Quantitative Research Assignment

Effectiveness of Mirror Therapy on Upper Extremity
Functioning among Stroke Patients

Rohini T. Chaudhari1, Seeta Devi2, Dipali Dumbre3

1MSc , 2Asst. Professor, 3Tutor, Symbiosis College of , Symbiosis International
(Deemed University), Pune

ABSTARCT

Background: The prevalence of stroke in the general population varies from 40 to 270 per 1000,000 in
India. Approximately 12% of all strokes occur in those older than 40 years. Stroke may require a variety of
rehabilitation services. One of them Mirror therapy is a simple, inexpensive and most importantly patient
directed treatment that may improve hand function after stroke.

Objective: To assess the effectiveness of mirror therapy on upper extremity functioning among stroke
patients at selected neuro- rehabilitation centres

Method: A quantitative research approach was used in this study. Research design was Quasi-
experimental: pre-test post-test. Sample size was 50 post stroke patients who receive stroke rehabilitation
at Neurorehabilitation centres. The 25 subjects were randomly divided into two groups, experimental group
and control group. The experimental group has received mirror therapy with the conventional therapy for 3
days in a week for 4 weeks. Other side the control group has received only conventional therapy for 4 weeks,
and 3 days in a week. The effectiveness was evaluated by Modified Brunnstrom’s motor function test

Result: An average hand functioning score in pre-test was 8.2 which increased to 12.6 in post-test and 7.6
which increased to 13.4 in post-test for upper extremity functioning among experimental group, following
for the control group as in pre-test an average was 8.3 which increased to 11.2 for hand and 8.1 which
increased to 11.7 of upper extremity.

Conclusion: The findings of the study show that there is significant difference between the scores of
experimental and control group.

Keywords: Mirror Therapy, Upper Extremity Stroke , Neuro Rehabilitation Centre

INTRODUCTION

As human, we move our bodies to explicit our wants,
needs, emotions, thoughts, and ideas. Basically, how
well we move- and how much we move- decides how
well we engage with the world and make our full purpose
in life. Mostly the active movement helps us in function
completely, interact with the world, feel well physically
and emotionally, connect and build relationship with
others, and communicate and express ourselves. Also
the movement helps us recover if our brain is injured
or inflamed. Body movements are comparable important
for smooth and effective day to day activities.1

Nervous system is a one of the system of our body,
which perform all the sensory and motor function

of body. The reason a healthy nervous system is so
important is because it’s what runs everything in our
body. When nervous system is functioning correctly,
body is able to perform all the things it needs to do.
However, when the nervous system is compromised, or
not working efficiently, body begins to break down.2

Stroke is the third biggest killer in India after heart
attack and cancer and is a major public health concern.1
Stroke occurs when there is (1) lack of blood flow to a
section of brain or (2) haemorrhage into the brain that
results in death of brain cells. The predominance of stroke
in the population varies from 40 to 270 per 1000,000 in
India. Approximately 12% of all strokes occur in those
older than 40 years. It was projected that by 2015 the
number of cases of stroke would be increase to 1666,372

DOI Number: 10.5958/0973-5674.2019.00026.1

Indian Journal of Physiotherapy and Occupational Therapy, January-March 2019, Vol.13, No. 1 129

in the country. A predicted 5.7 million people died from
stroke in 2005 and it is projected that these deaths would
rise to 6.5 million by 2015.3

Impact on daily life, 4 out of 10 stroke survivors
leave hospital requiring help with daily living activities
but almost a third receive no social service visits. Around
a third of stroke survivors experience depression after
their stroke.4

15 million people suffer from stroke worldwide each
year. Of these, 5 million die and another 5 million are
permanently DISABLED.5Ischemic stroke 10% in 30
days, 23% in 1 year and 52 % in 5 year. Same as Intra-
cerebral haemorrhage 52% in 30 days, 62% in 1 year
and 70% in 5 years. The sub-arachnoid haemorrhage
was 45% in 30 days, 48% in 1 year and 52 % in 5 years.
They also concluded that this prevalence of stroke may
increase till 2020. Stroke patient may require a variety of
rehabilitation services like physiotherapy, occupational
therapy, speech therapy etc. One of them MIRROR
THERAPY is an inexpensive, simple and patient
directed treatment. The principle of mirror therapy is use
of a mirror to create a reflective illusion of an affected
limb in order to trick the brain into thinking movement
has occurred without pain. 5

METHODOLOGY

A quantitative research approach was used in this
study. Research design was Quasi-experimental: pre-test
post-test. Content validity was obtained by experts of
medical surgical nursing and physiotherapy opinion. Tool
reliability (0.8) was calculated by inter rated reliability
method. The consent was taken from the subjects for
participation in study. Data collection was carried out

from 14/02/2018 to 15/03/2108. Sample size was 50
post stroke patients who receive stroke rehabilitation
at Neurorehabilitation centres. The 25 subjects were
randomly divided into two groups, experimental group
and control group. The experimental group has received
mirror therapy with the conventional therapy for 3 days
in a week for 4 weeks. Other side the control group has
received only conventional therapy for 4 weeks, and
3 days in a week. The effectiveness was evaluated by
Modified Brunnstrom’s motor function test before and
after intervention. Data was compiled and analysis was
done by using inferential and descriptive statistics.

