Effects of task-based mirror therapy on upper limb motor function in hemiplegia: study protocol for a randomized controlled clinical trial.

BACKGROUND AND PURPOSE: Research to date has lacked definitive evidence to determine whether mirror therapy promotes the recovery of upper extremity function after stroke. Considering that previous studies did not stratify patients based on structural retention, this may be one of the reasons for the negative results obtained in many trials. The goal evaluates the efficacy of TBMT (utilizing an innovatively designed mirror) versus standard occupational therapy for stroke patient's upper limb functionality. METHODS AND ANALYSIS: This single-center randomized controlled trial will involve 50 patients with stroke. All patients will be randomly assigned to either the task-based mirror therapy or the control group. The interventions will be performed 5 days per week for 4 weeks. The primary outcomes will be the mean change in scores on both the FMA-UE and modified Barthel Index (MBI) from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The other outcomes will include the Action Research Arm Test (ARAT), the Nine Hole Peg Test (9HPT), the Functional Independence Measure, and MRI. DISCUSSION: This trial will not only to establish that task-based mirror therapy (TBMT) could improve the recovery of hand function after stroke but also to explore the underlying mechanisms. We expect that this finding will clarify the brain activation and brain network mechanisms underlying the improvement of hand function with task-oriented mirror therapy and lead to new ideas for stroke hand function rehabilitation. TRIAL REGISTRATION: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR2300068855. Registered on March 1, 2023.

360° immersive virtual reality-based mirror therapy for upper extremity function and satisfaction among stroke patients: a randomized controlled trial.

BACKGROUND: Stroke is a leading cause of long-term disability worldwide; therefore, an effective rehabilitation strategy is fundamental. Mirror therapy (MT) has been a popular approach for upper extremity rehabilitation, but it presents some limitations. Recent advancements in virtual reality (VR) technology have introduced immersive VR-based MT, potentially overcoming these limitations and enhancing rehabilitation outcomes. AIM: This study aimed to evaluate the effectiveness of a novel 360° immersive virtual reality-based MT (360MT) in upper extremity rehabilitation for stroke patients, comparing it to traditional MT (TMT) and conventional physical therapy control group (CG). DESIGN: A prospective, active control, assessor blinded, parallel groups, randomized controlled trial. POPULATION: Forty-five participants with chronic stroke within six months of onset. METHODS: The participants were randomly allocated to 360MT, TMT, or CG groups. Outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), and Manual Function Test (MFT). Additionally, patient experience and satisfaction in the groups of 360MT and TMT were assessed through questionnaires and interviews. RESULTS: Results revealed that the 360MT group showed significantly greater improvements in FMA-UE, MFT and BBT compared to TMT (P<0.05) and CG (P<0.001) groups. Patient experience and satisfaction were more favorable in the 360MT group, with participants reporting higher engagement and motivation. CONCLUSIONS: 360MT appears to be a promising approach for upper extremity rehabilitation in stroke patients, providing better outcomes and higher patient satisfaction. However, further research is needed to confirm these findings and strengthen the evidence base for 360MT in stroke rehabilitation. CLINICAL REHABILITATION IMPACT: 360MT demonstrated notably enhanced upper extremity rehabilitation outcomes as well as better patient satisfaction among chronic stroke patients within six months of onset compared to traditional MT and conventional physical therapy. This novel approach not only fostered functional improvements but also elevated levels of engagement and motivation among participants, suggesting a promising future application in stroke rehabilitation framework.

Virtual Reality Self Co-Embodiment: An Alternative to Mirror Therapy for Post-Stroke Upper Limb Rehabilitation.

