To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain.
Mirror Therapy, or mirror box therapy, is a physiotherapy (or physical therapy) and occupational therapy technique used to help increase movement and decrease pain in limbs. It is suitable to treat conditions such as complex regional pain syndrome (CRPS), phantom limb pain, stroke and other chronic pain conditions. In many of these conditions the affected limb may not move well and it might be very painful when you try to move it. With adequate practise using mirror therapy, both patients and therapists have reported positive outcomes.
Mirror therapy was first theorized by V. S. Ramachandran, Director of the Centre for Brain and Cognition, and Distinguished Professor with the Psychology Department and the Neurosciences Program at the University of California, San Diego. He is trained as a doctor and then obtained a Ph.D. from Trinity College at the University of Cambridge.
Ramachandran is credited with the invention of the mirror box and the introduction of mirror visual feedback as a treatment for phantom limb paralysis. This is known as mirror therapy.
V. S. Ramachandran has published over 180 papers in scientific journals and is referred to as “The Marco Polo of neuroscience” by Richard Dawkins and “The modern Paul Broca” by Eric Kandel.
To read more about the background and invention of mirror therapy, click here.
The brain is known to be “plastic”. The activity you perform daily, change the way the limb is represented in the brain. For example, if you are a pianist, both of your hands have a bigger representation in your brain. After any injury, the representation of the affected limb in the brain may be smaller or associated with pain.
Mirror therapy uses the brain’s prioritization of visual feedback over the sensation of the limb. In other words, mirror therapy involves using a mirror to “trick” the brain into thinking the affected limb is okay. During mirror therapy treatment exercises, the affected limb is covered and hidden behind a mirror. The movement of the good limb will thus be reflected in the mirror, allowing the brain to think that the affected limb is moving freely.
Evidence has shown that the areas of the brain are active during observation of the movement which are involved in the performance of movements. In simple terms, even though the brain can feel the affected limb is not moving, it forgets this and chooses to believe what it can see reflected in the mirror. With regular use of mirror therapy, the representation of the affected limb in the brain will change again. The brain will start to “learn” that this limb is okay and therefore will start to move it more easily.
Mirror therapy equipment can either be purchased and put together independently or can be bought online as a set. There are a variety of types of mirror boxes. However, as long as the main principles are followed, the shape and design of the box should not matter. The most important thing is that the affected limb is hidden and that the mirror is big enough to see all movements carried out with the opposite limb. The recommended size is a mirror of 25 x 20 inches for the upper limb, and at least 35 x 25 inches for the lower limb.
The choice of material for the mirror is also important. Perspex mirrors with smooth edges can be used to avoid injuries but it is important that the mirror does not buckle as this would distort the image. The “box” part of the mirror box should be made from a neutral colour so that it does not draw attention away from the patient, and the mirror should be large enough to cover the whole of the affected limb. If making a mirror box is too difficult, you can purchase a ready-made mirror box therapy equipment from us here.
Find out more about Mirror Box Therapy Exercises for Hands & Legs here.
Grezes, J. & Decety, J. (2001).Functional anatomy of execution, mental simulation, observation and verb generation of actions: a meta-analysis. Human Brain Mapping, 12 (1), 1-19.
Neuro Orthopaedic Institute (NOI) http://www.noigroup.com/documents/noi-mirror-box-instructions.pdf accessed 29/9/17
Rothgangel AS, Braun SM. (2013). Mirror therapy: Practical protocol for stroke rehabilitation. Munich: Pflaum Verlag. doi: 10.12855/ar.sb.mirrortherapy.e2013
Objective: To determine the effect of activity-based mirror therapy (MT) on motor recovery and gait in chronic poststroke hemiparetic subjects.
Design: A randomised, controlled, assessor-blinded trial.
Setting: Rehabilitation institute.
Participants: Thirty-six chronic poststroke (15.89 ± 9.01 months) hemiparetic subjects (age: 46.44 ± 7.89 years, 30 men and functional ambulation classification of median level 3).
Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management.
Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT).
Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference = 3.29, 95% CI = 1.23–5.35, p = .003) and RVGA (mean difference = 5.41, 95% CI = 1.12–9.71, p = .015) in comparison to the control group. No considerable changes were observed on 10-MWT.
Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects.
Saebo, Inc. is a medical device company primarily engaged in the discovery, development and commercialization of affordable and novel clinical solutions designed to improve mobility and function in individuals suffering from neurological and orthopedic conditions. With a vast network of Saebo-trained clinicians spanning six continents, Saebo has helped over 100,000 clients around the globe achieve a new level of independence. In 2001, two occupational therapists had one simple, but powerful goal – to provide neurological clients access to transformative and life changing products. At the time, treatment options for improving arm and hand function were limited. The technology that did exist was expensive and inaccessible for home use. With inadequate therapy options often leading to unfavorable outcomes, health professionals routinely told their clients that they have “reached a plateau” or “no further gains can be made”. The founders believed that it was not the clients who had plateaued, but rather their treatment options had plateaued. Saebo’s commitment – “No Plateau in Sight” – was inspired by this mentality; and the accessible, revolutionary solutions began. Saebo’s revolutionary product offering was based on the latest advances in rehabilitation research. From the SaeboFlex which allows clients to incorporate their hand functionally in therapy or at home, to the SaeboMAS, an unweighting device used to assist the arm during daily living tasks and exercise training, “innovation” and “affordability” can now be used in the same sentence. Over the last ten years, Saebo has grown into a leading global provider of rehabilitative products created through the unrelenting leadership and the strong network of clinicians around the world. As we celebrate our history and helping more than 100,000 clients regain function, we are growing this commitment to affordability and accessibility even further by making our newest, most innovative products more accessible than ever.
Loss of upper-extremity motor function is one of the most debilitating deficits following stroke. Two promising treatment approaches, action observation therapy (AOT) and mirror therapy (MT), aim to enhance motor learning and promote neural reorganization in patients through different afferent inputs and patterns of visual feedback. Both approaches involve different patterns of motor observation, imitation, and execution but share some similar neural bases of the mirror neuron system. AOT and MT used in stroke rehabilitation may confer differential benefits and neural activities that remain to be determined. This clinical trial aims to investigate and compare treatment effects and neural activity changes of AOT and MT with those of the control intervention in patients with subacute stroke.
An estimated total of 90 patients with subacute stroke will be recruited for this study. All participants will be randomly assigned to receive AOT, MT, or control intervention for a 3-week training period (15 sessions). Outcome measurements will be taken at baseline, immediately after treatment, and at the 3-month follow-up. For the magnetoencephalography (MEG) study, we anticipate that we will recruit 12 to 15 patients per group. The primary outcome will be the Fugl-Meyer Assessment score. Secondary outcomes will include the modified Rankin Scale, the Box and Block Test, the ABILHAND questionnaire, the Questionnaire Upon Mental Imagery, the Functional Independence Measure, activity monitors, the Stroke Impact Scale version 3.0, and MEG signals.
This clinical trial will provide scientific evidence of treatment effects on motor, functional outcomes, and neural activity mechanisms after AOT and MT in patients with subacute stroke. Further application and use of AOT and MT may include telerehabilitation or home-based rehabilitation through web-based or video teaching.
Stroke is the leading cause of long-term adult disability worldwide . Most patients with stroke experience upper-extremity (UE) motor impairment  and show minimal recovery of the affected arm even 6 months after stroke . Due to the potentially severe adverse effects after stroke, it is critical in clinical practice to develop effective and specific stroke interventions to improve arm function and to explore the neural mechanisms involved [4, 5]. Action observation therapy (AOT) and mirror therapy (MT) are two examples of novel approaches concerning stroke motor recovery that are supported by neuroscientific foundations [6, 7]. However, the relative efficacy of AOT versus MT has not been validated in patients with stroke.
