Document Type : Research Paper


1 M.Sc. of Sport Injury and Corrective Exercises, Department of Sport Sciences, Faculty of Humanities, Shahrekord University, Shahrekord, Iran

2 Associate Professor of Sport Injury and Corrective Exercises, Department of Sport Sciences, Faculty of Humanities, Shahrekord University, Shahrekord, Iran

3 Assistant Professor of Motor Behavior, Department of Sport Sciences, Faculty of Humanities, Shahrekord University, Shahrekord, Iran


The purpose of this study was to investigate the effect of eight weeks of mirror training on balance in patients with subacute stroke. The statistical population included subacute stroke patients referring to Tabassom stroke rehabilitation clinic in Tehran. The sample consisted of 30 subacute patients with inclusion criteria who participated in the study with their consent and volunteering. The Samples were randomly divided into experimental and control of mirror training. Both groups participated in the pre-test and intermediate test, which was performed after four weeks and post-test of Berg Balance Scale after eight weeks. The training program of two groups was the same and included eight weeks, each week, two sessions, each session 90 minutes Consist 60 minutes of normal rehabilitation and 30 minutes of training with mirror in experimental group and without mirror in control group. Data were analyzed by mixed analysis variance (2 * 3) with SPSS23 software. The results showed that all three factors of balance (p = 0.001), group (p = 0.001) and balance and group interaction (p=0.008) had significant effect. Balance was significantly different in all three stages of pre, mid and post-tests (P=0.001). The interactive effect of balance and group in the two experimental and control groups was significantly different between the three stages test (P = 0.001). Overall, mirror training improved the balance of patients with subacute stroke. Therefore, it is recommended to using a mirror training in the subacute stroke patient.