We present Virtual Reality Self Co-embodiment, a new method for post-stroke upper limb rehabilitation. It is inspired by mirror therapy, where the patient's healthy arm is involved in recovering the affected arm's motion. By tracking the user's head, wrists, and fingers' positions, our new approach allows the handicapped arm to control a digital avatar in order to pursue a reaching task. We apply the concept of virtual co-embodiment to use the information from the unaffected arm and complete the affected limb's impaired motion, which is our added unique feature. This requires users to mechanically involve the incapacitated area as much as possible, prioritizing actual movement rather than the sole imagination of it. As a result, subjects will see a seemingly normally functional virtual arm primarily controlled by their handicapped extremity, but with the constant support of their healthy limb's motion. Our experiment compares the task execution performance and embodiment perceived when interacting with both mirror therapy and our proposed technique. We found that our approach's provided sense of ownership is mildly impacted by users' motion planning response times, which mirror therapy does not exhibit. We also observed that mirror therapy's sense of ownership is moderately affected by the subject's proficiency while executing the assigned task, which our new method did not display. The results indicate that our proposed method provides similar embodiment and rehabilitation capabilities to those perceived from existing mirror therapy. This experiment was performed in healthy individuals to have an unbiased comparison of how mirror therapy's and VRSelfCo's task performance and degree of virtual embodiment compare, but future work explores the possibility of applying this new approach to actual post-stroke patients.

Maximum tolerable daily dose of mirror movement therapy ankle exercises after stroke: an early phase dose screening study.

BACKGROUND: Mirror movement therapy may reduce lower limb motor impairment after stroke. The dose is unknown. OBJECTIVE: identify the maximum tolerable dose a day (MTD) of lower limb mirror movement therapy DESIGN: 3 + 3 cohort rule-based, dose escalation/de-escalation study. After undertaking baseline measures participants performed mirror movement therapy for 14 consecutive days. Participants then undertook outcome measures. Cohort One trained for 15 minutes daily. Subsequent cohorts exercised at a dose set according to pre-set rules and the modified Fibonacci sequence. The study stopped when the difference between set doses for consecutive cohorts was 10% or less. SETTING: Participants' homes (intervention) and a movement analysis laboratory (measures). PARTICIPANTS: Adults discharged from statutory stroke rehabilitation services. INTERVENTION: Mirror movement therapy ankle exercises. OUTCOME MEASURES: Motricity Index (primary) and bilateral time symmetry from movement onset to peak activation of Tibialis Anterior muscles during standardised sit-to-stand (secondary). RESULTS: Five cohorts of three participants were included (n = 15). Mean (SD) age and time after stroke were 61 (9) years and 35 (42) months respectively. Set daily doses for the five cohorts were: 15, 30, 50, 40 then 35 minutes. The set dose for a subsequent cohort (six) would have been 38 minutes thus the difference from cohort five would have been three minutes i.e., 9% different. Therefore, the study stopped CONCLUSION: The identified MTD of lower limb mirror therapy was 35 minutes daily when frequency was set at seven days a week and duration as two weeks. CLINICAL TRIAL REGISTRATION NUMBER: NCT04339803 (ClinicalTrials.gov) CONTRIBUTION OF THE PAPER: This early phase study found that the maximum tolerable dose per day (MTD) of mirror movement therapy ankle exercises was 35 minutes when frequency was set at seven days a week and duration as two weeks. The optimal therapeutic dose will therefore be somewhere in the range of 15 (starting dose) to 35 minutes per day. Further dose articulation studies are required to identify the optimal therapeutic dose before use of findings in clinical practice. This study is the first step in that research process.

Task-based and Magnified Mirror Therapy for Unilateral Spatial Neglect among post-stroke subjects: Study protocol for a randomized controlled trial.

