Mirror therapy after stroke is a unique rehabilitation technique that can help individuals improve mobility in the hand and arms — and sometimes even legs. The most attractive aspect of mirror therapy for stroke patients is that it is accessible to survivors with extremely limited mobility and even post-stroke paralysis.
To learn how mirror therapy for stroke patients works, it’s important to understand the role of mirror neurons and the phenomenon of neuroplasticity. This article will discuss how mirror therapy can help you improve function and the best way to practice it and promote recovery.
Use the links below to jump straight to any section:
- What is Mirror Therapy?
- Neuroplasticity in Stroke Recovery
- Improving Mobility After Stroke
- How to Practice Mirror Therapy
- Combining Mirror Therapy with Music Glove
What Is Mirror Therapy?
Mirror therapy is a therapeutic intervention first introduced to help relieve phantom limb pain, which occurs when an individual experiences pain in their amputated limb. It involves using a tabletop mirror to create a reflection of your arm or hand. The mirror is placed in the middle of the body, hiding the affected side and facing toward the non-affected side, so that the non-affected side appears in the reflection.
Then, the individual uses the non-affected arm to perform various arm and hand exercises while watching the reflection in the mirror. Practicing movements with your non-affected limb while watching its mirror image (which appears to be your affected limb) moving helps “trick” the brain into thinking that you’re moving your affected arm even though you aren’t.
In amputees, numerous sessions of mirror therapy were found to reduce phantom pain by helping the brain recognize and “feel” the amputated limb. As the applications of mirror therapy expanded, similar effects were also seen in individuals with pain and/or sensation deficits post-stroke. Furthermore, researchers found that mirror therapy is especially effective in helping to improve movement in the affected limb(s) of stroke survivors.
The Importance of Neuroplasticity for Stroke Recovery
One of the main reasons that mirror therapy works is due to mirror neurons. These are nerve cells that are activated by performing a movement or by simply watching a movement occur. Mirror therapy provides the visual feedback necessary to help mirror neurons fire by simply seeing the movement. As a result, your brain gets the feedback necessary to spark the rewiring process called neuroplasticity.
Neuroplasticity is the brain’s ability to heal and rewire itself after a neurological injury like a stroke. It is best activated through high repetition of therapeutic exercises, or massed practice. Neuroplasticity strengthens existing neural pathways (connections) and creates new ones. The stronger the neural pathways for a specific function become, the higher the chances of restoring that function.
After a stroke, many neural pathways become damaged or destroyed. Depending on the area(s) of the brain affected by stroke, specific functions may become impaired. Fortunately, neuroplasticity allows healthy parts of the brain to take over lost functions. For example, when the brain has trouble sending signals to the hand after a stroke, neuroplasticity allows new areas of the brain to take over hand function.
Mirror therapy is a great way to activate neuroplasticity, as it repetitively activates mirror neurons involved in affected movements. For example, consistently practicing specific movements, such as hand therapy exercises, during mirror therapy can help the brain rewire itself and strengthen the pathways that control hand function. Thus, mirror therapy can help activate neuroplasticity and promote overall recovery.
How Mirror Therapy Can Help Improve Mobility After Stroke
Mirror therapy is often used in rehabilitation clinics to help survivors pursue recovery, especially after a stroke. Even though it seems like a simulation, mirror therapy provides many benefits.
Benefits of mirror therapy exercises after stroke include:
- Hand and/or arm paralysis can improve. Studies have shown that the most common application for mirror therapy after stroke is to improve upper extremity function, and best of all – survivors don’t need any preexisting movement to benefit from this therapy.
- Leg mobility may increase. Although mirror therapy is often used on the upper extremities, studies show that it can also be used to improve leg function, but a bigger mirror will be required.
- Post-stroke pain can be reduced. Although not one of the most common applications of mirror therapy, there is some evidence that mirror therapy can improve post-stroke pain. For example, one study even found that mirror therapy helped reduce post-stroke pain in a survivor 5 years after a thalamic stroke.
- Activities of daily living may be easier to perform. After a stroke, it can be challenging for many survivors to return to their daily activities. Studies have found that mirror therapy can improve an individual’s ability to perform self-care.
