The purpose of this project is to assess the effects of four weeks of mirror-box training on
weakness of one arm secondary to stroke. Primary measures are function and strength.
Secondary measures will evaluate muscle tone, flexibility, and the subject's perception of
their everyday function and improvement. Research Hypothesis: For chronic upper limb
hemiparesis secondary to stroke, four weeks of mirror-box training with movement of the
unaffected limb only results in a mean increase of 10 points on the Fugl-Meyer Test of Motor
Recovery (Upper Extremity).
Due to the relatively new nature of mirror training, there are few randomized controlled
studies. This pilot case series will serve as our initial step in trying to identify the
frequency, duration, and treatment exercises needed in this population. Additionally, this
pilot will allow us to ensure our outcome measures are appropriate to detect meaningful
treatment changes. After obtaining informed consent, patients will undergo two separate
baseline assessments of strength, function, and tone 4 weeks apart. Training sessions will
consist of supervised activities using the unaffected arm while observing its mirror
reflection; the affected arm will remain still. Sessions will be one hour a day, five days
a week, for four weeks. Patients will be tested for strength, function and tone in the
affected arm at completion of the four week treatment period by the same occupational
therapist that performed the pretests.
- First unilateral ischemic stroke resulting in hemiparesis at least 6 months prior to
- Age at time of enrollment: 30-80 years.
- Voluntary informed consent of patient.
- Patient willing to comply with protocol and is available for all scheduled visits.
- Residual upper extremity hemiparesis.
- No changes in medications planned during 8-week participation.
- No other motor rehabilitative therapy during 8-week participation, including E-stim
- At least 20 degrees of active wrist extension and 10 degrees of active finger
extension against gravity in the affected upper limb, as measured by goniometry.
- Serious cognitive deficits, as evidenced by score of <20 on Modified Mini-Mental
- Hemorrhagic or bilateral strokes
- Excessive spasticity at the elbow, wrist, or hand, defined as a Modified Ashworth
Scale score of >2
- History of botulinum toxin injection in affected upper extremity in the past 4 months
- Lacking >40 degrees of passive elbow extension
- Less than 45 degrees of passive shoulder flexion
- Global or receptive aphasia present on physical exam
- Hemispatial neglect present on physical exam
- Patient participating in constraint-induced therapy during study time period
- Severe visual deficits or visual field deficits as determined by ability to ascertain
number of fingers held up on visual field testing
- Deformity/amputation of unaffected upper limb