilitation of the severely affected paretic arm after stroke represents a major challenge, especially in the presence of sensory impairment. Objective. To evaluate the effect of a therapy that includes use of a mirror to simulate the affected upper extremity with the unaffected upper extremity early after stroke. Methods. Thirty-six patients with severe hemiparesis because of a first-ever ischemic stroke in the territory of the middle cerebral artery were enrolled, no more than 8 weeks after the stroke. They completed a protocol of 6 weeks of additional therapy (30 minutes a day, 5 days a week), with random assignment to either mirror therapy (MT) or an equivalent control therapy (CT). The main outcome measures were the Fugl-Meyer subscores for the upper extremity, evaluated by independent raters through videotape. Patients also underwent functional and neuropsychological testing. Results. In the subgroup of 25 patients with distal plegia at the beginning of the therapy, MT patients regained more distal function than CT patients. Furthermore, across all patients, MT improved recovery of surface sensibility. Neither of these effects depended on the side of the lesioned hemisphere. MT stimulated recovery from hemineglect. Conclusions. MT early after stroke is a promising method to improve sensory and attentional deficits and to support motor recovery in a distal plegic limb.
Or this trial:
Motor Recovery and Cortical Reorganization After Mirror Therapy in Chronic Stroke Patients
A Phase II Randomized Controlled Trial
Abstract
Objective. To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis. Methods. A total of 40 chronic stroke patients (mean time post .onset, 3.9 years) were randomly assigned to the mirror group (n = 20) or the control group (n = 20) and then joined a 6-week training program. Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practiced at home 1 hour daily, 5 times a week. The primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip force, spasticity, pain, dexterity, hand-use in daily life, and quality of life at baseline—posttreatment and at 6 months—were all measured by a blinded assessor. Changes in neural activation patterns were assessed with functional magnetic resonance imaging (fMRI) at baseline and posttreatment in an available subgroup (mirror, 12; control, 9). Results. Posttreatment, the FMA improved more in the mirror than in the control group (3.6 ± 1.5, P < .05), but this improvement did not persist at follow-up. No changes were found on the other outcome measures (all Ps >.05). fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only (weighted laterality index difference 0.40 ± 0.39, P < .05). Conclusion. This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization. Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains.
I got mirror therapy back in 1972. Are they re-evaluating it?
ReplyDeleteI think it is more that they are finally getting more trials of it to prove it works. I'm amazed at the 1972 date, I talked to my therapists about this in 2007 and they had not heard about using it for stroke, just amputating phamtom linbs.
ReplyDeleteDean, thank you for doing this. I've spent the last hour perusing your blog, and you are fabulous. I am an OT, I've been to one of Pete Levine's workshops, and I found you via his stroke recovery blog. Keep up the good work!
ReplyDeleteYou describe this as a dangerous therapy but there is on evidence to suggest this, there is no lasting side effects. Some people find it uncomfortable but the feeling stops immediately then the mirror box is removed. In these cases the therapy should be discontinued.
ReplyDeleteAlso amazed at the date I thought Mirror therapy was first described by V.S. Ramachandran in the 90's for treatment of phantom limb pain, but it has since been proven in the treatment of complex regional pain syndrome (CRPS) / RSD, and stroke rehabilitation, as well as for hand and foot rehabilitation following an injury or surgery. www.mirrorboxtherapy.com is a good place to start; it has lots of information and a link to where you can purchase a mirror box.
But Mike you are missing all the problems with this. Breaking a mirror causing 7 years of bad luck. Causing the brain to not be able to disdtinguish right from left. And the main one - depriving the doctors and therapists income from providing this to patients. That line was totally tongue in cheek, needed because of my inability to suggest any course of medical action. As when I suggested asking your doctor for permission to be a 'bad patient'. You don't need a mirror box, a hand mirror in the lap works too.
ReplyDeleteI had the opportunity to experience mirror therapy while getting OT. I found it very exhilarating and worthwhile. Unfortunately, they only offered it on the last day after I plateaued. With the suggestion I can continue it at home.
ReplyDelete-phildogg