Effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke: A randomized sham-controlled pilot trial

Abstract

Objective:To evaluate the effectiveness of mirror therapy on lower extremity motor recovery, balance and mobility in patients with acute stroke.Design:A randomized, sham-controlled, assessor blinded, pilot trial.Setting:Inpatient stroke rehabilitation unit.Subjects:First time onset of stroke with mean post-stroke duration of 6.41 days, able to respond to verbal instructions, and Brunnstrom recovery stage 2 and above were enrolled.Intervention:Mirror therapy group performed 30 minutes of functional synergy movements of non-paretic lower extremity, whereas control group underwent sham therapy with similar duration. In addition, both groups were administered with conventional stroke rehabilitation regime. Altogether 90 minutes therapy session per day, six days a week, for two weeks duration was administered to both groups.Outcome Measures:Lower extremity motor subscale of Fugl Meyer Assessment (FMA), Brunnel Balance Assessment (BBA) and Functional Ambulation Categories (FAC).Results:Amongst the 22 patients included, equal number of patients participated in mirror group (N = 11) and control group (N = 11). Baseline variables were similar in both groups, except for Brunnstrom recovery stage. There was no statistical difference between groups, except for FAC. (FMA: P = 0.894; BBA: P = 0.358; FAC: P = 0.02). Significance was set at P < 0.05.Conclusion:Administration of mirror therapy early after stroke is not superior to conventional treatment in improving lower limb motor recovery and balance, except for improvement in mobility.

Effect of teaching with or without mirror on balance in young female ballet students

“…This improvement is due to the time. These results did not support the initial hypothesis that mirror training would be more effective to improve balance compared non-mirror training, consistent with a recent clinical study in which the use of a mirror was proved not to be useful in improving balance [50]. The lack of between-group difference could probably be due to the short duration of administration of mirror visual feedback.…”

A novel bilateral lower extremity mirror therapy intervention for individuals with stroke

“…It is important to emphasize that this intervention combined MT with bilateral training of LE movements which to our knowledge is the first post-stroke MT intervention for the LE to do so. While previous MT interventions for the UE incorporated bilateral movements [10], those for the LE have employed unilateral movement of the unaffected limb only [21], [22]. In the present study, participants demonstrated improved tolerance and endurance for bilateral MT training over the intervention period.…”

“…One randomized controlled trial (RCT) of a MT intervention that used ankle dorsiflexion movement for 5 days a week, 2 to 5 h a day, for 4 weeks in individuals with chronic stroke reported improved motor recovery and functional independence, but no difference in functional ambulation category (FAC) [21]. A second RCT included six LE-MT exercises for individuals with acute stroke for 30 min a day, six days a week, for two weeks [22]. Findings included improved ambulation as measured by FAC but no differences between groups in Brunnel Balance Assessment scores or motor recovery [22].…”

“…A second RCT included six LE-MT exercises for individuals with acute stroke for 30 min a day, six days a week, for two weeks [22]. Findings included improved ambulation as measured by FAC but no differences between groups in Brunnel Balance Assessment scores or motor recovery [22].…”

“…These factors may explain why the previous studies of MT for the LE [21], [22] chose to train unilateral movement of the unaffected LE only. Therefore, the challenge of our proposed combination of bilateral LE movement training with MT was to design a device that facilitated movement of the affected LE behind the mirror.…”