- Hemineglect may improve. This condition involves loss of attention on one’s affected side. Although research is limited, some believe that mirror therapy may help improve visuospatial neglect, or hemineglect, in stroke survivors.
- Sensation deficits can be improved. While motor impairments are often the focus of mirror therapy for stroke patients, it can also be used to address sensation problems, such as discriminating hot and cold.
- Low-risk treatment option after stroke. Mirror therapy is considered a safe and affordable therapeutic intervention as it simply involves a tabletop mirror and gentle exercises.
Another benefit from mirror therapy is that it can be done with your therapist in a clinical setting, or it can be performed at home on your own. In the next section we’ll discuss how you can perform mirror therapy exercises after stroke safely and independently.
How to Practice Mirror Therapy After Stroke
Mirror therapy after stroke can be practiced with the help of a therapist or on your own. The following video and instructions are provided to illustrate how to practice mirror therapy for the hands specifically. However, if you want to target arm or leg mobility, simply adjust the protocol for that limb.
Here is a video from Bob & Brad (the “most famous physical therapists on the internet”) to help demonstrate mirror therapy:
Here are steps you can follow to perform mirror therapy:
- Place a tabletop mirror over your affected arm and hand, with the non-affected arm resting on the table next to the mirror, ensuring that it is fully in view in the reflection. Make sure your affected hand is out of view.
- Spend a few minutes observing the reflection and getting accustomed to the optical illusion.
- It can be helpful to think of the mirror as a window, instead of a reflection. This can help further “trick” your brain into thinking that you’re viewing your affected side.
- Then, begin by practicing simple hand therapy exercises with your non-affected hand. This can include touching your thumb to your fingertips, making a fist and then opening the hand, or turning your palm up and down.
- Complete these mirror therapy stroke exercises for at least 10 minutes, working your way up to half-hour sessions. Make sure to keep your eyes on the reflection in the mirror the entire time.
It’s important to be strategic and repetitive with your mirror therapy exercises. Practicing specific hand exercises repetitively will help activate neuroplasticity. The more you practice mirror therapy exercises, the more your brain will rewire itself, and the higher the chances of restoring hand and/or arm function.
Combining Mirror Therapy Exercises with MusicGlove
The thumb-to-fingertip hand exercise is often used in mirror therapy. This gentle movement helps stimulate neuroplasticity and provides a stepping stone to improving hand mobility. Similarly, like in mirror therapy, this hand exercise is a common movement in MusicGlove hand therapy.
MusicGlove is a neurorehab device designed to improve hand function after stroke. It motivates you to achieve high repetition of hand therapy exercises through a fun, interactive game. Best of all, the device has been clinically proven to improve hand function in 2 weeks.
However, MusicGlove does require some preexisting movement to get started, which can limit survivors with hand paralysis from using the device. To work around this limitation, some therapists have combined MusicGlove with mirror therapy by placing the glove on the survivor’s non-affected hand.
While the survivor is practicing hand exercises with their mobile hand, the affected hand behind the mirror may eventually start to develop twitches, which is a sign of movement slowly returning due to the power of mirror neurons and neuroplasticity. Of course, this is not the way that MusicGlove was intended to work, but therapists have self-reported positive results with this approach.
Here’s a video from a clinician at Helen Hayes hospital showing a demonstration of MusicGlove:
If you’re looking for a motivating way to stay engaged in mirror therapy at home, this could be a great option.
Understanding Mirror Therapy for Stroke Recovery
Mirror therapy is a promising stroke rehabilitation method for survivors— especially for individuals with hand or arm paralysis. It works by “tricking” the brain into thinking that you’re moving your affected side, even though it is a reflection. This triggers mirror neurons in the brain to fire, which helps improve motor recovery after stroke.
Although mirror therapy exercises can be performed on your own, try working with a therapist to get comfortable first. Then, practice as much as you can at home. Consistency is key to activating neuroplasticity and promoting stroke recovery.
We hope this article helped you understand how mirror therapy for stroke patients can help improve motor function.