Motor Recovery and Cortical Reorganization After Mirror Therapy in Chronic Stroke Patients: A Phase II Randomized Controlled Trial

Marian Michielsen*, Ruud Selles, Jos van der Geest, Manuel Eckhardt, MG Yavuzer, Henk Stam, Marion Smits, Gerard Ribbers, Hans Bussmann

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

290 Citations (Scopus)


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). Conclusion. 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.
Original languageEnglish
Pages (from-to)223-233
Number of pages11
JournalNeurorehabilitation and Neural Repair
Issue number3
Publication statusPublished - 4 Nov 2011

Bibliographical note

The author(s) disclosed receipt of the following financial support
for the research and/or authorship of this article: Fonds NutsOhra
[SNO-T-0602-23]; Innovatiefonds Zorgverzekeraars [06-262];
Wetenschappelijk College Fysiotherapie [WU/2007/07] and Hersenstichting Nederland [15F07.54]

Research programs

  • EMC MUSC-01-46-01
  • EMC NIHES-01-50-01-A
  • EMC ONWAR-01-94-01


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