The The Effects of mirror therapy in postural and kinesthetic rehabilitation on stance phase of gait in subacute stroke

Main Article Content

Arooj Fatima
Muhammad Hamza
Ayesha Ejaz
Qasim Murtaza
Hanan Azfar
Shumaila Tabbassum


Background: This study explored the effectiveness of mirror therapy in improving postural and kinesthetic rehabilitation during the stance phase of gait in subacute stroke patients. Given the crucial role of balance and functional recovery in enhancing mobility and overall quality of life in stroke survivors, the primary focus was on these aspects.

Objective: The primary objective was to evaluate the impacts of mirror therapy on postural and kinesthetic rehabilitation during the stance phase of gait in subacute stroke patients.

Methods: A randomized controlled trial was conducted over nine months in Rahim Yar Khan, involving both private and government hospitals. Sixty-four participants were randomly assigned to two groups: the Conventional+KTR group and the Mirror Therapy group, with 32 participants in each. Inclusion criteria required participants to have a single episode of hemiplegic subacute stroke diagnosed by a neurologist, inclusion of both ischemic and hemorrhagic stroke, and sufficient cognitive ability to follow instructions as indicated by a Mini-Mental State Examination (MMSE) score of 24 or higher. Mild spasticity in all joints of the affected limb was defined by a Modified Ashworth Scale score of less than 3. The intervention for the experimental group involved mirror therapy conducted four days a week for six weeks, supplemented by a home plan for the remaining three days. The control group received conventional therapy, including proprioceptive neuromuscular facilitation (PNF) and electrical interventions, also for four days a week, with a home plan for the remaining days. Key outcome measures were the Berg Balance Scale (BBS) for balance and the Fugl-Meyer Assessment for functional recovery. Data were analyzed using SPSS Version 25, with significance set at p<0.05.

Results: The Mirror Therapy group showed significantly greater improvements in balance scores, with a mean BBS of 40.31 at week 6 compared to 36.78 in the Conventional+KTR group (p<0.001). Functional recovery was more pronounced in the Conventional+KTR group, which had a mean Fugl-Meyer Assessment score of 35.63 at week 6 compared to 30.50 in the Mirror Therapy group (p<0.001). Gender distribution was similar across both groups, with the Conventional+KTR group consisting of 21.9% males and 78.1% females, and the Mirror Therapy group having 18.8% males and 81.3% females.

Conclusion: Mirror therapy significantly enhances postural and kinesthetic rehabilitation in subacute stroke patients, particularly in improving balance more effectively than Conventional+KTR therapy. Conversely, Conventional+KTR therapy showed better results in functional recovery. These findings suggest that mirror therapy can be a valuable addition to stroke rehabilitation programs, offering a potential avenue for improved patient outcomes.

Keywords: Mirror Therapy, Subacute Stroke Rehabilitation, Gait Improvement, Postural Awareness, Kinesthetic Awareness, Berg Balance Scale, Fugl-Meyer Assessment, Randomized Controlled Trial, Stroke Recovery, Balance Rehabilitation.

Article Details

How to Cite
Arooj Fatima, Muhammad Hamza, Ayesha Ejaz, Qasim Murtaza, Hanan Azfar, & Shumaila Tabbassum. (2024). The The Effects of mirror therapy in postural and kinesthetic rehabilitation on stance phase of gait in subacute stroke . Journal of Health and Rehabilitation Research, 4(2), 1659–1665.


Aitkens, S., Lord, J., Bernauer, E., Fowler Jr, W. M., Lieberman, J. S., Berck, P. J. M., & Medicine, N. O. J. o. t. A. A. o. E. (1989). Relationship of manual muscle testing to objective strength measurements. 12(3), 173-177.

Alamer, A., Getie, K., Melese, H., & Mazea, H. J. O. A. J. o. C. T. (2020). Effectiveness of Body Awareness Therapy in Stroke Survivors: A Systematic Review of Randomized Controlled Trials. 12, 23.

Aqueveque, P., Ortega, P., Pino, E., Saavedra, F., Germany, E., & Gómez, B. J. P. D.-T. I. (2017). After stroke movement impairments: a review of current technologies for rehabilitation. 10, 95-116.