BACKGROUND: Unilateral spatial neglect (USN) is a commonly occurring neurocognitive disability after a stroke. The neglect may affect the motor recovery of the upper and lower limbs and functional performances. Mirror therapy, a simple and economical approach has the potential to reduce the USN and related impairments. AIM: The primary objective of this study is to determine the effectiveness of task-based and magnified mirror therapy on the USN and on the motor recovery of the post-stroke subjects. The secondary objective is to investigate the effectiveness of the intervention on the function and disability of the subjects. METHODS: In this randomized controlled, assessor-blinded trial, 86 post-stroke subjects will be recruited from the neuro-rehabilitation laboratory of a rehabilitation institute, located in northern India. The participants,aged20 to 80 years, with 1 to 36 months of stroke onset, hemiparesis, and the USN, will be considered eligible for the study. In addition to the conventional rehabilitation, the experimental group(n = 43) will receive 40 sessions (8 weeks) of Task-based and MAGnified Mirror Therapy for Unilateral Spatial Neglect (T-MAGUSN). The control group (n = 43) will undergo a dose-matched conventional program only. The participants will be assessed at baseline, post-intervention and 4-week follow-up using primary (Line Bisection Test, Letter Cancellation Test, and Fugl-Myer Assessment) and secondary (Catherine Bergego Scale, Berg Balance Scale, Functional Ambulation Classification, Modified Rankin Scale) outcome measures. DISCUSSION: This proposed study will lead to the development of a novel rehabilitation protocol for the management of USN, aiming to enhance motor and functional recovery. The investigation will consider both the upper and lower limbs for the intervention, reducing the impact of cognitive disability in stroke. TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI) as CTRI/2023/05/053184 (www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=74659).

Evidence of mirror therapy for recruitment of ipsilateral motor pathways in stroke recovery: A resting fMRI study.

Mirror therapy (MT) has been proposed to promote motor recovery post-stroke through activation of mirror neuron system, recruitment of ipsilateral motor pathways, or/and increasing attention toward the affected limb. However, neuroimaging evidence for these mechanisms is still lacking. To uncover the underlying mechanisms, we designed a randomized controlled study and used a voxel-based whole-brain analysis of resting-state fMRI to explore the brain reorganizations induced by MT. Thirty-five stroke patients were randomized to an MT group (n â€‹= â€‹16) and a conventional therapy (CT) group (n â€‹= â€‹19) for a 4-week intervention. Before and after the intervention, the Fugl-Meyer Assessment Upper Limb subscale (FMA-UL) and resting-state fMRI were collected. A healthy cohort (n â€‹= â€‹16) was established for fMRI comparison. The changes in fractional amplitude of low-frequency fluctuation (fALFF) and seed-based functional connectivity were analyzed to investigate the impact of intervention. Results showed that greater FMA-UL improvement in the MT group was associated with the compensatory increase of fALFF in the contralesional precentral gyrus (M1) region and the re-establishment of functional connectivity between the bilateral M1 regions, which facilitate motor signals transmission via the ipsilateral motor pathways from the ipsilesional M1, contralesional M1, to the affected limb. A step-wise linear regression model revealed these two brain reorganization patterns collaboratively contributed to FMA-UL improvement. In conclusion, MT achieved motor rehabilitation primarily by recruitment of the ipsilateral motor pathways. Trial Registration Information: http://www.chictr.org.cn. Unique Identifier. ChiCTR-INR-17013644, submitted on December 2, 2017.

The effect of mirror therapy in the rehabilitation of flexor tendon injuries after primary surgical repair.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of mirror therapy and to provide a clinical basis for better functional recovery in the rehabilitation of patients with flexor tendon injury. MATERIALS AND METHODS: Thirty patients were included and randomly divided between two groups: mirror therapy and conventional treatment. A physical therapy program consisting of whirlpool, ultrasound and transcutaneous electrical nerve stimulation was applied to both groups. In the mirror therapy group, flexor tendon gliding, blocking exercises, joint range of motion and resistance exercises were performed with the healthy hand via a mirror. In the conventional treatment group, the same exercises were performed with the affected hand without mirror. This treatment was continued for 12 sessions over 4 weeks. Joint range of motion, handgrip strength, pain, functionality, dexterity and kinesiophobia were evaluated before and after treatment. RESULTS: More improvement was observed in the mirror therapy group in terms of pain on visual analog scale, Patient-Rated Wrist Evaluation, Hand Function Index and Disabilities of the Arm, Shoulder and Hand scores (p = 0.025, p = 0.004, p < 0.001 and p < 0.001, respectively). There was no significant difference between groups for the other parameters (Tampa Kinesiophobia Scale, Purdue Pegboard test, total active range movement, or handgrip strength: p > 0.05). CONCLUSION: This study shows that mirror therapy in postoperative rehabilitation of flexor tendon injuries is more effective than conventional in terms of reducing the severity of pain and restoring hand function.

