MIRROR THERAPY'S EFFICACY AND MECHANISM IN THE PROMOTION OF MOTOR RECOVERY IN HEMIPARETIC POST STROKE POPULATIONS

Purpose: Mirror therapy (MT) has been thought to be affective for treating complex regional pain syndrome, hemiparesis, and phantom limb pain. This treatment uses imagery to reflect movements of the unaffected side off a mirror as if it were the affected side. The purpose of this review is to highlight the advances in MT research as a treatment option for patients suffering from hemiparesis post stroke. Methods: Five authors searched all accessible databases from a university. All significant randomized controlled trials (RCT's) and history of mirror therapy were obtained. For context, cortical neuroplasticity post stroke, bilateral training, imagery training, electrical cortical stimulation, and constraint-induced movement therapy (CIMT) were also reviewed. Results: Over the past decade RCT's and reviews have supported the efficacy for treating motor impairments due to stroke in acute, subacute, and chronic conditions. Functional outcome measures to support these findings were the Fugl-Meyer Assessment, Brunnstrom scale, and the Motor Assessment Scale. The mechanism for MT is based on fMRI studies which show MT promotes cortical reorganization of the ipsilesional primary motor cortex (M1) and may even prevent over dominance of the contralesional M1 region. CIMT and electrical stimulation use the same mechanism of preventing inhibition of the ipsilesional M1 region by the contralesional M1 region by stimulating the ipsilesional side. While the MT literature addresses the upper extremities the most, some RCT's have shown similar outcomes with the lower extremities. Outcomes for treating sensory recovery has been supported with some evidence, however, there are stronger arguments and evidence that mirror therapy is most effective with motor recovery in patients suffering from hemi-paresis post stroke. Conclusions: By providing patients with a mirror at home or in the clinic, MT provides a simple, inexpensive, and effective way to improve functional motor recovery in patients suffering from hemiparesis. Other methods have been used consistently in the literature along with MT including standard physical and occupational therapy, bilateral arm training, strength training, and neuromuscular electrical stimulation. CIMT has not been studied with MT. Since a functional extremity is required with CIMT and MT has promoted motor recovery in acute populations, MT may be the beginning segway into motor recovery before transitioning to CIMT along with other treatment methods.