AOT is a promising approach grounded in basic neuroscience and the recent discovery of the mirror neuron system (MNS) . AOT commonly includes action observation and action execution and allows patients to safely practice movements and motor tasks. AOT is recommended to help patients with stroke to form accurate images of motor actions  and to mediate their motor relearning process after stroke . Researchers have found that AOT can induce stronger cognitive activity than motor imagery in patients with stroke and have suggested that AOT could be an effective approach for patients who have difficulty with motor representation . AOT is a new approach in stroke rehabilitation; therefore, only a few studies have targeted enhancement of UE motor recovery and investigated the effects of AOT in patients with stroke [8, 10, 11, 12, 13, 14]. Based on these studies, AOT has been shown to be a beneficial and effective approach to improve patient motor function. However, the heterogeneity of study designs and small sample sizes of the studies lead to no clear conclusions about the efficacy of AOT in stroke rehabilitation.
MT has emerged as another novel stroke-rehabilitation approach during the last decade [15, 16, 17]. In this treatment, participants are instructed to move their arms and watch the action reflection of the non-affected arm in the mirror, as if it were the affected one. The process creates the visual illusion of the non-affected arm as the affected arm is normally moving. MT focuses on visual and proprioceptive feedback of the non-affected limb, which may provide substitute inputs for absent or reduced proprioceptive feedback from the affected side of the body . A growing amount of academic literature has demonstrated that patients with stroke gain improvements in motor and daily function, movement control strategies, and activities of daily living [16, 17] after treatment with MT, which supports its use in stroke rehabilitation. In short, MT is potentially a simpler, less expensive, and effective stroke-rehabilitation approach for practical implementation in clinical settings.
Action observation is based on activities of the MNS and mainly involves brain areas of the inferior parietal lobe, inferior frontal gyrus, and ventral premotor cortex . Mirror neurons discharge both during the execution of motor acts or goal-directed actions and during the observation of other people performing the same or similar actions . Experimental studies in healthy adults have demonstrated that the MNS was activated during both the observation and execution of movements, which helped to form new motor patterns during action observation [21, 22, 23]. In addition, although positive effects of MT have been demonstrated in patients with stroke , there is no consensus about the underlying neural mechanisms of MT. Three hypotheses have been recently proposed to explain the beneficial effects of MT on motor recovery . Accordingly, MT may affect perceptual motor processes via three functional neural networks: (1) activation of brain regions associated with MNS [25, 26], (2) recruitment of ipsilateral motor pathways , and (3) substitution of abnormal proprioception from the affected limb with feedback from the non-affected limb [15, 18]. Few AOT and MT neurophysiological or imaging studies have been conducted in patients with stroke. No studies have directly compared and unraveled the similarities or differences in neural plastic changes between AOT and MT in these patients. It is crucial to compare neuroplasticity mechanisms between these intervention regimens to optimize rehabilitative outcomes.
The main purposes of this clinical trial are to (1) compare the immediate and retention treatment effects of AOT and MT on different outcomes with those of a dose-matched control group and (2) explore and compare the neural mechanisms and changes in cortical neural activity associated with the effects of AOT and MT in stroke patients, using magnetoencephalography (MEG).[…]
Continue —> Effects of action observation therapy and mirror therapy after stroke on rehabilitation outcomes and neural mechanisms by MEG: study protocol for a randomized controlled trial | Trials | Full Text
To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain.
Single-blind case series.
Three outpatient physical therapy clinics.
Patients with shoulder pain and limited AROM (N=69).
Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder.
We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy.
There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°.
A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects.
To investigate the effectiveness of mirror therapy combined with neuromuscular electrical stimulation in promoting motor recovery of the lower limbs and walking ability in patients suffering from foot drop after stroke.
Randomized controlled study.
Inpatient rehabilitation center of a teaching hospital.
Sixty-nine patients with foot drop.
Patients were randomly divided into three groups: control, mirror therapy, and mirror therapy + neuromuscular electrical stimulation. All groups received interventions for 0.5 hours/day and five days/week for four weeks.
