Mirror Therapy for Improving Motor Function After Stroke

Thieme, Holm; Mehrholz, Jan; Pohl, Marcus; Behrens, Johann; Dohle, Christian

doi:10.1161/strokeaha.112.673087

Cited by 102 publications

(44 citation statements)

References 1 publication

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“…Generally speaking, a previous meta-analysis32 based on stroke patients had similar trends as the results we obtained, meaning that non-pharmacological therapy will be important to pursue in future clinical practice. Music is a non-pharmacological, non-invasive, non-adverse reaction and inexpensive intervention training that can be delivered easily and successfully.…”

Section: Discussionsupporting

confidence: 82%

Improvement in Stroke-induced Motor Dysfunction by Music-supported Therapy: A Systematic Review and Meta-analysis

Zhang

Ren

et al. 2016

Sci Rep

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To conduct a meta-analysis of clinical trials that examined the effect of music-supported therapy on stroke-induced motor dysfunction, comprehensive literature searches of PubMed, Embase and the Cochrane Library from their inception to April 2016 were performed. A total of 10 studies (13 analyses, 358 subjects) were included; all had acceptable quality according to PEDro scale score. The baseline differences between the two groups were confirmed to be comparable. Compared with the control group, the standardized mean difference of 9-Hole Peg Test was 0.28 (−0.01, 0.57), 0.64 (0.31, 0.97) in Box and Block Test, 0.47 (0.08, 0.87) in Arm Paresis Score and 0.35 (−0.04, 0.75) in Action Research Arm Test for upper-limb motor function, 0.11 (−0.24, 0.46) in Berg Balance Scale score, 0.09 (−0.36, 0.54) in Fugl-Meyer Assessment score, 0.30 (−0.15, 0.74) in Wolf Motor Function Test, 0.30 (−0.15, 0.74) in Wolf Motor Function time, 0.65 (0.14, 1.16) in Stride length and 0.62 (0.01, 1.24) in Gait Velocity for total motor function, and 1.75 (0.94, 2.56) in Frontal Assessment Battery score for executive function. There was evidence of a positive effect of music-supported therapy, supporting its use for the treatment of stroke-induced motor dysfunction. This study was registered at PRESPERO (CRD42016037106).

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Section: Discussionsupporting

confidence: 82%

Improvement in Stroke-induced Motor Dysfunction by Music-supported Therapy: A Systematic Review and Meta-analysis

Zhang

Ren

et al. 2016

Sci Rep

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“…This evidence is in the medium (=0.35) to large (=0.8) range66 and is comparable to widely applied therapy methods such as, CIMT (15 studies, N = 355, SMD of 0.33 with 95% CI: 0.33 to 1.42, I 2 =78%)67 mirror therapy (11 studies, N = 481, SMD of 0.61 with 95% CI: 0.22 to 1.00, I 2 =75%)6 and mental practice (5 studies, N = 102, 0.62 of with 95% CI: 0.05 to 1.19) 68. Furthermore, it clearly stands out in the context of other emerging technologies such as robotic interventions (31 studies, N = 1078, SMD of 0.35 with 95% CI: 0.18 to 0.51, I 2 = 36%),6 tDCS (7 studies, N = 431, SMD of 0.11, with 95% CI of 0.33 to 1.42, I 2 = 41%)69 and VR (10 studies, N = 363, SMD of 0.27 with 95% CI: 0.05 to 0.49, I 2 = 9%) interventions. Regarding actual FMA‐UE scores, we found six studies with improvements that exceeded a MCID of 5.25 points in the BCI groups, whereas such improvements occurred in only three control groups.…”

Section: Discussionmentioning

confidence: 59%

“…However, approximately 20–30% of all stroke survivors do not qualify for CIMT or other rehabilitation strategies. For those patients, mirror therapy,6 motor imagery,7, 8 action observation therapy,9 electrical stimulation (e.g., noninvasive brain stimulation,10, 11, 12 or vagus nerve stimulation13) and robot‐aided sensorimotor stimulation14 have been investigated as possible alternatives over the last several years. Driven by advances in other technological areas such as virtual and augmented reality (VR/AR), robotics, invasive and noninvasive brain‐computer interfaces (BCIs),15 as well as pharmacology,16, 17 post‐stroke motor rehabilitation is now a fast growing, emerging field.…”

