Effectiveness of mirror therapy in the motor recovery of upper extremity in the post stroke hemiplegic patients: a randomized controlled trial in a tertiary care hospital in Manipur, Northeast India


  • Ningthemba Yumnam Department of Physical Medicine & Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Joy Singh Akoijam Department of Physical Medicine & Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Longjam Nilachandra Singh Department of Physical Medicine & Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Joymati Oinam Department of Community Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India




Brunnstrom stages, FIM, Mirror therapy, Stroke, Upper extremity


Background: Stroke is a leading cause of disability and majority of the stroke survivors experience upper extremity functional limitations. Therefore, the objective of this study was to evaluate the effectiveness of mirror therapy in addition with a conventional upper limb rehabilitation program in a post stroke hemiplegic patient.

Methods: A randomized controlled trial was conducted among 72 post stroke patients aged 35-65 years having hemipa¬resis attending the PMR department, RIMS, Manipur from 2013 to 2016. Assessment was done at baseline, 1 and 6 months for FIM self care, Brunnstrom stages of motor recovery and MAS for spasticity. Both the group participated in a stroke rehabilitation program and study group was given mirror therapy in addition. Descriptive statistics such as mean±SD and inferential statistics like Chi-square test, Student’s t test, and ANOVA were used. A p-value < 0.05 was taken as statistically significant.

Results: There was an improvement in Brunnstrom stage and FIM self-care score in both groups, but the post-treatment score was significantly higher in the mirror therapy group. Statistically significant difference in FIM self care and motor recovery between the study and control groups was noted [1.1±0.38 (study) versus 0.88±0.32 (control) for motor recovery and 34.1±2.59 (study) versus 29.5±4.58 (control) for FIM self care]. However, no significant difference was seen in spasticity between the groups.

Conclusions: Mirror therapy used in addition to conventional stroke rehabilitation program was found to be effective in the recovery of upper extremity motor functions and daily self care activities in post stroke hemiplegic patients.


Global Health Estimates. Geneva: World Health Organization; 2012. Available at: http://www.who.int/healthinfo/global_burden_disease/en/. Accessed on 5th June 2017.

Michielsen ME, Selles RW, Geest JNV, Eckhardt M, Yavuzer G, Stam HJ, et al. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: A phase II randomized controlled trial. Neurorehabilitation Neural Repair. 2011;24(3):223-33.

Thieme H, Bayn M, Wurg M, Zange C, Pohl M, Behrens J. Mirror therapy for patients with severe arm paresis after stroke - A randomized controlled trial. Clin Rehabil. 2012;27(4):314-24.

Arjundas D, Pandiyan U, Arjundas G, Henry B. Surveillance of stroke: WHO STEP-wise approach: A Chennai stroke unit report. Ann Indian Acad Neurol. 2007;10:154-9.

Barker RN, Gill TJ, Brauer SG. Factors contributing to upper limb recovery after stroke: a survey of stroke survivors in Queensland Australia. Disabil Rehabil. 2007;29:981-9.

Prange GB, Jannink MJ, Groothuis-Oudshoorn CG, Hermens HJ, IJzerman MJ. Systematic review of the effect of robot-aided therapy on recovery of the hemiparetic arm after stroke. J Rehabil Res Dev. 2006;43:171-84.

Wu CY, Huang PC, Chen YT, Lin KC, Yang HW. Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2013;94:1023-30.

Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. Mirror therapy for improving motor function after stroke. Stroke. 2013;44:1-2.

Ramachandran VS, Rogers-Ramachandran D, Stewart M. Perceptual correlates of massive cortical reorganization. Science. 1992;258:1159-60.

Machado S, Velasques B, PaesF, Cunha M, Basile LF, Budde H, et al. Terapia-espelho aplicada à recuperação funcional de paciente pós-acidente vascular cerebral. Rev Neurocienc. 2011;19(1):171-5.

Altschuler EL, Wisdom SB, Stone L, Foster C, Galasko D, Llewellyn ME, et al. Rehabilitation of hemi paresis after stroke with mirror. Lancet 1999;353(9169):2035-6.

Yavuzer G, Selles R, Sezer N, Sutbeyaz S, Bussmann JB, Koseoglu F, et al. Mirror therapy improves hand functions in subacute stroke: A randomized controlled trial. Arch Phys Med Rehabil. 2009;89:393-8.

Dohle C, Püllen J, Nakaten A, et al.: Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair. 2009;23:209-17.

Sawner K, Lavigne J. Brunnstrom’s Movement Therapy in Hemiplegia. In: A Neurophysiological Approach, 2nd ed. Pennsylvania: JB Lippincott Company; 1992:41-65.

Hamilton BB, Granger CV, Sherwin FS, Zielezny M, Tashman JS. A uniform national data system for medical rehabilitation. In: Rehabilitation outcomes: analysis and measurement. Baltimore: Brookes Publishing, 1987:137-147.

Appelros P, Stegmayr B, Terent A. Sex differences in stroke epidemiology: a systemic review. Stroke. 2009;40(4):1082-92.

Gurbuz N, Afsar SI, Ayaş S, Cosar SNS. Effect of mirror therapy on upper extremity motor function in stroke patients: a randomized controlled trial. J Phys Ther Sci. 2016;28:2501-6.

Dhamija RK, Sarika A, Gaba P, Jais M, Kaintura A, Kumar M, et al. Study of genetic, metabolic and inflammatory risk factors in patients of acute ischemic stroke. Indian J Clin Biochem. 2008;23(2):136-43.

Tufail M, Wadhwa RK, Borah DB, Nonica L, Kothari SY. Evaluation of mirror therapy for upper limb rehabilitation in stroke. IJPMR. 2013;24(3):63-9.

Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database Syst Rev. 2012;3:CD008449.

Zacharis D, Moumtzi E, Terzis N, Roussos N, Patatoukas D. The use of mirror therapy in stroke patients with hemiplegic upper limb: a randomized controlled trial. Ann Phys Rehabil Med. 2014;57(1):441-6.

Invernizzi M, Negrini S, Carda S, Lanzotti L, Cisari C, Baricich A. The value of adding mirror therapy for upper limb motor recovery of subacute stroke patients. Eur J Phys Rehabil Med. 2013;49(3):311-7.

Bahrami M, Mazloom SR, Hasanzadeh F, Ghandehari K. The effect of mirror therapy on self care of patients with stroke. J Mazandaran Univ Med Sci. 2013;23(107):78-88.






Original Research Articles