RESULTS

Fig. 1: Effectiveness of mirror therapy in stroke
patients on the functioning of hand

In pre-test, all the experimental and control group stroke
patients had poor functioning of hand. In post-test, 48% of
the experimental group samples had poor functioning of
hand and 52% of them had average functioning of hand.
In control group, 68% of the samples had poor functioning
of hand and 32% of them had average functioning of hand.
This shows that the mirror therapy remarkably improved
the hand functioning of stroke patients.

Table 1: Paired t-test for effectiveness of mirror therapy in stroke patients on the functioning of hand
N = 25, 25

Group Day Mean SD T Df p-value

Experimental
Pre-test 8.2 1.37

12.8 24 0.000
Post-test 12.6 1.71

Control
Pre-test 8.3 1.41

10.6 24 0.000
Post-test 11.2 1.72

Researcher applied paired t-test for effectiveness of
mirror therapy in stroke patients on the functioning of
hand. In experimental group, average hand functioning
score in pre-test was 8.2 which increased to 12.6 in post-

test. T-value for this test was 12.8 with 24 degrees of
freedom. Corresponding p-value was of the order of
0.000, which is small (less than 0.05), the null hypothesis
is rejected.

130 Indian Journal of Physiotherapy and Occupational Therapy, January-March 2019, Vol.13, No. 1

In control group, average hand functioning score
in pre-test was 8.3 which increased to 11.2 in post-test.
T-value for this test was 10.6 with 24 degrees of freedom.
Corresponding p-value was of the order of 0.000, which
is small (less than 0.05), the null hypothesis is rejected.
Average for experimental group in post-test is higher
as compared to that for control group. Mirror therapy
is proved to be significantly effective in improving the
hand functioning of stroke patients.

Fig. 2: Effectiveness of mirror therapy in stroke
patients on the functioning of upper extremity

In pre-test, all the experimental and control group
stroke patients had poor functioning of upper extremity.
In post-test, 56% of the experimental group samples had
poor functioning of upper extremity and 44% of them
had average functioning of upper extremity. In control
group, 92% of the samples had poor functioning of upper
extremity and 8% of them had average functioning of
upper extremity. This shows that the mirror therapy
remarkably improved the upper extremity functioning
of stroke patients.

Table 2: Paired t-test for effectiveness of mirror
therapy in stroke patients on the functioning of

upper extremity
N = 25, 25

Group Day Mean SD t Df p-value

Experimental

Pre-
test

7.6 1.15
14.6 24 0.000

Post-
test

13.4 1.80

Control

Pre-
test

8.1 1.17
11.0 24 0.000

Post-
test

11.7 1.51

Researcher applied paired t-test for effectiveness of
mirror therapy in stroke patients on the functioning of
upper extremity. In experimental group, average upper
extremity functioning score in pre-test was 7.6 which
increased to 13.4 in post-test. T-value for this test was
14.6 with 24 degrees of freedom. Corresponding p-value
was of the order of 0.000, which is small (less than 0.05),
the null hypothesis is rejected. In control group, average
upper extremity functioning score in pre-test was 8.1
which increased to 11.7 in post-test. T-value for this
test was 11 with 24 degrees of freedom. Corresponding
p-value was of the order of 0.000, which is small (less
than 0.05), the null hypothesis is rejected. Average post
test score for experimental group is higher as compared
to that of control group. Mirror therapy is proved to be
significantly effective in improving the upper extremity
functioning of stroke patients.

Table 3: Two sample t-test for comparison
of experimental and control group for hand

functioning
N = 25, 25

Group Mean SD T df p-value
Experimental 4.4 2.8

4.3 48 0.000
Control 1.7 1.3

Researcher applied two sample t-test for comparison
of average change in hand functioning score of
experimental and control group. Average change in hand
functioning score of experimental group was 4.4 which
was 1.7 for control group. T-value for this comparison
was 4.3 with 48 degrees of freedom. Corresponding
p-value was 0.000, which is small (less than 0.05).
This indicates that the mirror therapy has significantly
improved the functioning score of hand as compared to
that of control group.

