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Mirror Therapy Promotes Recovery From Severe Hemiparesis: A Randomized Controlled Trial

Godeshöhe Neurological Rehabilitation Center, Bonn, Germany, Klinik Berlin, Department of Neurological Rehabilitation, Charite-University Medicine Berlin, Campus Benjamin Franklin, Germany, dohle.berlin{at}median-kliniken.de

Judith Püllen

Godeshöhe Neurological Rehabilitation Center, Bonn, Germany, Center for Evaluation and Methods, Department of Psychology, University of Bonn, Germany

Antje Nakaten

Godeshöhe Neurological Rehabilitation Center, Bonn, Germany

Jutta Küst, PhD

Godeshöhe Neurological Rehabilitation Center, Bonn, Germany

Christian Rietz, PhD

Center for Evaluation and Methods, Department of Psychology, University of Bonn, Germany

Hans Karbe, MD

Godeshöhe Neurological Rehabilitation Center, Bonn, Germany

Background. Rehabilitation of the severely affected paretic arm after stroke represents a major challenge, especially in the presence of sensory impairment. Objective. To evaluate the effect of a therapy that includes use of a mirror to simulate the affected upper extremity with the unaffected upper extremity early after stroke. Methods. Thirty-six patients with severe hemiparesis because of a first-ever ischemic stroke in the territory of the middle cerebral artery were enrolled, no more than 8 weeks after the stroke. They completed a protocol of 6 weeks of additional therapy (30 minutes a day, 5 days a week), with random assignment to either mirror therapy (MT) or an equivalent control therapy (CT). The main outcome measures were the Fugl-Meyer subscores for the upper extremity, evaluated by independent raters through videotape. Patients also underwent functional and neuropsychological testing. Results. In the subgroup of 25 patients with distal plegia at the beginning of the therapy, MT patients regained more distal function than CT patients. Furthermore, across all patients, MT improved recovery of surface sensibility. Neither of these effects depended on the side of the lesioned hemisphere. MT stimulated recovery from hemineglect. Conclusions. MT early after stroke is a promising method to improve sensory and attentional deficits and to support motor recovery in a distal plegic limb.

Key Words: Stroke rehabilitation • Arm • Mirror therapy • Randomized clinical trial • Motor recovery • Hemineglect

This version was published on March 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 3, 209-217 (2009)
DOI: 10.1177/1545968308324786


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