Development of digital mirror therapy for stroke-severe patients.

Mirror therapy (MT), which is used in the existing stroke rehabilitation environment, has significant limitations for use with severe stroke patients. Since mirrors only reflect symmetrical movement, allowing a patient to observe precise asymmetrical movement is impossible. This study proposes a new MT system by developing a pyramid hologram technology that uses delayed motion to create realistic images. Significant differences, observed via electroencephalogram, were shown in all motor cortex channels immediately after the event in the delayed condition when compared to before the event (C3: p < 0.001; Cz: p < 0.001, C4: p < 0.001). The illusion of asymmetrical movement using the proposed system can be applied to severe stroke patients to increase the positive outcome of rehabilitation.

A mirror therapy system using virtual reality and an actuated exoskeleton for the recovery of hand motor impairments: a study of acceptability, usability, and embodiment.

Hand motor impairments are one of the main causes of disabilities worldwide. Rehabilitation procedures like mirror therapy are given crucial importance. In the traditional setup, the patient moves the healthy hand in front of a mirror; the view of the mirrored motion tricks the brain into thinking that the impaired hand is moving as well, stimulating the recovery of the lost hand functionalities. We propose an innovative mirror therapy system that leverages and couples cutting-edge technologies. Virtual reality recreates an immersive and effective mirroring effect; a soft hand exoskeleton accompanies the virtual visual perception by physically inducing the mirrored motion to the real hand. Three working modes of our system have been tested with 21 healthy users. The system is ranked as acceptable by the system usability scale; it does not provoke adverse events or sickness in the users, according to the simulator sickness questionnaire; the three execution modes are also compared w.r.t. the sense of embodiment, evaluated through another customized questionnaire. The achieved results show the potential of our system as a clinical tool and reveal its social and economic impact.

Terapia espelho, impacto na recuperação funcional do doente pós AVC: revisão sistemática da literatura / Mirror therapy, impact on the functional recovery of post-stroke patients: a systematic review of the literature

O Acidente Vascular Cerebral (AVC) é uma das principais causas de morte e incapacidade a longo prazo em todo o mundo. A Terapia Espelho (TE) tem sido explorada como uma abordagem de reabilitação para melhorar os défices motores pós- AVC, e assim, contribuir para uma melhor autonomia nas Atividades da Vida Diária (AVD) e qualidade de vida. Objetivo ­ Avaliar o impacto da TE na reabilitação de pacientes pós-AVC, com base na evidência científica, e determinar o nível de recuperação funcional e melhoria na autonomia nas AVD. Métodos ­ Foi realizada uma revisão sistemática da literatura nas bases de dados eletrónicas: Medline via PubMed, ScienceDirect via Elsevier, Cochrane Central Register of Controlled Trials e B-ON (Biblioteca do Conhecimento Online). Os critérios de seleção incluíram artigos publicados nos últimos 10 anos que abordassem a eficácia da TE na reabilitação pós-AVC. Resultados ­ Dos 79,772 artigos identificados inicialmente, 6,026 artigos únicos foram avaliados após remoção de duplicatas. Posteriormente, 226 foram considerados para avaliação mais detalhada, dos quais 26 foram selecionados para análise completa. A maioria destes estudos confirmou que a TE foi eficaz na melhoria da função motora, com impacto positivo nas AVD e qualidade de vida dos pacientes. Contudo, alguns estudos apontam a necessidade de mais investigações com amostras maiores e designs mais rigorosos. Conclusões ­ A TE mostra-se como uma intervenção terapêutica promissora, podendo auxiliar significativamente na recuperação motora de pacientes que sofreram AVC e melhorar a sua autonomia nas atividades diárias.