Arya, K. N. J. N. I. (2016). Underlying neural mechanisms of mirror therapy: Implications for motor rehabilitation in stroke. 64(1), 38.

Blievernicht, J., Sullivan, K., Erickson, M. R. J. P. T., & Practice. (2012). Outcomes following kinesthetic feedback for gait training in a direct access environment: A case report on social wellness in relation to gait impairment. 28(4), 326-332.

Bohannon, R. W. J. C. r. (1989). Selected determinants of ambulatory capacity in patients with hemiplegia. 3(1), 47-53.

Boissoneault, C., Grimes, T., Rose, D. K., Waters, M. F., Khanna, A., Datta, S., & Daly, J. J. J. B. s. (2020). Innovative long-dose neurorehabilitation for balance and mobility in chronic stroke: a preliminary case series. 10(8), 555.

Bosma, M. S., Nijboer, T. C., Caljouw, M. A., Achterberg, W. P. J. A. o. p., & medicine, r. (2020). Impact of visuospatial neglect post-stroke on daily activities, participation and informal caregiver burden: A systematic review. 63(4), 344-358.

Catz, A., Ron, S., Solzi, P., Korczyn, A. D. J. A. j. o. p. m., & rehabilitation. (1994). The vestibulo-ocular reflex and dysequilibrium after hemispheric stroke. 73(1), 36-39.

Chiu, H.-C., Chern, J.-Y., Shi, H.-Y., Chen, S.-H., & Chang, J.-K. J. T. K. j. o. m. s. (2000). Physical functioning and health-related quality of life: before and after total hip replacement. 16(6), 285-292.

Eng, J. J., & Tang, P.-F. J. E. r. o. n. (2007). Gait training strategies to optimize walking ability in people with stroke: a synthesis of the evidence. 7(10), 1417-1436.

Erkinjuntti, T., Bowler, J. V., DeCarli, C. S., Fazekas, F., Inzitari, D., O'Brien, J. T., . . . disorders, a. (1999). Imaging of static brain lesions in vascular dementia: implications for clinical trials. 13, S81-90.

Farooq, A., Venketasubramanian, N., & Wasay, M. J. C. D. E. (2021). Stroke care in Pakistan. 11(3), 118-121.

Gyllensten, A. L., Hansson, L., & Ekdahl, C. J. A. i. P. (2003). Outcome of basic body awareness therapy. A randomized controlled study of patients in psychiatric outpatient care. 5(4), 179-190.

Handelzalts, S., Kenner-Furman, M., Gray, G., Soroker, N., Shani, G., Melzer, I. J. N., & repair, n. (2019). Effects of perturbation-based balance training in subacute persons with stroke: a randomized controlled trial. 33(3), 213-224.

Hinksman, C. A., Haylock, R. G., & Gillies, M. J. R. R. (2022). Cerebrovascular disease mortality after occupational radiation exposure among the UK National Registry for Radiation Workers Cohort. 197(5), 459-470.

Hyndman, D., Ashburn, A. J. D., & rehabilitation. (2003). People with stroke living in the community: Attention deficits, balance, ADL ability and falls. 25(15), 817-822.

Ji, S. G., & Kim, M. K. J. C. r. (2015). The effects of mirror therapy on the gait of subacute stroke patients: a randomized controlled trial. 29(4), 348-354.

Jongbloed, L. J. S. (1986). Prediction of function after stroke: a critical review. 17(4), 765-776.

Kamphuis, J. F., de Kam, D., Geurts, A. C. H., & Weerdesteyn, V. (2013). Is Weight-Bearing Asymmetry Associated with Postural Instability after Stroke? A Systematic Review. Stroke Research and Treatment, 2013, 692137.

Kim, M.-K., Ji, S.-G., & Cha, H.-G. J. H. K. P. J. (2016). The effect of mirror therapy on balance ability of subacute stroke patients. 34, 27-32.

Kuptniratsaikul, V., Kovindha, A., Suethanapornkul, S., Massakulpan, P., Permsirivanich, W., & Kuptniratsaikul, P. S.-a. J. I. J. o. N. (2017). Motor recovery of stroke patients after rehabilitation: one-year follow-up study. 127(1), 37-43.