10-Meter walk test, Brunnstrom stage of motor recovery of the lower limbs, Modified Ashworth Scale score of plantar flexor spasticity, and passive ankle joint dorsiflexion range of motion were assessed before and after the four-week period.
After four weeks of intervention, Brunnstrom stage (P = 0.04), 10-meter walk test (P < 0.05), and passive range of motion (P < 0.05) showed obvious improvements between patients in the mirror therapy and control groups. Patients in the mirror therapy + neuromuscular electrical stimulation group showed better results than those in the mirror therapy group in the 10-meter walk test (P < 0.05). There was no significant difference in spasticity between patients in the two intervention groups. However, compared with patients in the control group, patients in the mirror therapy + neuromuscular electrical stimulation group showed a significant decrease in spasticity (P < 0.001).
|1.||Brewer L, Horgan F, Hickey A, Stroke rehabilitation: recent advances and future therapies. QJM 2013; 106: 11–25. Google Scholar CrossRef, Medline|
|2.||Bethoux F, Rogers HL, Nolan KJ, The effects of peroneal nerve functional electrical stimulation versus ankle-foot orthosis in patients with chronic stroke: a randomized controlled trial. Neurorehabil Neural Repair 2014; 28: 688–697. Google Scholar Link|
|3.||O’Dell MW, Dunning K, Kluding P, Response and prediction of improvement in gait speed from functional electrical stimulation in persons with poststroke drop foot. PM R 2014; 6: 587–601; quiz 601. Google Scholar CrossRef, Medline|
|4.||Michielsen ME, Selles RW, van der Geest JN, Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil Neural Repair 2011; 25: 223–233. Google Scholar Link|
|5.||Samuelkamaleshkumar S, Reethajanetsureka S, Pauljebaraj P, Mirror therapy enhances motor performance in the paretic upper limb after stroke: a pilot randomized controlled trial. Arch Phys Med Rehabil 2014; 95: 2000–2005. Google Scholar CrossRef, Medline|
|6.||Sousa Nanji L, Torres Cardoso A, Costa J, Analysis of the Cochrane review: interventions for improving upper limb function after stroke. Cochrane Database Syst Rev 2014; 11: CD010820; Acta Med Port 2015; 28: 551–553. Google Scholar|
|7.||Thieme H, Mehrholz J, Pohl M, Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev 2012; 3: CD008449. Google Scholar CrossRef|
|8.||Stein C, Fritsch CG, Robinson C, Effects of electrical stimulation in spastic muscles after stroke: systematic review and meta-analysis of randomized controlled trials. Stroke 2015; 46: 2197–2205. Google Scholar CrossRef, Medline|
|9.||Knutson JS, Fu MJ, Sheffler LR, Neuromuscular electrical stimulation for motor restoration in hemiplegia. Phys Med Rehabil Clin N Am 2015; 26: 729–745. Google Scholar CrossRef, Medline|
|10.||Sabut SK, Sikdar C, Kumar R, Functional electrical stimulation of dorsiflexor muscle: effects on dorsiflexor strength, plantarflexor spasticity, and motor recovery in stroke patients. NeuroRehabilitation 2011; 29: 393–400. Google Scholar Medline|
|11.||You G, Liang H, Yan T. Functional electrical stimulation early after stroke improves lower limb motor function and ability in activities of daily living. NeuroRehabilitation 2014; 35: 381–389. Google Scholar Medline|
|12.||Kojima K, Ikuno K, Morii Y, Feasibility study of a combined treatment of electromyography-triggered neuromuscular stimulation and mirror therapy in stroke patients: a randomized crossover trial. NeuroRehabilitation 2014; 34: 235–244. Google Scholar Medline|
|13.||Kim H, Lee G, Song C. Effect of functional electrical stimulation with mirror therapy on upper extremity motor function in poststroke patients. J Stroke Cerebrovasc Dis 2014; 23: 655–661. Google Scholar CrossRef, Medline|
|14.||Yun GJ, Chun MH, Park JY, The synergic effects of mirror therapy and neuromuscular electrical stimulation for hand function in stroke patients. Ann Rehabil Med 2011; 35: 316–321. Google Scholar CrossRef, Medline|
|15.||Lee D, Lee G, Jeong J. Mirror Therapy with Neuromuscular Electrical Stimulation for improving motor function of stroke survivors: a pilot randomized clinical study. Technol Health Care 2016; 24: 503–511. Google Scholar CrossRef, Medline|
