Possible benefits of Mirror Box Therapy for stroke

In some cases, paralysis and muscle weakness after a stroke have a psychological element. A stroke survivor may ‘neglect’ part of his or her body, or have an unconscious negative reaction to a damaged limb. It can be difficult to tell if there is a psychological aspect to the deficit left by a stroke. In 2005, a pilot study of mirror box therapy showed that it could speed up recovery for some people. Sathian et al studied a group of stroke survivors six months after their assault:

‘Six months post stroke the patient was given MVF for 2 weeks and there was a striking recovery of grip strength and other useful movements (e.g. opening a lock) in the paretic [partially paralyzed] arm.’³

There have been numerous studies on the effectiveness of mirror box therapy.⁴ The majority of these have shown good results for a significant number of participants. For example, in 2008 in a high-quality study, 40 patients with an average age of 62 were tested within a year of their stroke. The study showed that ‘patients who received mirror therapy in addition to conventional therapy showed significant improvement’ in specific tests that measure the recovery of movement. Participants were randomly broken into two groups. Both groups continued their standard therapy, in addition to extra wrist and finger exercises. One group used a mirror while exercising; the other group used the un-reflective side of the mirror:

‘The treatments were carried out through a period of 4 weeks with a follow-up at 6 months (both real and placebo mirror treatments were 30 minutes per day, and standard therapy was 5 days per week, 2-5 hours per day). …  Immediately following treatment, patients who received mirror therapy in addition to conventional therapy showed significant improvement in scores of the Brunnstrom stages for the hand and upper extremity as well as in the FIM self-care score (all p<.01). The above measures also showed statistical significance in favour of the mirror group for between-group differences measured from post treatment to 6 months follow-up (all p <.05).’⁵

Arguments against using Mirror Box Therapy for stroke

Mirror box therapy is effective where there is a psychological element to the paralysis or weakness. While this may be the case for many stroke survivors, it is not the case for everyone. Therefore, mirror box therapy does not work in every case. However, it might be hard to tell whether someone could benefit from the treatment or not until they have gone through a trial period. It has also been speculated that the success of the treatment depends, in part, on the exact location of the lesion and duration of paralysis following a stroke. If these variables are better understood, it might be possible to administer mirror box therapy to those patients who are likely to benefit most.⁶

We did not find any reports suggesting that mirror box therapy could cause damage or harm to the user. This treatment costs little or nothing and can be carried out at home with minimum help from a therapist. The simplicity and lack of danger in the procedure have led doctors to suggest that it should be implemented routinely alongside other therapies.⁷

Case histories

This video shows how to use a mirror box for stroke and phantom limb pain:

Notes and references

1. This short article describes a case where mirror box therapy was show to improve recovery after a stroke. ‘Doing It with Mirrors: A Case Study of a Novel Approach to Neurorehabilitation’ by K Sathian, Arlene I. Greenspan, and Stephen L. Wolf. In Neurorehabilitation and Neural Repair 2000;14:73-76
2. ‘Plasticity and functional recovery in neurology’. College Lectures by VS Ramachandran. In Clinical Medicine vol 5 no 4 July 2005
3. ‘Plasticity and functional recovery in neurology’. College Lectures by VS Ramachandran. In Clinical Medicine vol 5 no 4 July 2005
4. ‘The use of visual feedback, in particular mirror visual feedback, in restoring brain function’ by V.S. Ramachandran and Eric L. Altschuler. In Brain 2009 132(7):1693-1710
5. ‘Mirror Therapy Improves Hand Function in Subacute Stroke: A Randomized Controlled Trial’ by Yavuzer G., Selles R., et al. In Archives of Physical Medicine and Rehabilitation, 2008 89, 393-398.
6. ‘The use of visual feedback, in particular mirror visual feedback, in restoring brain function’ by V.S. Ramachandran and Eric L. Altschuler. In Brain 2009 132(7):1693-1710.
7. ‘The use of visual feedback, in particular mirror visual feedback, in restoring brain function’ by V.S. Ramachandran and Eric L. Altschuler. In Brain 2009 132(7):1693-1710