Stroke is one of the leading causes of death and long-term disability worldwide. Mirror Therapy (MT) has been explored as a rehabilitation approach to improve post-stroke motor deficits, and thus contribute to better autonomy in Activities of Daily Living (ADLs) and quality of life. Objective - To evaluate the impact of MT on the rehabilitation of post-stroke patients, based on scientific evidence, and to determine the level of functional recovery and improvement in autonomy in ADLs. Methods - A systematic literature review was carried out using electronic databases: Medline via PubMed, ScienceDirect via Elsevier, Cochrane Central Register of Controlled Trials and B-ON (Online Knowledge Library). The selection criteria included articles published in the last 10 years that addressed the efficacy of MT in post-stroke rehabilitation. Results - Of the 79,772 articles initially identified, 6,026 unique articles were evaluated after removing duplicates. Subsequently, 226 were considered for further evaluation, of which 26 were selected for full analysis. Most of these studies confirmed that MT was effective in improving motor function, with a positive impact on patients' ADLs and quality of life. However, some studies point to the need for further research with larger samples and more rigorous designs. Conclusions - MT is a promising therapeutic intervention that can significantly aid the motor recovery of stroke patients and improve their autonomy in daily activities.

Mirror therapy combined with neuromuscular electrical stimulation for poststroke lower extremity motor function recovery: a systematic review and meta-analysis.

The combination of mirror therapy (MT) and neuromuscular electrical stimulation (NMES) has been devised as an intervention method in stroke rehabilitation; however, few studies have investigated its efficacy in lower extremity motor function recovery. In this systematic review and meta-analysis, we examined the effectiveness of combined MT and NMES therapy in improving poststroke walking speed, spasticity, balance and other gait parameters. Randomized controlled trials (RCTs) were selected from PubMed, Cochrane Library, EMBASE, and Scopus databases. In total, six RCTs which involving 181 participants were included. Our findings indicate that MT combined with NMES elicits greater improvement relative to control group in walking speed (SMD = 0.67, 95% confidence interval [CI] 0.26-1.07, P = 0.001), Berg Balance Scale (SMD = 0.72; 95% CI 0.31-1.13; P = 0.0007), cadence (SMD = 0.59, 95% CI 0.02-1.16, P = 0.04), step length (SMD = 0.94, 95% CI 0.35-1.53, P = 0.002), and stride length (SMD = 0.95, 95% CI 0.36-1.54, P = 0.002) but not in modified Ashworth scale (SMD = - 0.40, 95% CI - 1.05 to 0.26, P = 0.23). Our findings suggest that MT combined with NMES may be a suitable supplemental intervention to conventional therapy in stroke survivors.

Design of a Passive Wearable Device Using an Optimized Mechanical Metamaterial for Mirror Therapy.

Mirror Therapy (MT) is an effective therapeutic method used in the rehabilitation of hemiplegics. The effectiveness of this method is improved by employing a bi-modal approach which requires the synchronous movement of the affected and unaffected arm. For this purpose, we describe the design of a wearable device using a Mechanical Metamaterial (MM) that is optimized for the specific user to provide passive assistance of wrist flexion-extension and enable synchronous motion of the affected and unaffected arm during MT.

[Effects of Mirror Therapy Combined With Task-Oriented Training on Limb Function Recovery in Stroke Patients With Hemiplegia].

