MIRROR THERAPY INDUCED BRAIN REORGANIZATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

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U.M. Bello1,2, S.J. Winser1, P. Kannan11The Hong Kong Polytechnic University, Rehabilitation Sciences, Hong Kong, China, 2Yobe State University Teaching Hospital, Physiotherapy Department, Damaturu, NigeriaBackground: Stroke is among the common causes of disability, resulting from a decline in upper and lower limb function. Increased activity in the affected hemisphere is associated with functional regain in stroke survivors. Mirror therapy resulted in functional improvement of the affected side of the body. A reconciliation of the mirror therapy training effect and changes in cortical structures will add to the theoretical basis for adopting mirror therapy in stroke rehabilitation.Purpose: This study aimed to quantify the improvement in function and cortical activation following mirror visual feedback (MVF) training among stroke survivors and healthy volunteers.Methods: Studies testing the effect of MVF training on different neural substrates using functional magnetic resonance imaging (fMRI) or functional near infrared spectroscopy (fNIRS) were included. Findings from studies reporting inter-hemispheric activation shift and functional regain were pooled in meta-analyses.Results: Eight studies (six on stroke survivors and two on healthy volunteers) were included. Eighty-nine stroke survivors and 24 healthy volunteers recruited in the studies were examined before and after MVF training. Majority of the included studies had moderate methodological quality. The training dosage for stroke survivors ranged between 30 to 90 minutes per session, 1 to 6 days per week, lasting from 1 to 8 weeks. Meta-analysis indicates a significant improvement in the motor performance post-training (SMD, 1.04; 95% CI, 0.52-1.56; p<0.0001) among stroke survivors. The activation shift in the primary motor cortices among stroke survivors, significantly favours the post-training shift towards the affected hemisphere (SMD, 0.80; 95% CI, 0.36-1.24; p<0.0004).Conclusion(s): MVF training resulted in a shift of inter-hemispheric activation balance towards the ipsilesional primary motor cortex among stroke survivors showing functional recovery.Implications: This finding provides further support for adopting mirror therapy as a rehabilitation modality in stroke rehabilitation.Funding, acknowledgements: NoneKeywords: Stroke, Mirror therapy, Brain areasTopic: Neurology: strokeDid this work require ethics approval? NoInstitution: N/ACommittee: N/AReason: Systematic reviewAll authors, affiliations and abstracts have been published as submitted.

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