EFFECT OF MIRROR THERAPY ON UPPER EXTREMITY MOTOR FUNCTION IN STROKE PATIENTS

EFFECT OF MIRROR THERAPY ON UPPER
EXTREMITY MOTOR FUNCTION IN STROKE
PATIENTS
PRESENT
BY
PT. ISMAILA MUHAMMAD BINJI
DEPARTMENT OF PHYSIOTHERAPY
MEDICINE/ CARDIOPULMONARY UNIT
USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL ,
SOKOTO STATE NIGERIA.

OUTLINE
 INTRODUCTION
 DEFINITION
 EPIDEMIOLOGY
 BRIEF ANATOMY
 RISK FACTOR
 WARNING SIGNS OF STROKE
 ASSESSMENT
 MIRROW THERAPY
 RECOMENDATION
 CONCLUSION
 REFERENCE

INTRODUCTION
Stroke is one of the main causes of disability around the globe.
plegia (complete paralysis) or paresis (partial weakness ) are
common following a stroke. According to the Journal of
Physical Therapy Science, about 85 percent of stroke survivors
will suffer from hemiplegia, and at least 69 percent will
experience a loss of motor function in the upper limb.

INTRODUCTION CONT’D
Although these changes may not be permanent, some people
regain partial or full limb function, the road to recovery can be
long. But did you know that it is possible to trick the brain into
believing what it sees? Mirror therapy is being used more and
more in stroke rehabilitation to dupe the brain and restore limb
function.
(Thieme H, Morkisch N et al,. 2018)

DEFINITIONS
STROKE: is defined as the rapidly developed clinical signs of
global or focal disturbance of cerebral function, lasting more than
24 hours or leading to death, with no apparent cause other than of
vascular origin. (WHO, 2017)
MOTOR FUNCTION motor function is the ability to learn or to
demonstrate the skillful and efficient assumption, maintenance,
modification, and control of voluntary postures and movement
patterns.
(American Physical Therapy Association, 2014)

EPIDEMIOLOGY
• Stroke is the second largest cause of early death globally and the
third leading cause of disabilities. (kevin pacheco.,et al. 2022)
• Motor skills are among the crucial areas affected by stroke, and
recovery from stroke typically takes more than six months,
especially in the upper limbs. Evidence shows that about 83% of
stroke survivors are able to walk again; however, only 5% to 20% of
survivors achieve full functional recovery of affected upper limb.
(Khandare K.,et al. 2013)

BRIEF ANATOMY OF BRAIN
 The central nervous system is made up of the brain and spinal cord.
 The main components of the brain are the cerebrum, cerebellum, and
brainstem.
 The cerebrum is divided into 2 hemispheres (right and left) by a deep
groove known as the longitudinal fissure.
 The 2 cerebral hemispheres are connected by the corpus callosum,
allowing them to communicate and send information to one another.
(Johns Hopkins medicine 2022)

RISKS FACTORS
The risk factors of stroke are classified into two
nonmodified and modified risk factors
NON MODIFIED RISK FACTORS
 Gender
 Age
 Family history of stroke
MODIFIED RISK FACTOR
 Smoking
 Alcohol consumption
 Physical inactivity
 ETC

WARNING SINGS OF STROKE
America stroke Association

ASSESSMENT
Subjective assessment
 Bio data
 Chief complain
 History of presenting complain
 Past medical history
 Family/social history

ASSESSMENTS CONT’D
objective assessment
Pain rating scale

 Tenderness
 Prom
 Shoulder sublaxation
 Edema
 Atrophy
 Muscle tone
 Sensation

 Functional assessment
Investigation
Diagnosis
Management

MANAGEMENT
The management of stroke patient who initially presented with
flaccid or loss of motor function of the upper extremity
include:
 STM with tropical analgesic
 Passive mobilization
 Auto assisted exercise
 Limb loading
 Electrical muscle stimulation
 Mirror therapy
 E.T.C

NEUROPLASTICITY/PRINCIPLE
Neural plasticity, which is also known as neuroplasticity, brain
plasticity, cortical plasticity, is the changing of the structure,
function, and organization of neurons in response to new
experiences.
• Neural plasticity specifically refers to strengthening or
weakening nerve connections or adding new nerve cells based on
outside experiences..

NEUROPLASTICITY/PRINCIPLE
NEURO PLASTICITY CLASSIFIED AS;
Temporary (short term memory)
• Chemical/synaptic changes
Long lasting (long term memory)
• Structural neuro plasticity: the brain ability
to change its physical structure as a result of
learning, involving reshaping nerve cell.
• Functional neuro plasticity: brain function
move from damage to un damage area.

• Kleim and Jone in 2008 highlighted these principle of
neuroplasticity that will make difference when co operate in our
therapy;-
 Use it or lose it
 Use it and improve it
 Specificity
 Repetition & Intensity ( Choa Han et al., 2012)
 Time
 Salience
 Age. (Kugler et al., 2003)

MIRROW THERAPY
In 1992, Ramachandran introduced the
use of mirror box illusion for the
treatment of two disorders that had
previously been thought to be
permanent and incurable; chronic pain
of central origin (such as phantom pain)
and hemi paresis following a stroke.
Diers M, Christmann et al,. 2010

PRINCIPLE OF MIRROR THERAPY
 Further, evidence suggests that damaged areas of the brain's
motor cortex may improve by viewing movements of intact,
functioning limbs.