Objective: To explore the effects of mirror therapy combined with task-oriented training on limb function recovery in stroke patients with hemiplegia. Methods: A total of 304 older patients with post-stroke hemiplegia who received treatment in Nanyang Third People's Hospital between March 2020 and March 2022 were enrolled as the subjects. They were assigned to the intervention group and the control group through a systematic randomization method, with 152 patients in each group. The control group was treated with conventional medication and task-oriented training, while the intervention group received a combined mirror therapy in addition to the treatment given to the control group. Both groups received continuous treatment for 3 months. The pre-treatment findings and those obtained after 3 month of treatment were compared between the two groups in the following areas, the neurological functions, including the levels of neuron-specific enolase (NSE) and S100ß, a central nervous system specific protein, upper and lower limb motor function as reflected by Fugl-Meyer Assessment (FMA) score, balance ability as measured by Berg Balance Scale (BBS), and the integrated electromyography (iEMG) values of quadriceps femoris, gastrocnemius, and tibialis anterior muscles, three-dimensional gait spatiotemporal parameters, and quality of life as reflected by the assessment results for the National Institute of Stroke Scale (NIHSS) and Stroke-Specific Quality of Life Scale (SS-QOL). The findings were compared to identify changes. Results: After 3 months of treatment, the FMA and BBS scores and three-dimensional gait spatio-temporal parameters in the intervention group were significantly better than those in the control group (all P<0.05). Conclusion: Mirror therapy combined with task-oriented training promotes the function recovery of the affected limbs in older patients with post-stroke hemiplegia, effectively improves their motor function and quality of life, and helps improve patient prognosis.

The effect of sequential combination of mirror therapy and robot-assisted therapy on motor function, daily function, and self-efficacy after stroke.

Robot-assisted therapy and mirror therapy are both effective in promoting upper limb function after stroke and combining these two interventions might yield greater therapeutic effects. We aimed to examine whether using mirror therapy as a priming strategy would augment therapeutic effects of robot-assisted therapy. Thirty-seven chronic stroke survivors (24 male/13 female; age = 49.8 ± 13.7 years) were randomized to receive mirror therapy or sham mirror therapy prior to robot-assisted therapy. All participants received 18 intervention sessions (60 min/session, 3 sessions/week). Outcome measures were evaluated at baseline and after the 18-session intervention. Motor function was assessed using Fugl-Meyer Assessment and Wolf Motor Function Test. Daily function was assessed using Nottingham Extended Activities of Daily Living Scale. Self-efficacy was assessed using Stroke Self-Efficacy Questionnaires and Daily Living Self-Efficacy Scale. Data was analyzed using mixed model analysis of variance. Both groups demonstrated statistically significant improvements in measures of motor function and daily function, but no significant between-group differences were found. Participants who received mirror therapy prior to robot-assisted therapy showed greater improvements in measures of self-efficacy, compared with those who received sham mirror therapy. Our findings suggest that sequentially combined mirror therapy with robot-assisted therapy could be advantageous for enhancing self-efficacy post-stroke.Trial registration: ClinicalTrials.gov Identifier: NCT03917511. Registered on 17/04/2019, https://clinicaltrials.gov/ct2/show/ NCT03917511.

Limitations and solutions of low cost virtual reality mirror therapy for post-stroke patients.

