Review Article

Mirror Therapy Rehabilitation in Stroke: A Scoping Review of Upper Limb Recovery and Brain Activities

Table 1

The summary of reviewed articles that used at least one outcome of upper limb recovery.

Author (year)Sample sizeSubjects’ characteristicsStudy designMT groupControl interventionMT protocolOutcome measuresFindings
Total sessionsHours of exposure to mirror/weekType of exerciseSize of mirror (cm)Body structure/functionActivity

Colomer et al. (2016) [17]31Age:
Stroke types:
Ischemic and haemorrhagic
Severe paresis upper limb
Brunnstrom stages I or II
FMA below 19
RCTUMT
45 mins, 3x/week, 8 weeks
Passive mobilisation
45 mins, 3x/week, 8 weeks
242 hrs 15 minsSimple exercise
Functional task
Not statedFMA
NSA
WMFTMT group provided a similar motor improvement
Choi et al. (2019) [57]36Age:
Stroke types:
Not stated
MAL below 2.5
RCT(1) BMT
(2) GR+MT
30 mins, 3x/week, 5 weeks
ST
30 mins, 3x/week, 5 weeks
151 hr 30 minsSimple exerciseNot statedMFTThe difference between conventional MT and CG significant in MFT
Arya et al. (2015) [18]33Age:
Stroke types:
Ischemic and haemorrhagic
Brunnstrom 2 or above
Pilot RCTUMT
90 mins, 5x/week, 8 weeks
CT
90 mins, 5x/week, 8 weeks
403 hrs 45 minsFunctional taskFMAMT group exhibited highly significant improvement on FMA scores
Guo et al. (2019) [24]120Age:
Stroke types:
Ischemic and haemorrhagic
MAS 2-3
RCT(1) UMT
(2) ESWT+MT
50 mins, 5x/week, 4 weeks
(1) ESWT
(2) CT
30 mins, 5x/week, 4 weeks
201 hr 40 minsSimple exerciseFMAMT combined with ESWT produced greater improvement in upper extremity motor performance than MT alone
Arya et al. (2018) [21]31Age:
Stroke types:
Ischemic and haemorrhagic
Diminished light touch
RCTUMT and BMT
90 mins, 5x/week, 6 weeks
CT
90 mins, 5x/week, 6 weeks
303 hrs 20 minsSimple exercise/functional taskFMA
Semmes Weinstein monofilament
FMA scores significantly increase in the MT group compared to control
Park et al. (2015) [25]30Age:
Stroke types:
Ischemic and haemorrhagic
Brunnstrom IV
RCTUMT
30 mins, 5x/week, 4 weeks
ST
30 mins, 5x/week, 4 weeks
202 hrs 30 minsSimple exerciseNot statedFMABBT
FIM
MT group significantly improved on upper-extremity function and activities of daily living compared to CG
Michielsen et al. (2011) [30]40Age:
Stroke types:
Ischemic and haemorrhagic
Brunnstrom III and IV
RCTBMT
60 mins, 5x/week, 6 weeks
Bilateral training
60 mins, 5x/week, 6 weeks
305 hrsSimple exercise
Functional task
Not statedFMAARAT
ABILHAND
FMA improved more in the MT group than CG. No sig. difference in ARAT and ABILHAND
Gurbuz et al. (2016) [26]31Age:
Stroke types:
Ischemic and haemorrhagic
Hospitalised
Brunnstrom I-IV
RCTUMT
20 mins, 5x/week, 4 weeks
ST
20 mins, 5x/week, 4 weeks
201 hr 40 minsSimple exerciseNot statedFMAFIMFMA score higher in the MT group than CG
No sig. difference between groups for FIM
Lin et al. (2014) [31]43Age:
Stroke types:
Ischemic and haemorrhagic
Brunnstrom III or above
RCT(1) BMT
(2) MG+MT
90 mins, 5x/week, 4 weeks
CT
90 mins, 5x/week, 4 weeks
205 hrsSimple exercise
Functional task
Not statedFMABBT
MAL
ABILHAND
and MT groups performed better than CG in the reduction of motor impairment
