Mirror Therapy

Background and Objectives: Stroke is a clinical syndrome consisting of rapidly developing clinical signs of focal disturbance of cerebral function lasting more than 24 hours or leading to death with no apparent cause other than a vascular origin." Some evidence-based studies proved that bilateral task-oriented exercise and Mirror therapy are effective in improving the hand function in hemiparetic stroke patient. But there is no comparative study of these two protocols. Hence the purpose of this study is to compare the effectiveness of bilateral task-oriented exercises and Mirror therapy in improving hand function in hemiparetic stroke patient. Methods: A total of 67 subjects met selection criteria for the study among them 7 members are dropouts from group A and B and were divided into 2 groups, 30 members in group A (bilateral task-oriented exercises), 30 members in group B (Mirror therapy). Both groups performed intervention for 5 days per week, for 4 weeks. The outcomes were Fugl Meyer and Motor Activity Log for measuring functional disabilities. Results: Paired "T" test was used to access the statistical significance within the groups. Statistical analysis between two groups using independent "t" test revealed that there is no significant difference between Bilateral taskoriented exercises and Mirror therapy groups. Conclusion: In this study, 4 weeks of bilateral task-oriented exercises and Mirror therapy showed that both approaches are equally effective in improving hand function in hemi paretic stroke.

Forward models allow individuals to learn to predict the sensory consequences of their own behavior. Social forward models have been proposed as an extension of forward models, allowing individuals to learn to predict the response of another to the individual's own behavior. This article proposes similarly that an individual who treats their reflection as another may learn to predict the behavior of their reflection, offering a new perspective on mirror self-recognition and a potential framework through which to investigate visual delusions. Specifically this article investigates this framework by considering four body image delusions; mirrored-self misidentification, body integrity disorder (BID), phantom limbs, and gender dysphoria, and two delusions associated with visual neglect; somatoparaphrenia and mirror agnosia.

The Confessio Amantis concludes with a revelatory scene in which Venus holds up a mirror to Amans, allowing him to recognize John Gower the poet— a moment that is often read as a mimetic and healing counterpoint to the Confessio’s sickness and self-questioning. My intention in this paper is to very slightly modify certain aspects of this narrative, to consider how the materiality of the mirror can inform its metaphoric deployments in the Confessio. I organize my discussion around two seemingly contrasting moments in the poem in which the self is seen and in different ways recognized through a reflective surface: the “Tale of Narcissus,” and the concluding moment in which Amans looks into the mirror to see, eventually, John Gower. Drawing in particular on the production and dissemination of mirrors in the Middle Ages, as well as basic properties of reflection, I point to certain challenges facing the medieval mirror: the hazy reflective properties of the lead mirror, and the impurities of the precariously made, limitedly accessible glass mirror. I ultimately suggest that, more than a revelation through reflective recognition, the Confessio’s ending would have proven most resonant for its portrayal of seeing through a complicated medium.

Stroke is one of the leading causes of long-term disability, and impairment of the arm explains approximately 50% of the variance in functional limitation after stroke. Therefore, we should tackle the issue that effective training approaches to promote motor recovery and activities of daily living are needed to reduce the burden of stroke. Since the 1990s, contemporary task-oriented treatment approaches have emerged and received increasing popularity in stroke rehabilitation. The contemporary approaches include constraint-induced therapy (CIT), bilateral arm training (BAT), robot-assisted therapy (RT), and mirror therapy (MT). MT is defined as an intervention that uses a mirror to create a reflection of the non-paretic upper or lower limb, thus giving the patient visual feedback of normal movement of the paretic limb. As an alternative treatment approach, MT is based on the theory of neuroplasticity and has been proposed as beneficial. The patients’ severity of impairments might range from mild to severe. Besides, other advantages of mirror therapy are also apparent, such as less labor-intensive, comparatively low cost and simplicity. When counting the number of clinical trials for improving upper limb function after stroke, the study published last year by the Cochrane Library showed that mirror therapy was one of the top two treatment approaches. And in recent years, there is growing evidence supporting the effects of MT for neurorehabilitation. This article summaries the treatment principles and possible mechanisms of MT as well as provides systematic reviews of MT and an overview of our published clinical trials. The possible mechanism of MT may be that when the visual image of the paretic limb is perceived by the patients, the activity of their cortical areas related to attention may be increased to resolve the perceptual incongruence between visual and somatosensory areas. Later, the mirror illusion may rebalance interhemispheric excitability, activate areas within the primary, somatosensory cortex as well as the mirror neuron system, and then reverse the functions of the paretic limb. The review of our published clinical trials also pointed to the enormous promise of MT for using alone or in combination with other regimens. The trials provide findings indicating that MT assists motor and sensory recovery. Furthermore, combined with the use of sensory afferent stimulation, the manual dexterity, ambulation and activity of daily function can be improved also. To extend the utility of MT, the authors have been studying the effects of MT combined with regimens such as transcranial direct current stimulation (tDCS) and the implementation of MT in home settings. Such efforts may contribute to evolution of the research and practice of stroke rehabilitation.

Objectives: The purpose of this study was to investigate Iintra-rater reliability of the Modified Tardieu Scale (MTS) in elbow flexors and
ankle plantar flexors in adult subjects with stroke. Materials and Methods: A total of 91 subjects with stroke participated in this test-retest
study. Intra-rater reliability of the MTS was investigated by a qualified and trained physiotherapist for elbow flexors and ankle plantar flexors
in two sessions. A rater was one who performed the procedure and an observer only records the angles so that the rater was blinded to
findings. Outcome measures in this study were measurable components of MTS, which are angle of muscle reaction (R1), passive range
of motion (R2), dynamic component (R2-R1), and quality of muscle reaction (grade 0 – 4) termed as MTS score. Results: Intra-rater
reliability of MTS was very good for R1, R2, R2-R1, and MTS score (ICC > 0.85, P<0.0001) across two sessions in elbow flexors and ankle
plantar flexors. Conclusion: MTS is a reliable clinical tool for measurement of spasticity in the elbow flexors and ankle plantar flexors in
adult subjects with stroke.

Objectives: Mirror therapy is a unique treatment with a touch of modality that is purported to improve the motor function of the affected limb in individuals with hemiplegia. Previous studies have focused on the neuro-physiological factors underlying the mechanism of the clinical effect of this technique. The present study aims to understand the mechanism using the rehabilitation method and neuro-occupation model as well as analyze the effects of mirror therapy on the upper limb function of subjects with spastic hemiplegic cerebral palsy. Methods: Single subject design known as withdrawal design was used by a convenience sample of four subjects. The study involved three observational phases known as baseline, treatment, and withdrawal phases that took place during a 10 week period. The study contained a home-based mirror therapy protocol whereby the participants were instructed to do some exercises on a daily basis. The improvement of the hand function of the hemiplegic side was examined by Box and Block test along with two more activities including Threading Beads and Stacking Rings. Results: The ability to perform the Box and Block test, Threading Beads, and Stacking Rings tended to remain steady in the baseline phase, whereas there was a noticeable improvement during the treatment phase and a decline in the withdrawal phase. Discussion: From the perspective of visual feedback neuro-occupation model, it could be hypothesized that alterations to the sensory system caused by the mirror reflection of non affected hand may have led to the destabilization of the sensory cortices that changed the participants' intention, meaning, and perception, thereby improving the subject's motor control.