|16.||Gregson JM, Leathley M, Moore AP, Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. Arch Phys Med Rehabil 1999; 80: 1013–1016. Google Scholar CrossRef, Medline|
|17.||Mehrholz J, Wagner K, Rutte K, Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil 2007; 88: 1314–1319. Google Scholar CrossRef, Medline|
|18.||Lee HJ, Cho KH, Lee WH. The effects of body weight support treadmill training with power-assisted functional electrical stimulation on functional movement and gait in stroke patients. Am J Phys Med Rehabil 2013; 92: 1051–1059. Google Scholar CrossRef, Medline|
|19.||Flansbjer UB, Holmback AM, Downham D, Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med 2005; 37: 75–82. Google Scholar CrossRef, Medline|
|20.||Sawner KA, LaVigne JM, Brunnstrom S. Brunnstrom’s movement therapy in hemiplegia: a neurophysiological approach. 2nd ed. Philadelphia, PA: Lippincott, 1992. Google Scholar|
|21.||Cho KH, Lee JY, Lee KJ, Factors related to gait function in post-stroke patients. J Phys Ther Sci 2014; 26: 1941–1944. Google Scholar CrossRef, Medline|
|22.||Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67: 206–207. Google Scholar CrossRef, Medline|
|23.||Jung IG, Yu IY, Kim SY, Reliability of ankle dorsiflexion passive range of motion measurements obtained using a hand-held goniometer and Biodex dynamometer in stroke patients. J Phys Ther Sci 2015; 27: 1899–1901. Google Scholar CrossRef, Medline|
|24.||Bakhtiary AH, Fatemy E. Does electrical stimulation reduce spasticity after stroke? A randomized controlled study. Clin Rehabil 2008; 22: 418–425. Google Scholar Link|
|25.||Sütbeyaz S, Yavuzer G, Sezer N, Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil 2007; 88: 555–559. Google Scholar CrossRef, Medline|
|26.||Arya KN. Underlying neural mechanisms of mirror therapy: implications for motor rehabilitation in stroke. Neurol India 2016; 64: 38–44. Google Scholar CrossRef, Medline|
|27.||Guo F, Xu Q, Abo Salem HM, The neuronal correlates of mirror therapy: a functional magnetic resonance imaging study on mirror-induced visual illusions of ankle movements. Brain Res 2016; 1639: 186–193. Google Scholar CrossRef, Medline|
|28.||Gondin J, Brocca L, Bellinzona E, Neuromuscular electrical stimulation training induces atypical adaptations of the human skeletal muscle phenotype: a functional and proteomic analysis. J Appl Physiol 2011; 110: 433–450. Google Scholar CrossRef, Medline|
|29.||Jones S, Man WD, Gao W, Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease. Cochrane Database Syst Rev 2016; 10: CD009419. Google Scholar CrossRef|
|30.||Shin HK, Cho SH, Jeon HS, Cortical effect and functional recovery by the electromyography-triggered neuromuscular stimulation in chronic stroke patients. Neurosci Lett 2008; 442: 174–179. Google Scholar CrossRef, Medline|
|31.||Sheffler LR, Chae J. Neuromuscular electrical stimulation in neurorehabilitation. Muscle Nerve 2007; 35: 562–590. Google Scholar CrossRef, Medline|
|32.||Weerdesteyn V, de Niet M, van Duijnhoven HJ, Falls in individuals with stroke. J Rehabil Res Dev 2008; 45: 1195–1213. Google Scholar CrossRef, Medline|
|33.||Yavuzer G, Selles R, Sezer N, Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil 2008; 89: 393–398. Google Scholar CrossRef, Medline|
|34.||Alfieri V. Electrical treatment of spasticity. Reflex tonic activity in hemiplegic patients and selected specific electrostimulation. Scand J Rehabil Med 1982; 14: 177–182. Google Scholar Medline|
|35.||King TIII. The effect of neuromuscular electrical stimulation in reducing tone. Am J Occup Ther 1996; 50: 62–64. Google Scholar CrossRef, Medline|
|36.||Rushton DN. Functional electrical stimulation and rehabilitation—an hypothesis. Med Eng Phys 2003; 25: 75–78. Google Scholar CrossRef, Medline|
|37.||Touzalin-Chretien P, Dufour A. Motor cortex activation induced by a mirror: evidence from lateralized readiness potentials. J Neurophysiol 2008; 100: 19–23. Google Scholar CrossRef, Medline|