Combining MT+MG stimulation showed additional effects on manual dexterity of the affected hand compared with MT alone
No significant different in MAL and ABILHAND
Oliviera et al. (2018) [58]21Age: 60.1
Stroke types:
Not stated
Pilot quasi experimentalBMT
15 mins, 3x/week, 4 weeks
(1) VG
(2) CT
15 mins, 3x/week, 4 weeks
121 hrSimple exercise
Functional task
Not statedRivermead Mobility IndexWMFT
JHFT
Significant findings were observed for MT or VT group when compared to the CG, obtaining improvements in all three functional tests
Lee et al. (2015) [19]48Age:
Stroke types:
Not stated
Moderate-mild impairment (FMA:18-55)
RCT(1) BMT
(2) MG+MT
(3) Sham MG+MT
90 mins, 5x/week, 4 weeks
205 hrsSimple exercise
Functional task
FMA
rNSA
BBT
FIM
No significant group differences in the FMA, rNSA. For BBT and FIM, MT+MG improved more than MT group
Kim et al. (2016) [27]25Age:
Stroke type:
Ischemic and haemorrhagic
RCTUMT
30 mins, 5x/week, 4 weeks
CT
30 mins, 5x/week, 4 weeks
202 hrs 30 minsFunctional taskFMAARAT
BBT
FIM
MT group showed significant improvements compared to CG, both in body structure/function and activity domain
Lin et al. (2014) [32]16Age: 55.64
Stroke type:
Ischemic and haemorrhagic
Brunnstrom >III
RCT: pilot study(1) BMT
(2) MG+MT
90 mins, 5x/week, 4 weeks
205 hrsSimple exercise
Functional task
Not statedMASBBT
ARAT
FIM
BBT, grasping scales ARAT, FIM presented significantly large effects in favour of MT+MG group
Shaker et al. (2020) [59]30Age:
Stroke types:
Ischemic
MMT: Grade 3 above
Case controlBMT
40 mins
3x/week, 8 weeks
CT
40 mins, 3x/week, 8 weeks
241 hr 15 minsSimple exercise
Functional task
35×35ROM (goniometer)
Strength (dynamometer)
JHFTMT group improved significantly in ROM, hand strength and JHFT compared to CG
Chinnavan et al. (2020) [28]25Age: 45 to 65 years old
Stroke types:
Ischemic and haemorrhagic
Quasi experimentalUMT
45 mins, 3x/weeks, 6 weeks
CT
45 mins, 3x/week, 6 weeks
1845 minsSimple exercise
Functional task
Not statedFMAFIMThere is significant improvement in MT group compared to CG in both domains.
Ji et al. (2014) [29]35Age:
Stroke types:
Ischemic and haemorrhagic
RCT(1) UMT
(2) rTMS+MT
30 mins, 5x/week, 6 weeks
ST
30 mins, 5x/week, 6 weeks
302 hrs 30 minsSimple exerciseFMABBTMT+rTMS more effective to improve upper extremity function, than MT group and CG
Wu et al. (2013) [20]33Age:
Stroke types:
Ischemic and haemorrhagic
Mild to moderate impairment (FMA: 26-56)
RCTBMT
90 mins, 5x/week, 4 weeks
CT
90 mins, 5x/week, 4 weeks
205 hrsSimple exercise
Functional task
Not statedFMA
rNSA
MAL
ABILHAND
FMA showed sig. and large to moderate effects favouring the MT group. No sig. differences on MAL and ABILHAND

UMT: unilateral mirror therapy; BMT: bilateral mirror therapy; CT: conventional therapy; ST: sham therapy; CG: control group; FMA: Fugl-Meyer Assessment; ARAT: Action Research Arm Test; WMFT: Wolf Motor Function Test; BBT: Box and Block Test; rNSA: revised Nottingham Sensory Assessment; MAL: Motor Activity Log; JHFT: Jebsen Hand Function Test; FIM: Functional Independence Measure; RCT: randomized controlled trial; rTMS: transcranial magnetic stimulation; MG: mesh glove; GR: gesture recognition; ESWT: extracorporeal shockwave therapy; VG: vibration.