Lindvall, M. A., Carlsson, A. A., Forsberg, A. J. J. o. B., & therapies, m. (2016). Basic Body Awareness Therapy for patients with stroke: Experiences among participating patients and physiotherapists. 20(1), 83-89.

Liu, H., Song, L., & Zhang, T. J. N. r. r. (2014). Changes in brain activation in stroke patients after mental practice and physical exercise: a functional MRI study. 9(15), 1474.

Marigold, D. S., Eng, J. J., Tokuno, C. D., Donnelly, C. A. J. N., & repair, n. (2004). Contribution of muscle strength and integration of afferent input to postural instability in persons with stroke. 18(4), 222-229.

Masiero, S., Celia, A., Rosati, G., Armani, M. J. A. o. p. m., & rehabilitation. (2007). Robotic-assisted rehabilitation of the upper limb after acute stroke. 88(2), 142-149.

Mohan, D. M., Khandoker, A. H., Wasti, S. A., Ismail Ibrahim Ismail Alali, S., Jelinek, H. F., & Khalaf, K. J. F. i. N. (2021). Assessment methods of post-stroke gait: A scoping review of technology-driven approaches to gait characterization and analysis. 12, 650024.

Naito, E., Morita, T., & Amemiya, K. J. N. R. (2016). Body representations in the human brain revealed by kinesthetic illusions and their essential contributions to motor control and corporeal awareness. 104, 16-30.

O'Sullivan, S. B., Schmitz, T. J., & Fulk, G. (2019). Physical rehabilitation. FA Davis.

Page, S. J., Sisto, S., Johnston, M. V., Levine, P., Hughes, M. J. A. o. p. m., & rehabilitation. (2002). Modified constraint-induced therapy in subacute stroke: a case report. 83(2), 286-290.

Perennou, D., Amblard, B., Leblond, C., & Pelissier, J. J. N. l. (1998). Biased postural vertical in humans with hemispheric cerebral lesions. 252(2), 75-78.

Pérennou, D. A., Amblard, B., Laassel, E. M., Benaim, C., Hérisson, C., Pélissier, J. J. A. o. p. m., & rehabilitation. (2002). Understanding the pusher behavior of some stroke patients with spatial deficits: a pilot study. 83(4), 570-575.

Rossetti, Y. J. C., & cognition. (1998). Implicit short-lived motor representations of space in brain damaged and healthy subjects. 7(3), 520-558.

Rousseaux, M., Allart, E., Bernati, T., & Saj, A. J. N. (2015). Anatomical and psychometric relationships of behavioral neglect in daily living. 70, 64-70.

Rw, B., & Smith, M. J. P. t. (1987). Interrater reliability of a modified Ashworth scale of muscle spasticity. 67(2), 206-207.

Salem, H. M. A., Huang, X. J. I. J. o. B., & Engineering, B. (2015). The effects of mirror therapy on clinical improvement in hemiplegic lower extremity rehabilitation in subjects with chronic stroke. 9(2), 163-166.

Silow, T. (2002). The kinesthetic sense: Exploring sensation, self-emergence, awareness and stress negotiation through somatic practice. The Ohio State University.

Skidmore, E. R., Whyte, E. M., Holm, M. B., Becker, J. T., Butters, M. A., Dew, M. A., . . . rehabilitation. (2010). Cognitive and affective predictors of rehabilitation participation after stroke. 91(2), 203-207.

Turner, M. L., Falkingham, P. L., Gatesy, S. M. J. I., & Biology, C. (2022). What is Stance Phase on Deformable Substrates?

Weerdesteijn, V., Niet, M. d., Van Duijnhoven, H., & Geurts, A. C. (2008). Falls in individuals with stroke.

Winter, D. A. (1991). Biomechanics and motor control of human gait: normal, elderly and pathological.

Wu, H., Zhou, Z., Wang, J., An, H., & Wei, Q. (2016). Recognization of stance phase using flexible pressure sensors. 2016 8th International Conference on Intelligent Human-Machine Systems and Cybernetics (IHMSC),

Yeo, S. S. J. T. J. o. K. P. T. (2017). Changes of gait variability by the attention demanding task in elderly adults. 29(6), 303-306.