Source: Effects of mirror therapy combined with neuromuscular electrical stimulation on motor recovery of lower limbs and walking ability of patients with stroke: a randomized controlled studyClinical Rehabilitation – Qun Xu, Feng Guo, Hassan M Abo Salem, Hong Chen, Xiaolin Huang, 2017
[Purpose] The purpose of this study was to examine what changes occur in brain waves when patients with stroke receive mirror therapy intervention.
[Subjects and Methods] The subjects of this study were 14 patients with stroke (6 females and 8 males). The subjects were assessed by measuring the alpha and beta waves of the EEG (QEEG-32 system CANS 3000). The mirror therapy intervention was delivered over the course of four weeks (a total of 20 sessions).
[Results] Relative alpha power showed statistically significant differences in the F3, F4, O1, and O2 channels in the situation comparison and higher for hand observation than for mirror observation. Relative beta power showed statistically significant differences in the F3, F4, C3, and C4 channels.
[Conclusion] This study analyzed activity of the brain in each area when patients with stroke observed movements reflected in a mirror, and future research on diverse tasks and stimuli to heighten activity of the brain should be carried out.
Dysfunction from upper extremity hemiparesis impairs performance of many activities of daily living (ADL)1) . Individuals affected by stroke will learn or relearn competencies necessary to perform ADL. Traditionally, the practice of skills provided in neurologic rehabilitation has focused on reducing motor impairment and minimizing physical disability2, 3) . Since 2000, various studies of upper extremity function recovery using interventions such as constraint-induced movement therapy, functional electric stimulation, robotic-assisted rehabilitation, and bilateral arm training have been carried out4) . Such interventions were effective in increasing upper extremity functions in patients with stroke and are continually utilized in the clinical field5–7) .
However, most of the treatment protocols for the paretic upper extremity are labor intensive and require one on one manual interaction with therapists for several weeks, which makes the provision of intensive treatment for all patients difficult8) . Hence, alternative strategies and therapies are needed to reduce the long-term disability and functional impairment from upper extremity hemiparesis9) .
Mirror therapy may be a suitable alternative because it is simple; inexpensive; and, most importantly, patient-directed treatment that may improve upper extremity function8, 10) . Emerging methods in mirror therapy aim to restore motor control through a change in brain function, i.e. motor relearning11, 12) . Voluntary movements of the paretic upper extremity and hand by referring to a mirror activate the bilateral cortex and cause reorganization for other areas around the damaged brain to replace its function, thereby affecting recovery in motor function13) .
Although such methods are promising, they have failed to restore functional motor control for many patients who have experienced stroke. It is important to explore new methods that may facilitate the recovery of brain function and the restoration of more normal motor control14) . Many studies have addressed the neurophysiological effects of mirror therapy. The EEG study gave diverse stimulations to the thumb with or without a mirror to examine which area of the cortex was activated. They observed common activation areas in the primary motor cortex (M1), cingulate, and prefrontal cortex15) . And the study with healthy adults used mirror therapy with functional MRI (fMRI) and showed no difference between the dominant and non-dominant hand. Excitability of M1 ipsilateral to a unilateral hand movement was facilitated by viewing a mirror reflection of the moving hand16) . This finding provides neurophysiological evidence supporting the application of mirror therapy in stroke rehabilitation. Even though, previous studies concerned healthy subjects and had no interventions, a diversity of studies have shown upper extremity functional improvement through mirror therapy8) .
