Mirror Therapy for Stroke Recovery

By: Lindsey Holbrook, OTR/L, OTD, CBIS

What is Mirror Therapy?

Mirror therapy is an intervention primarily used when one side of the body is affected more than the other. An individual places a mirror in the middle of their body facing the non-affected side, obstructing their view of the affected side. The non-affected side then appears in the reflection of the mirror providing an illusion of two identically functioning sides. Individuals then complete exercises and activities with their non-affected side while focusing on the mirror image.

The Science Behind Mirror Therapy

The foundation of mirror therapy is based on the principle of neuroplasticity and mirror neurons. Neuroplasticity is the brain’s ability to rewire pathways and connections to allow healthy areas of the brain to take over for injured areas. Mirror neurons are cells that are activated by performing or observing a movement.

When individuals complete exercises with their non-affected side during mirror therapy, it creates the visual feedback needed for mirror neurons to fire and initiate the process of neuroplasticity. Massed practice and repetitive exercises are utilized when performing mirror therapy so that individuals can further strengthen the neural pathways needed to restore function.

Mirror Therapy and Stroke

Mirror therapy was originally created help treat phantom limb pain in individuals who have experienced limb loss. It has since been adapted to help individuals who have experienced a stroke due to its ability to promote neuroplasticity. It is a low-risk and accessible intervention that can be used with all individuals, even if they do not have any active movement on their affected side.

Benefits of mirror therapy include:

  • Improving hand and arm function
  • Reducing post-stroke pain
  • Improving hemi-neglect on the affected side
  • Reducing sensation or sensory deficits

How to Complete Mirror Therapy at Home

Mirror therapy can be completed in a clinic setting or at home. Mirror therapy boxes can be purchased, or you can make your own by attaching a mirror to a box that is large enough to place your arm through. Here is a video tutorial on how to make your own mirror box at home.

Each time you begin a mirror therapy session, make sure your affected side is completely obstructed and give yourself time to adjust to the illusion. Then, complete specific and repetitive movements such as:

  • Making a fist
  • Flipping your hand over
  • Sliding your arm on a towel
  • Stacking coins
  • Clipping clothespins
  • Touching your thumb to each of your fingers

The more repetitions completed, the greater the chance of initiating neuroplasticity.

If you have any questions, contact your occupational therapist for more information and specific exercise recommendations.

References:

Gandhi DB, Sterba A, Khatter H, Pandian JD. Mirror Therapy in Stroke Rehabilitation: Current Perspectives. Ther Clin Risk Manag. 2020 Feb 7;16:75-85. doi: 10.2147/TCRM.S206883. PMID: 32103968; PMCID: PMC7012218.

Pérez-Cruzado, D; Merchán-Baeza, JA; González-Sánchez, M; Cuesta-Vargas, AI (2017). “Systematic review of mirror therapy compared with conventional rehabilitation in upper extremity function in stroke survivors”. Australian Occupational Therapy Journal. 64 (2): 91–112. doi:

Yang, Yue; Zhao, Qingchun (October 15, 2018). “Effect of Mirror Therapy on Recovery of Stroke Survivors: A Systematic Review and Network Meta-analysis”. Neuroscience. 15 (390): 318–336. doi:10.1016/j.neuroscience.2018.06.044.

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