Mirror therapy is applied to reduce phantom pain and as a rehabilitation technique in post-stroke patients. Using Virtual Reality and head-mounted displays this therapy can be performed in virtual scenarios. However, for its efficient use in clinical settings, some hardware limitations need to be solved. A new system to perform mirror therapy in virtual scenarios for post-stroke patients is proposed. The system requires the patient a standalone virtual reality headset with hand-tracking features and for the rehabilitator an external computer or tablet device. The system provides functionalities for the rehabilitator to prepare and follow-up rehabilitation sessions and a virtual scenario for the patient to perform rehabilitation. The system has been tested on a real scenario with the support of three experienced rehabilitators and considering ten post-stroke patients in individual sessions focused on upper limb motor rehabilitation. The development team observed all the sessions and took note of detected errors regarding technological aspects. Solutions to solve detected problems will be proposed and evaluated in terms of feasibility, performance cost, additional system cost, number of solved issues, new limitations, or advantages for the patient. Three types of errors were detected and solved. The first error is related to the position of the hands relative to the head-mounted display. To solve it the exercise area can be limited to avoid objectives that require turning the head too far. The second error is related to the interaction between the hands and the virtual objects. It can be solved making the main hand non-interactive. The last type of error is due to patient limitations and can be mitigated by having a virtual hand play out an example motion to bring the patient's attention back to the exercise. Other solutions have been evaluated positively and can be used in addition or instead of the selected ones. For mirror therapy based on virtual reality to be efficient in post-stroke rehabilitation the current head-mounted display-based solutions need to be complemented with specific strategies that avoid or mitigate the limitations of the technology and the patient. Solutions that help with the most common issues have been proposed.

Is mirror therapy associated with progressive muscle relaxation more effective than mirror therapy alone in reducing phantom limb pain in patients with lower limb amputation?

Mirror therapy is a widely used treatment for phantom limb pain (PLP) relief in patients with limb loss. Less common is progressive muscle relaxation (PMR), used mostly in other medical conditions (psychological, terminal cancer pain, etc). The purpose of this study is to evaluate the efficacy of a mirror therapy preceded by PMR intervention compared to mirror therapy preceded by unguided generic relaxation-mirror therapy in patients with lower limb amputation suffering from PLP. This pilot study was a single-blind, controlled, randomized trial. Thirty lower limb amputees suffering from PLP were recruited and randomly assigned to three groups respectively undergoing a PMR-mirror therapy rehabilitative intervention, generic relaxation-mirror therapy, and conventional physiotherapy (ConvPT). Selected items from Prosthesis Evaluation Questionnaire (PEQ) and the Brief Pain Inventory (BPI) were used to test the pain features at the beginning and 1 week after 3 weeks of intervention. A decrease of about 65% was found in the rate and duration of PLP at the PEQ in PMR-mirror therapy with respect to generic relaxation-mirror therapy (about 30%) and ConvPT (about 6%). A decrease of about 90% in intensity (worst and average) of PLP in PMR-mirror therapy when compared to generic relaxation-mirror therapy (about 45%) and ConvPT (about 20%) was found at the BPI. We preliminary concluded, albeit with limitations due to the small sample of patients, that mirror therapy can improve PLP when associated with PMR. Further studies are required to confirm that PMR could be an effective technique for more successful PLP management.

Mirror Therapy for the Management of Phantom Limb Pain: A Single- Center Experience.

BACKGROUND: Phantom limb pain (PLP) can have devastating consequences, affecting up to 90% of amputees. PLP is associated with analgesia dependence and impaired quality of life. Mirror therapy (MT) is a novel treatment that has been applied in other pain syndromes. We prospectively evaluated MT in the management of PLP. METHODS: A prospective study of patients recruited between 2008 and 2020 who underwent unilateral major limb amputation, with a healthy contralateral limb. Participants were invited to attend weekly MT sessions. Pain in the 7 days prior to each MT session was scored on a Visual Analog Scale (VAS: 0-10 mm) and the short form McGill pain questionnaire. RESULTS: Ninety eight patients (68 males and 30 females) aged 17-89 years were recruited over 12 years. Forty four percent of patients had amputations due to peripheral vascular disease. Over an average of 2.5 sessions, the final treatment score on the VAS scale was 2.6 (standard deviation ± 3.0) with a reduction of 4.5 points on VAS score. As a comparison using the short form McGill pain questionnaire scoring system, the average final treatment score was 3.2 (± 5.0) with 91% overall improvement. CONCLUSIONS: MT is a very powerful and effective intervention for PLP. It is an exciting addition to the armory of vascular surgeons in the management of this condition.