PRINCIPLE OF MIRROR THERAPY
 In mirror therapy, a mirror is placed beside the unaffected limb,
blocking the view of the affected limb. This creates the illusion that
both limbs are functioning properly.
 Mirror theory is based on evidence that action observation
activates the same motor areas of the brain as action execution.
Observed actions lead to the generation of intended actions,
engaging motor planning and execution.

MIRROR NEURON
Mirror neurons are type of brain cell that respond
equally when we perform an action and when we
witness someone else perform the same action. They
were first discovered in the early 1990s, when a team
of Italian researchers found individual neurons in the
brains of macaque monkeys that fired both when the
monkeys grabbed an object and also when the
monkeys watched another primate grab the same
object.

( Diekhoff – kreb et.,al 2017 )

GENERAL REQUIREMENT
Patient characteristics
 Motor abilities
 Vision
 Trunk control
 Non affected limb
 Cognitive abilities (Wade DT et al., 2011)
Informing the patient
 Possible Negative effect
Environment and required materials
 Surrounding
 Jewellery and other marks
 Mirror

WHEN CHOOSING A MIRROR
A size of 25x 20 inches for the upper limb and at least 35 x 25
inches
Physiotherapist Should Pay Attention To The Following
Aspects:
 It should provide a coherent mirror image without any
noteworthy distortion.
 There should be no risk of injury.

CHARACTERISTIC OF
TREATMENT
 Frequency of therapy &
duration of sessions
Min duration 10mins
Max duration 30 Min
 Position of affected limb
 Position of un affect limb
 Position of the mirror

A Mirror box therapy at Department of physiotherapy UDUTH sokoto state, Nig. Dec 2023

SYSTEMATIC REVIEW
 Additional evidence supports the use of mirror therapy for the
recovery of some upper and lower limb function, while also
highlighting its ability to potentially enhance walking speed and
balance. (Li Y, Wei Q, Gou W, et,.al 2018)
 A Cochrane Review; the effectiveness of mirror therapy for
improving motor function, activities of daily living, pain and
visuospatial neglect in patients after stroke. 14 studies with a
total of 567 participants that compared mirror therapy with other
interventions were compared. At the end of treatment, mirror
therapy improved movement of the affected limb and the ability
to carry out daily activities (Thieme H at,. el 2012)

 In a study tittle Mirror therapy promotes recovery from severe
hemiparesis: a randomized controlled trial. it was suggested
that mirror therapy is more effective for stroke patients with
severe paresis or even a flaccid upper limb. (Dohle C, Pullen
J, Nakaten A, Kust J, Rietz C, Karbe H. 2009.)
 This review provides evidence that mirror therapy is effective
to increase muscle strength in post-stroke patients. (zahrotul
jannah et,.al 2023)

CONCLUSION
Mirror therapy (MT) relies on a mirror and movements of the
healthy limb to generate visual illusions of movement of the
paralyzed limb. MT has proven to be effective for the motor
rehabilitation of the upper limb of stroke patients. (MT) is
relatively easy to do, and has be completed or to be done at
home by individual themselves. For more effectiveness.

RECOMENDATION
I recommend physiotherapists to include MT in their therapeutic
plan for better recovery . And also encourage patient to do more
at home.

REFERENCE
• Kwakkel G., Kollen B. J., Wagenaar R. C. Long term effects of intensity of
upper and lower limb training after stroke: a randomised trial. Journal of
Neurology, Neurosurgery, & Psychiatry. 2002;72(4):473–479.
doi: 10.1136/jnnp.72.4.473. [PMC free article] [PubMed]
[CrossRef] [Google Scholar] [Ref list]
• Lawrence E. S., Coshall C., Dundas R., et al. Estimates of the prevalence of
acute stroke impairments and disability in a multiethnic
population. Stroke. 2001;32(6):1279–1284.
doi: 10.1161/01.str.32.6.1279. [PubMed] [CrossRef] [Google Scholar] [Ref
list]
• Dohle C, Pullen J, Nakaten A, Kust J, Rietz C, Karbe H. 2009. Mirror therapy
promotes recovery from severe hemiparesis: a randomized controlled trial.
Neurorehabil Neural Repair 23: 209-17

REFERENCE
• Rothgangel AS, Morton A, Van den Hout JWE, Beurskens AJHM. 2004.
Phantoms in the brain: mirror therapy in chronic stroke patients; a pilot
study. Ned Tijdschr Fys 114: 36-40
• Thieme H, Bayn M, Wurg M, Zange C, Pohl M, Behrens J. 2013.
Mirrortherapy for patients with severe arm paresis after stroke – a
randomized controlled trial. Clin Rehabil. 27, 4: 314-24
• Yavuzer G, Selles R, Sezer N, Sutbeyaz S, Bussmann JB, Koseoglu F et al.
2008. Mirror therapy improves hand function in subacute stroke: a
randomized controlled trial. Arch Phys Med Rehabil 89: 393-8

EFFECT OF MIRROR THERAPY ON UPPER EXTREMITY MOTOR FUNCTION IN STROKE PATIENTS

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