Section: Introductionmentioning

confidence: 99%

Brain‐computer interfaces for post‐stroke motor rehabilitation: a meta‐analysis

Cervera

Soekadar

Ushiba

et al. 2018

Ann Clin Transl Neurol

345

267

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Brain‐computer interfaces (BCIs) can provide sensory feedback of ongoing brain oscillations, enabling stroke survivors to modulate their sensorimotor rhythms purposefully. A number of recent clinical studies indicate that repeated use of such BCIs might trigger neurological recovery and hence improvement in motor function. Here, we provide a first meta‐analysis evaluating the clinical effectiveness of BCI‐based post‐stroke motor rehabilitation. Trials were identified using MEDLINE, CENTRAL, PEDro and by inspection of references in several review articles. We selected randomized controlled trials that used BCIs for post‐stroke motor rehabilitation and provided motor impairment scores before and after the intervention. A random‐effects inverse variance method was used to calculate the summary effect size. We initially identified 524 articles and, after removing duplicates, we screened titles and abstracts of 473 articles. We found 26 articles corresponding to BCI clinical trials, of these, there were nine studies that involved a total of 235 post‐stroke survivors that fulfilled the inclusion criterion (randomized controlled trials that examined motor performance as an outcome measure) for the meta‐analysis. Motor improvements, mostly quantified by the upper limb Fugl‐Meyer Assessment (FMA‐UE), exceeded the minimal clinically important difference (MCID=5.25) in six BCI studies, while such improvement was reached only in three control groups. Overall, the BCI training was associated with a standardized mean difference of 0.79 (95% CI: 0.37 to 1.20) in FMA‐UE compared to control conditions, which is in the range of medium to large summary effect size. In addition, several studies indicated BCI‐induced functional and structural neuroplasticity at a subclinical level. This suggests that BCI technology could be an effective intervention for post‐stroke upper limb rehabilitation. However, more studies with larger sample size are required to increase the reliability of these results.

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“…It is also non-invasive and causes no side-effects, making it safe for patients [25]. Dohle et al [26] reported that mirror therapy led to improvements in upper limb and hand functions in 36 patients with acute ischemic stroke, regardless of their lesions, suggesting that mirror therapy can be performed on different types of patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Mirror Therapy Containing Functional Tasks in Poststroke Patients

et al. 2016

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ObjectiveTo investigate the effect of mirror therapy containing functional tasks on upper extremity function and activities of daily living in patients with subacute stroke.MethodsThe subjects were randomly divided into two groups: the mirror therapy group (30 patients) and the sham therapy group (30 patients). The mirror therapy group underwent a mirror therapy program together with conventional therapy for 20 minutes per day on 5 days per week for 4 weeks. The control group received a sham conventional therapy program under the same schedule as the mirror therapy group. The Fugl-Meyer Motor Function Assessment (FMA), Brunnstrom motor recovery stage, and Modified Barthel Index (MBI) were evaluated 4 weeks after the treatment.ResultsThe upper extremity function on the affected side and ability to perform daily life activities after the intervention were significantly improved in both groups. After 4 weeks of intervention, improvements in the FMA (p=0.027) and MBI (p=0.041) were significantly greater in the mirror therapy group than the sham therapy group.ConclusionIn this study, we found that the mirror therapy containing functional task was effective in terms of improving the upper extremity functions and activities of daily living in patients with subacute stroke.

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Mirror Therapy for Improving Motor Function After Stroke

Cited by 102 publications

References 1 publication

Improvement in Stroke-induced Motor Dysfunction by Music-supported Therapy: A Systematic Review and Meta-analysis

Improvement in Stroke-induced Motor Dysfunction by Music-supported Therapy: A Systematic Review and Meta-analysis

Brain‐computer interfaces for post‐stroke motor rehabilitation: a meta‐analysis

Efficacy of Mirror Therapy Containing Functional Tasks in Poststroke Patients

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