Table 4: Two sample t-test for comparison of
experimental and control group for upper extremity

functioning
N = 25, 25

Group Mean SD t df p-value
Experimental 5.8 3.6

4.9 48 0.000
Control 2.0 1.6

Researcher applied two sample t-test for comparison
of average change in upper extremity functioning score

Indian Journal of Physiotherapy and Occupational Therapy, January-March 2019, Vol.13, No. 1 131

of experimental and control group. Average change
in upper extremity functioning score of experimental
group was 5.8 which was 2 for control group. T-value
for this comparison was 4.9 with 48 degrees of freedom.
Corresponding p-value was 0.000, which is small (less
than 0.05). This indicates that the mirror therapy has
significantly improved the functioning score of upper
extremity as compared to that of control group.

This shows that mirror therapy was effective on
upper extremity function among stroke patients.

DISCUSSION

The literature includes some studies that support
the use of Mirror Therapy in post-stroke rehabilitation.
However, researches involving MT have evolved over
the past years, acquiring better methodological quality.

The studies found in this review assessed individuals
in the post-stroke and showed similar effects concerning
the effectiveness of MT on recovery of the motor
function.

The above findings of the study are supported by
a study conducted by, Pournima Pawar, vijaykumar
biradar to evaluate the effectiveness of the constraint
induced movement therapy (CIMT) and combined
mirror therapy for patient’s rehabilitation of the patients
with subacute and chronic stroke patients.Twenty
patients were enrolled and divided into two groups
CIMT group, CIMT with Mirror therapy group. CIMT
group 6 hours a day for 4 days per week for 4 weeks
,and CIMT with Mirror therapy group 30 minutes of
mirror with CIMT for 4 days per week for 4 weeks .
The fugl-meyer motor function assessment (FMS) and
Brunnstrom Voluntary control grading were evaluated
4weeks after the treatment. The score of the Brunnstrom
Voluntary control grading p value (P value 0.0001)
and Fugl-meyer scale P value (0.0001), mirror therapy
combined with CIMT showed more improvement than
the CIMT after 4 weeks of treatment.6

Kil-Byung Lim, Hong-Jae Lee, Jeehyun Yoo,
Hyun-Ju Yun, Hye-Jung Hwang conducted study on
efficacy of mirror therapy containing tasks in post stroke
patients to investigate the effect of mirror therapy on
upper extremity function and activities of daily living.
The samples were randomly divided into two groups
that were mirror therapy group and sham therapy
group, each group contains 30 samples. The mirror

therapy group has undergone a mirror therapy with
conventional therapy for 20 minutes per day on 5 days
per 4 weeks. The Fugl Meyer assessment, Brunnstrom
motor recovery stage and modified barthel index were
evaluated 4 weeks after the treatment. After 4 weeks of
intervention, improvements in the FMA (p=0.027) and
MBI (p=0.041) were significantly greater in the mirror
therapy group than the sham therapy group. The mirror
therapy containing functional task was effective in terms
of improving the upper extremity functions.7

CONCLUSION

The findings of the study show that there is significant
difference between the scores of experimental and
control group. The finding shows that the mirror therapy
brought a significantly effect in pre-test and post-test on
upper extremity functioning.

Conflict of Interest: Nil declared

Source Funding: Self

Ethical Clearance: This study is ethically approved by
Symbiosis College of nursing, Symbiosis International
(Deemed University)

REFERENCES

1. Krista Scott-Dixon, The Real reasons healthy
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2. Lewis, Medical Surgical , Second South
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2015, pg no- 1445.

3. Snehal Narsinha Waghavkar and Suvarna Shyam
Ganvir, Effectiveness of Mirror Therapy to
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stroke patients, International journal of Neuro-
rehabilitation., 2015 2(4), 1-3. doi:10.4172/2376-
0281.1000184.

4. Rothgangel, S, Braun,S, Beurskens,A, Seitz,R,
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5. Fiona c Taylor, Suresh Kumar, Stroke in India –
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132 Indian Journal of Physiotherapy and Occupational Therapy, January-March 2019, Vol.13, No. 1

6. Pournima pawar, Vijaykumar biradar, Compare
the effect of cimt versus mirror therapy on hand
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7. Kil-Byung Lim, Hong-Jae Lee, JeehyunYoo,
Hyun-Ju Yun, Hye-Jung Hwan, efficacy of mirror
therapy containing tasks in post stroke patients,
Ann Rehabil Med 2016;40(4):629-636, pISSN:
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