REVIEW Systematic review of the effectiveness of mirror therapy in upper extremity function DANIE ¨ LLE EZENDAM 1,2 , RAOUL M. BONGERS 1 & MICHIEL J. A. JANNINK 2,3 1 Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, 2 Roessingh Research and Development, Enschede, The Netherlands, and 3 Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands Accepted March 2009 Abstract Purpose. This review gives an overview of the current state of research regarding the effectiveness of mirror therapy in upper extremity function. Method. A systematic literature search was performed to identify studies concerning mirror therapy in upper extremity. The included journal articles were reviewed according to a structured diagram and the methodological quality was assessed. Results. Fifteen studies were identified and reviewed. Five different patient categories were studied: two studies focussed on mirror therapy after an amputation of the upper limb, five studies focussed on mirror therapy after stroke, five studies focussed on mirror therapy with complex regional pain syndrome type 1 (CRPS1) patients, one study on mirror therapy with complex regional pain syndrome type 2 (CRPS2) and two studies focussed on mirror therapy after hand surgery other than amputation. Conclusions. Most of the evidence for mirror therapy is from studies with weak methodological quality. The present review showed a trend that mirror therapy is effective in upper limb treatment of stroke patients and patients with CRPS, whereas the effectiveness in other patient groups has yet to be determined. Keywords: Mirror therapy, stroke, pain, amputation, upper extremity Introduction Presenting visual feedback about motor performance to improve the effect of training is widespread in rehabilitation practice. A relative new way of using visual feedback to help patients is exploited in mirror therapy. Ramachandran [1] first used mirror therapy in patients who suffered from a phantom limb after amputation. Patients who participated in these experiments mainly experienced phantom arms that were ‘paralysed’ or ‘frozen’ in an awkward and sometimes painful position, i.e. the phantom arms could not be moved voluntary by the patients. To relieve these patients from awkward or painful feelings they were given the idea that their ampu- tated limb was still ‘alive’. To achieve this, a mirror, which showed the reflection of the intact arm, was placed in the sagittal plane. The mirror image of the intact arm gives the patient the illusion the ampu- tated arm is resurrected: Moving the intact limb and looking at its reflection in the mirror produces visual feedback of the whereabouts of an arm at the location of the amputated arm. In this setup, some amputees with a phantom arm reported that they felt as though their phantom arm was moving. This movement relieved some of the patients from the awkward position and pain of their phantom arm. In short, the visual feedback via the mirror gives the illusion that the phantom arm is moving in response to the brain’s command, suggesting that the amputated arm is ‘alive’ again and can be moved around [2]. On the basis of effect of visual feedback through a mirror in patients with phantom pain, mirror therapy was employed with more patient groups. The appeal of mirror therapy lies therein that it provides some Correspondence: Michiel J. A. Jannink, Roessingh Research and Development, PO Box 310, 7500 AH Enschede, The Netherlands. Tel: þ3153-48-75-738. E-mail: m.jannink@rrd.nl Disability and Rehabilitation, 2009; 31(26): 2135–2149 ISSN 0963-8288 print/ISSN 1464-5165 online ª 2009 Informa UK Ltd. DOI: 10.3109/09638280902887768 Disabil Rehabil Downloaded from informahealthcare.com by University of Groningen on 03/02/11 For personal use only.