Background
Mirror therapy is used to improve motor function after stroke. During mirror therapy, a mirror is placed in the person's midsagittal plane, thus reflecting movements of the non-paretic side as if it were the affected side.

Objectives
To summarise the effectiveness of mirror therapy compared with no treatment, placebo or sham therapy, or other treatments for improving motor function and motor impairment after stroke. We also aimed to assess the effects of mirror therapy on activities of daily living, pain, and visuospatial neglect.

Search methods
We searched the Cochrane Stroke Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED, PsycINFO and PEDro (last searched 16 August 2017). We also handsearched relevant conference proceedings, trials and research registers, checked reference lists, and contacted trialists, researchers and experts in our field of study.

Selection criteria
We included randomised controlled trials (RCTs) and randomised cross-over trials comparing mirror therapy with any control intervention for people after stroke.

Data collection and analysis
Two review authors independently selected trials based on the inclusion criteria, documented the methodological quality, assessed risks of bias in the included studies, and extracted data. We assessed the quality of the evidence using the GRADE approach. We analysed the results as standardised mean differences (SMDs) or mean differences (MDs) for continuous variables, and as odds ratios (ORs) for dichotomous variables.

Main results
We included 62 studies with a total of 1982 participants that compared mirror therapy with other interventions. Of these, 57 were randomised controlled trials and five randomised cross-over trials. Participants had a mean age of 59 years (30 to 73 years). Mirror therapy was provided three to seven times a week, between 15 and 60 minutes for each session for two to eight weeks (on average five times a week, 30 minutes a session for four weeks).When compared with all other interventions, we found moderate-quality evidence that mirror therapy has a significant positive effect on motor function (SMD 0.47, 95% CI 0.27 to 0.67; 1173 participants; 36 studies) and motor impairment (SMD 0.49, 95% CI 0.32 to 0.66; 1292 participants; 39 studies). However, effects on motor function are influenced by the type of control intervention. Additionally, based on moderate-quality evidence, mirror therapy may improve activities of daily living (SMD 0.48, 95% CI 0.30 to 0.65; 622 participants; 19 studies). We found low-quality evidence for a significant positive effect on pain (SMD −0.89, 95% CI −1.67 to −0.11; 248 participants; 6 studies) and no clear effect for improving visuospatial neglect (SMD 1.06, 95% CI −0.10 to 2.23; 175 participants; 5 studies). No adverse effects were reported.

Authors' conclusions
The results indicate evidence for the effectiveness of mirror therapy for improving upper extremity motor function, motor impairment, activities of daily living, and pain, at least as an adjunct to conventional rehabilitation for people after stroke. Major limitations are small sample sizes and lack of reporting of methodological details, resulting in uncertain evidence quality.

Mirror therapy for improving motor function after stroke

Effect of Mirror Therapy on Recovery of Stroke Survivors: A Systematic Review and Network Meta-analysis.

With the development of the social economy, the demand for rehabilitation medical devices is also increasing. However, most rehabilitation devices on the market currently have problems such as bulky equipment, inconvenient operation, and high cost. Taking hand grasp force as the main monitoring parameter, this paper designs a low-cost hand rehabilitation system that is convenient to use, can remotely monitor the progress of hand rehabilitation. The system can well solve the large volume of equipment caused by the complex structure of the existing hand rehabilitation equipment. It can also solve the problems that the device cannot obtain the data of the patient’s recovery in real-time and the use cost is too high. The system includes five modules: flexible pressure sensor module, voltage conversion module, microcomputer module, LCD module and NB-IoT communication module. The flexible pressure sensor module can be attached to the patient’s hand to monitor the recovery data in real-time and see the recovery progress visually on the LCD screen. In addition, rehabilitation data can be uploaded remotely through the NB-IoT communication module for remote guidance by professional doctors to speed up the process of hand rehabilitation.

Hand Rehabilitation System Based on Flexible Pressure Sensor

Objective To explore mirror therapy on upper extremity function in patients with cerebral apoplexy hemiplegia and hand function. Methods Forty patients with of stroke hemiplegia were divided into control group and rehabilitation group. Control group had routine rehabilitation training,including the good limb position puts,the passive joints,muscle strength training,balance training,walk training therapy,homework therapy,physical factor and so on. Rehabilitation group added mirror therapy besides those routine trainings. Both groups had finished 4 weeks treatment,before treatment and 2 weeks and 4 weeks after treatment for the Fugl-Mayer scale,STEF and Barthel index evaluation. Results Two and four weeks after rehabilitation treatment group FMA score were 36. 37 ± 16. 36,44. 36 ± 14. 58,STEF score were 58. 75 ± 7. 57,73. 32 ± 8. 81,BI score were 57. 33 ± 15. 26,67. 50 ± 13. 48,score before the treatment and control group in the two groups after treatment were increased,and the rehabilitation group was better than control group( P < 0. 05). Conclusion Mirror therapy can improve the stroke patients with hemiplegia of upper limb function and hand function,and to improve their ability of daily life activities has a role in promoting.

Wang Wei

Papers

Mirror therapy on upper extremity function in patients with cerebral apoplexy hemiplegia and hand function