Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial.
OBJECTIVE
To evaluate for any clinical effects of home-based mirror therapy and subsequent cortical reorganization in patients with chronic stroke with moderate upper extremity paresis.


METHODS
A total of 40 chronic stroke patients (mean time post .onset, 3.9 years) were randomly assigned to the mirror group (n = 20) or the control group (n = 20) and then joined a 6-week training program. Both groups trained once a week under supervision of a physiotherapist at the rehabilitation center and practiced at home 1 hour daily, 5 times a week. The primary outcome measure was the Fugl-Meyer motor assessment (FMA). The grip force, spasticity, pain, dexterity, hand-use in daily life, and quality of life at baseline-posttreatment and at 6 months-were all measured by a blinded assessor. Changes in neural activation patterns were assessed with functional magnetic resonance imaging (fMRI) at baseline and posttreatment in an available subgroup (mirror, 12; control, 9).


RESULTS
Posttreatment, the FMA improved more in the mirror than in the control group (3.6 ± 1.5, P < .05), but this improvement did not persist at follow-up. No changes were found on the other outcome measures (all Ps >.05). fMRI results showed a shift in activation balance within the primary motor cortex toward the affected hemisphere in the mirror group only (weighted laterality index difference 0.40 ± 0.39, P < .05).


CONCLUSIONS
This phase II trial showed some effectiveness for mirror therapy in chronic stroke patients and is the first to associate mirror therapy with cortical reorganization. Future research has to determine the optimum practice intensity and duration for improvements to persist and generalize to other functional domains.
Erasmus MC, University Medical Center, Rotterdam, Netherlands. m.michielsen@erasmusmc.nl
Marian E
ME
Michielsen
Ruud W
RW
Selles
Jos N
JN
van der Geest
Martine
M
Eckhardt
Gunes
G
Yavuzer
Henk J
HJ
Stam
Marion
M
Smits
Gerard M
GM
Ribbers
Johannes B J
JB
Bussmann
D000328:Adult; D000368:Aged; D002540:Cerebral Cortex / Q000473:pathology / Q000503:physiopathology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059167:Mirror Neurons / Q000473:pathology; D009473:Neuronal Plasticity / Q000502:physiology; D017063:Outcome Assessment, Health Care / Q000379:methods; D010291:Paresis / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000639:trends; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000473:pathology; D000071939:Stroke Rehabilitation