Mirror Therapy for Stroke Patients

Mirror Therapy for Stroke Patients

Mirror Therapy for Stroke Patients

May 9, 2023

Mirror therapy was initially introduced in 1996 by Ramachandran et al. as a treatment for phantom pain after amputation. Since then, it has been utilized for various other conditions, including complex regional pain syndrome, severe hyperesthesia after hand injuries, rehabilitation of the hemiplegic side in patients with cerebrovascular accidents (CVO), and the treatment of peripheral nerve injuries and coordination disorders in individuals with hemiplegia.

Mirror therapy is believed to be effective through the mirror neuron system. This system is located in the frontoparietal region and was first discovered in the ventral premotor cortex (F5 area) and later in the macaque monkey’s inferior parietal lobule (PGF area). Mirror neurons are bimodal visuomotor neurons that discharge both when a certain movement is actively performed and when a similar movement is passively observed by someone else. Neuroimaging studies have shown that specific movements activate the mirror neuron system, which is thought to play important roles in higher cognitive functions. Mirror therapy has been applied to treat phantom pain after amputation, complex regional pain syndrome, sensory reeducation of severe hyperesthesia developing after hand injuries, hemiplegic side rehabilitation in patients with hemiplegia due to the cerebrovascular accident (CVA), treatment of peripheral nerve injuries, and coordination disorders.

Studies emphasized the importance of observation prior to an activity for inducing neuroplasticity in the human motor cortex. In Lahav et al.’s study, which examined mirror neuron responses in musical works that subjects had heard or not heard before, the same result was found to be valid for auditory processes. Two possible answers come to mind when considering the reason for the existence of mirror neurons in humans: the perception of observed movement and the imitation of movement. Two different mirror systems may be involved in the ability to perceive and imitate. While there is no conclusive evidence for the presence of the mirror neuron system in newborns, the ability of newborns to imitate facial expressions may be related. The experience-dependent system serves the perception-action duo, and its development critically depends on the individual’s observation of their own movements. Congenital mirror neurons may develop through observing personal movements while developing hand movements.

When applying mirror therapy, the mirror is placed between the patient’s hemiplegic and healthy extremities, with the hemiplegic extremity facing the back of the mirror, and the patient is asked to move the healthy extremity. The patient is motivated but not forced to perform the same movement with the hemiplegic limb behind the mirror. An important aspect of this therapy is that the patient constantly looks in the mirror and focuses on the mirror image of the intact extremity while ensuring that the hemiplegic extremity is not visible. Mirror therapy has been reported to be beneficial in the development of motor function, particularly in the distal part of the upper extremity.

It has been stated in the literature that patients with subacute SVO can improve their self-care activities in addition to increasing motor recovery in the upper extremity. Mirror therapy is an easy-to-apply, inexpensive, safe, and noninvasive treatment method used in the rehabilitation of hemiplegia. It is also patient-controlled and improves the function of the affected side compared to other methods.


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  2. Lahav, A., Saltzman, E., & Schlaug, G. (2007). Action representation of sound: audiomotor recognition network while listening to newly acquired actions. Journal of Neuroscience, 27(2), 308-314.

  3. Thieme, H., Mehrholz, J., Pohl, M., Behrens, J., & Dohle, C. (2013). Mirror therapy for improving motor function after stroke. Stroke, 44(1), e1-e2.

  4. Yavuzer, G., Selles, R., Sezer, N., Sütbeyaz, S., Bussmann, J. B., Köseoğlu, F, & Stam, H. J. (2008). Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Archives of physical medicine and rehabilitation, 89(3), 393-398.

  5. Thieme, H., Morkisch, N., Mehrholz, J., Pohl, M., Behrens, J., Borgetto, B., & Dohle, C. (2018). Mirror therapy for improving motor function after stroke. Cochrane database of systematic reviews, (7).

  6. Gandhi, D. B., Sterba, A., Khatter, H., & Pandian, J. D. (2020). Mirror therapy in stroke rehabilitation: current perspectives. Therapeutics and clinical risk management, 75-85.

  7. Rothgangel, A. S., Braun, S. M., Beurskens, A. J., Seitz, R. J., & Wade, D. T. (2011). The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature. International Journal of Rehabilitation Research, 34(1), 1-13.

  8. Lee, M. M., Cho, H. Y., & Song, C. H. (2012). The mirror therapy program enhances upper-limb motor recovery and motor function in acute stroke patients. American journal of physical medicine & rehabilitation, 91(8), 689-700.

  9. Rossiter, H. E., Borrelli, M. R., Borchert, R. J., Bradbury, D., & Ward, N. S. (2015). Cortical mechanisms of mirror therapy after stroke. Neurorehabilitation and neural repair, 29(5), 444-452.

  10. Michielsen, M. E., Selles, R. W., Van Der Geest, J. N., Eckhardt, M., Yavuzer, G., Stam, H. J., & Bussmann, J. B. (2011). Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabilitation and neural repair, 25(3), 223-233.

  11. Ezendam, D., Bongers, R. M., & Jannink, M. J. (2009). Systematic review of the effectiveness of mirror therapy in upper extremity function. Disability and rehabilitation, 31(26), 2135-2149.

  12. was first described by Ramachandran, M. T. (2018). Mirror therapy for motor function of the upper extremity in patients with stroke: a meta-analysis. J Rehabil Med, 50, 8-15.