Efficacy of mirror therapy on lower limb motor recovery, balance and gait in subacute and chronic stroke: A systematic review.

OBJECTIVE: Mirror therapy (MT) has been proposed to be an effective therapeutic regimen for lower limb stroke rehabilitation. This review is the first to evaluate the efficacy of MT in subacute and chronic stroke for lower-limb motor functions, balance and gait focusing on particular stage of stroke with specific outcome measures. METHODS: According to PRISMA guidelines, all relevant sources were searched from 2005 to 2020 using "PIOD" framework. Search methods included electronic database, hand and citation searching. Screening and quality assessment was performed by two individual reviewers. Data was extracted and synthesised from 10 studies. Thematic analysis was considered, random-effect models were used and pooled analysis was performed using forest plots. RESULTS: For motor recovery, MT showed statistically significant effects compared to control group using Fugl-Meyer Assessment and Brunnstorm stages as outcome measures (SMD 0.59; 95% CI 0.29 to 0.88; p < 0.0001; I2  = 0%). Statistical significant improvement was reported for balance in MT compared to control using Berg Balance Scale and Biodex in pooled analysis (SMD 0.47; 95% CI 0.04 to 0.90; p = 0.03; I2  = 0%). When compared with electric stimulation and action-observation training MT showed no signifiant improvement for balance (SMD -0.21; 95% CI -0.91 to 0.50; p = 0.56; I2  = 39%). For gait, MT showed statistical and clinical significant improvement compared to control group (SMD 1.13; 95% CI 0.27-2.00; p = 0.01; I2  = 84%) and when compared to action-observation training and electrical stimulation, presented statistical improvement using 10-m walk test and Motion Capture system (SMD -0.65; 95% CI -1.15 to -0.15; p = 0.01; I2  = 0%). CONCLUSION: This review has shown that MT is effective in lower-limb motor recovery, balance and gait in subacute and chronic stroke in patients 18 years or above with no severe cognitive disorder, MMSE score ≥24 and FAC level ≥2. MT could be used for 30 min/day, 5 days/week for 4 weeks, as stand-alone for motor recovery and balance or as an adjunct with electric stimulation for gait for beneficial effects.

Three Ways to Improve Arm Function in the Chronic Phase After Stroke by Robotic Priming Combined With Mirror Therapy, Arm Training, and Movement-Oriented Therapy.

OBJECTIVE: To examine the effects of bilateral robotic priming combined with mirror therapy (R-mirr) vs bilateral robotic priming combined with bilateral arm training (R-bilat), relative to the control approach of bilateral robotic priming combined with movement-oriented training (R-mov) in patients with stroke. DESIGN: A single-blind, preliminary, randomized controlled trial. SETTING: Four outpatient rehabilitation settings. PARTICIPANTS: Outpatients with stroke and mild to moderate motor impairment (N=63). INTERVENTIONS: Patients received 6 weeks of clinic-based R-mirr, R-bilat, or R-mov for 90 min/d, 3 d/wk, plus a transfer package at home for 5 d/wk. MAIN OUTCOME MEASURES: Fugl-Meyer Assessment Upper Extremity subscale (FMA-UE), ABILHAND, and Stroke Impact Scale v3.0 scores before, immediately after, and 3 months after treatment as well as lateral pinch strength and accelerometry before and immediately after treatment. RESULTS: The posttest results favored R-mirr over R-bilat and R-mov on the FMA-UE score (P<.05). Follow-up analysis revealed that significant improvement in FMA-UE score was retained at the 3-month follow-up in the R-mirr over R-bilat or R-mov (P<.05). Significant improvements were not observed in the R-mirr over R-bilat and R-mov on other outcomes. CONCLUSIONS: Between-group differences were only detected for the primary outcome, FMA-UE. R-mirr was more effective at enhancing upper limb motor improvement, and the effect has the potential to be maintained at 3 months of follow-up.