Effectiveness of Mirror Therapy on Function for Chronic Stroke Patients

SIGNIFICANCE: Clients often receive limited therapy for motor recovery 6 mo after a cerebrovascular accident (CVA) due to lack of resources. Upper-extremity (UE) paralysis is the most common symptom of CVA and is critical for occupational performance; thus, more cost-effective outpatient and home-based interventions are needed.

INNOVATION: Mirror therapy (MT) uses visual feedback while focusing on the movement of contralateral limbs. Most research to date supports MT in conjunction with traditional stroke rehabilitation producing positive effects on UE function, including improvements in motor recovery and performance of the affected UE when provided within 2 to 12 mo poststroke at a high intensity. Addressed by this study is the need for low-cost, effective, alternative treatment strategies for individuals more than 12 mo poststroke due to residual UE deficits affecting occupational performance.

APPROACH: What are the effects of weekly 45-min sessions of MT over 6 wk on UE function in clients 12 mo or more poststroke? The hypothesized effect was improved upper-limb function as measured by the Fugl-Meyer Assessment (FMA)–UE when compared to individual baselines.

RATIONALE: Research is needed to compare a lower intensity and frequency MT protocol to higher intensity and frequency protocols used in past research for clients 12 mo or more poststroke. Findings will aid occupational therapists (OTs) in providing the most effective and affordable intervention strategies for improved UE use during functional activities for this population. This is vital, as strokes are the third leading cause of death in the United States and are the most common cause of disability, with approximately 4.5 million stroke survivors residing in the general population.

METHOD: We used a pretest–posttest, mixed-method research design consisting of an experimental group receiving MT for 45-min weekly sessions for 6 wk. Standardized and nonstandardized assessment measures were used to examine the effects of MT on UE function for individuals more than 12 mo poststroke. MT treatment was provided at no cost at a local university occupational therapy department.

Recruitment was via flyers at local physician offices and support groups. Inclusion criteria included the following: CVA within the last 1 to 5 yr, aged 19 yr or older, unaffected UE range of motion (ROM) within functional limits, access to transportation, and a score ≥8 on the Mini-Mental State Exam–Second Edition: Brief Version. Exclusion criteria included the following: signs of neglect (score of 44 on the Star Cancellation Test), comorbid degenerative diagnoses (e.g., Parkinson’s disease, multiple sclerosis), or low vision. Measurements included the FMA–UE, the Canadian Occupational Performance Measure (COPM), the Stroke Impact Scale (SIS), and qualitative questionnaires.

Nonparametric methods and descriptive analysis were used for quantitative analysis of assessment tools, whereas qualitative analysis of questionnaires was used to reveal general underlying themes and individual changes.

RESULTS: Two clients completed the full study. Results indicate positive change in perception of MT and occupational therapy as well as perception of stroke recovery measured with the SIS; however, no statistically significant change for performance/satisfaction on the COPM was noted. Slight improvements were noted on the FMA–UE, but they were not statistically significant.

CONCLUSION: This information adds to the existing body of knowledge regarding the effectiveness of MT on improving UE function in individuals more than 12 mo poststroke. Limitations in length of this study indicate that a more rigorous weekly protocol is needed for better outcomes.