Thus, the purpose of this study was to examine what changes occur in brain waves when patients with stroke receive mirror therapy intervention.
“Can I use MusicGlove if I have no hand movement?”
We hear this question a lot, and we’re obligated to answer with, “Unfortunately MusicGlove requires that you can touch your thumb to at least one of your finger tips and release this grip by a quarter of an inch or more.”
It’s a stiff, clinical response, but it’s the truth about 80% of the time.
Recently we had one woman challenge this notion – and it made us soooo happy!
Margaret, a post rehabilitation exercise specialist, purchased a MusicGlove for her husband, a stroke survivor who had absolutely no movement in his affected hand. He could not lift a single finger.
He was in stage 1 of the Brunnstrom stages of recovery: Flaccidity.
Some stroke survivors are told that there’s no hope for flaccidity, and limiting statements like this should be taken with a grain of salt.
Case in point: Margaret’s husband’s therapist said that he wouldn’t regain any hand movement, and that he would eventually lose all movement and die… What?!?!
We can’t even believe words like that are spoken in the clinic! Obviously this isn’t the norm, but it was still shocking to hear.
Needless to say, Margaret dismissed what the therapist said and started researching her options.
Because the truth is that if you have no movement in your affected hand, it’s still possible to regain movement. You can do whatever you put your mind to, as long as you put in the time and hard work.
And it helps to have a little ingenuity.
Margaret refused to accept that her husband couldn’t regain hand movement, so she took matters into her own hands.
She purchased MusicGlove and used it in combination with mirror therapy – with a twist. A huge twist.
Typically, mirror therapy involves using a tabletop mirror to reflect your ‘good’ hand in place of your affected hand. (See this image.)
When performing hand therapy exercises in this manner, it ‘tricks’ your brain into thinking that you’re actually moving your affected hand and helps rewire your brain.
It’s a highly effective method for regaining hand function after stroke. So Margaret used this principle, but ditched the mirror.
She placed the MusicGlove on her husband’s ‘good hand’ and had him use it that way. While he was doing this, she would assist his affected hand to mirror his movements.
She wouldn’t move his hand to the game; she moved his hand to exactly match what his other hand was doing. So if he missed a note, she missed a note.
This bilateral synchronicity helped rewire her husband’s brain, and he went from being completely flaccid to having twitches!
While twitches might not seem like a big deal to you, they were a big deal to this couple – especially when his therapist said it wasn’t possible.
Can you imagine the satisfaction and happiness they felt?
And twitches are just the beginning.
If he continues to use the device passively, then he can continue to improve until he can use the device independently. Then in due time and effort, he might progress into stage 7 of stroke recovery: full muscle control.
It’s a big, hairy goal – one that only a confident post-rehab specialist would think of – but it’s possible.
“The body achieves what the mind believes.”
If this couple took their therapists’ word as law, they wouldn’t have experienced this progress. They wouldn’t have witnessed his potential.
Whatever you believe becomes your reality. Make the choice to believe in a higher recovery.
Learn to question your therapists and get curious about your potential.
If you have no hand movement, then you can use MusicGlove – it just requires time, patience, and assistance.
You can use the device passively by using your unaffected hand to move your affected hand, which still helps your brain rewire itself. You can do this until you regain enough hand function to use the device actively without assistance.
There’s no guarantee about what will happen because every recovery is different.
The choice is yours to make.
But no matter what you choose, always believe in a higher recovery.
Challenge the status quo, and believe in progress even when no one else does.
Click here to learn more about MusicGlove. You’ll find our clinical trial results, more information about the device, a few video testimonials, and our contact number in case you’d like to discuss your questions with us.