1.   Mandal A. Stroke epidemiology. Medical News [cited 2014-11-27] Available from internet http://wwwnews-medicalnet/health/Stroke-Epidemiologyaspx. 2014.
2.   Gillen G,. Stroke rehabilitation. A function-based approach. edition t, editor. United States of America: Elsevier Mosby; 2011.
3.   Hachinski V, Iadecola C, Petersen RC, Breteler MM, Nyenhuis DL, Black SE, et al. National Institute of Neurological Disorders and Stroke – Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards. Stroke. 2006; 37:2220–41.
4.   Bolognini N, Pascual-Leone A, Fregni F. Using non-invasive brain stimulation to augment motor training-induced plasticity. Journal of neuroengineering and rehabilitation. 2009;6(8):1–5.
5.   Genthon N, Rougier P, Gissot AS, Froger J, Pélissier J, Pérennou D. Contribution of each lower limb to upright standing in stroke patients. J Am Heart Assoc. 2008;39:1793–9
6.   Oliveira CB MR, Greters MG, Conforto A.;. Abnormal sensory integration affects balance control in hemiparetic patients within the first year after stroke.. Clinics 2011;66(12):2043–8.
7.   Michael K, Goldberg AP, Treuth MS, Beans J, Normandt P, Macko RF. Progressive adaptive physical activity in stroke improves balance, gait, and fitness: preliminary results. Top Stroke Rehabil. 2009;16(2):133-9.
8.   Yavuzer G, Eser F, Karakus D, Karaoglan B, Stam HJ. The effects of balance training on gait late after stroke: randomized controlled trial. Clin Rehabil. 2006;20:960–96.
9.   Sawacha Z, Carraro E, Contessa P, Guiotto A, Masiero S, Cobelli C. Relationship between clinical and Instrumental balance assessments in chronic post-stroke hemiparesis subjects. Journal of neuroengineering and rehabilitation. 2013;10(95):1–7.
10. Mancini M, Horak FB. the relevance of clinical balance assessment tools to differentiate balance deficits. Eur J Phys Rehabil Med 2010;46(2):239–48.
11. Seo K, Kim H, Han J. Effects of dual-task balance exercise on stroke patient's balance performance. J Phys Ther Sci. 2012;24:593–5.
12. Peterka J R. Sensorimotor integration in human postural control.. Journal of neurophysiology. 2002;88(3):1097–118.
13. Oliveira CB, Medeiros RT, Frota NAF, Greters ME, Conforto AB. Balance control in hemiparetic stroke patients: main tools for evaluation. Journal of rehabilitation research and development. 2008;45(8):1215–26.
14. De Nunzio A, Zucchella C, Spicciato F, Tortola P, Vecchione C, Pierelli F, et al. Biofeedback rehabilitation of posture and weightbearing distribution in stroke: a center of foot pressure analysis. Funct Neurol 2014;29(2):127–34.
15. Arya KN. underlying neural mechanisms of mirror therapy: Implications for motor rehabilitation in stroke. neurology India. 2016;64(1):38.
16. Sathian k, Greenspan AI, Wolf SL. Doing it with mirrors: a case study of a novel approach to neurorehabilitation. Neurorehabilitation and Neural Repair. 2000;14(1):73-6.
17.  Mazlom S R, Bahrami M, Hasanzadeh F, Ghandehari K. Effect of mirror therapy on walking ability in patients with stroke. Journal of Birjand University of Medical Sciences. 2015; 22 (2):134-144.[persian]
 18. Flor H, Diers M. Sensorimotor training and cortical reorganization. NeuroRehabilitation. 2009; 25(1): 19-27.
19. Sutbeyaz S, Yavuzer G, Sezer N, Koseoglu BF. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2007;88(5):555-9.
20. Ji SG, MK. K. The effects of mirror therapy on the gait of subacute stroke patients: a randomized controlled trial. Clin Rehabil. 2015;29(4):348-54.
21. Stubbs PW, Nielsen JF, Sinkjær T, Mrachacz-KerstingN. Short-latency crossed spinal responses are impaired differently in sub-acute and chronic stroke patients. Clinical Neurophysiology. 2012;123((3)):541-9.
22. Abo-Salem H, Xiaolin H. The effects of mirror therapy on clinical improvement in hemiplegic lower extremity rehabilitation in subjects with chronic stroke. World Academy of Science, Engineering and Technology, International Journal of Medical, Health, Biomedical, Bioengineering and Pharmaceutical Engineering. 2015;9(2):163-6.
23. Cha HG , Kim MK. The Effects of Repetitive Transcranial Magnetic Stimulation Integrated Mirror Therapy on the Gait of Chronic Stroke Patients. Journal of Magnetics. 2015;20((2)):133-7.
24  Cho K, Lee WH. Effect of treadmill training based real-world video recording on balance and gait in chronic stroke patients: a randomized controlled trial. Gait & posture,. 2014;39(1):523-8.
25. Lee Y, Lin c, Wu C, Liao C, Lin J, Chen C. Combining afferent stimulation and mirror therapy for improving muscular, sensorimotor and daily functions after chronic stroke: A randomized, placebo-controlled study. American journal of physical medicine & rehabilitation. 2015;94(10s):859-69.
26. Srivastava A, Taly AB, Guptab A, Kumarb S, Muralid T. Bodyweight-supported treadmill training for retraining gait among chronic stroke survivors: A randomized controlled study. Annals of physical and rehabilitation medicine. 2016;59((4)):235-41.
26. Lee HJ, Kim YM, Lee DK. The effects of action observation training and mirror therapy on gait and balance in stroke patients. Journal of physical therapy science. 2017;29(3):523-6.
27. Shih TY, Wu CY, Lin KC, Cheng CH, Hsieh YW, Chen CL, et al. Effects of action observation therapy and mirror therapy after stroke on rehabilitation outcomes and neural mechanisms by MEG: study protocol for a randomized controlled trial. Trials. 2017;18(1):459.
28. Kim MK, Ji SG, Cha HG. The effect of mirror therapy on balance ability of subacute stroke patients. Hong Kong Physiotherapy Journal. 2016;34:27-32.
29. Carr JH, Shepherd RB,. Stroke rehabilitation: guidelines for exercise and training to optimize motor skill:. New York: Butterworth-Heinemann Medical;; 2003.
30. Berg K, Wood-Dauphine S, Williams J, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 1989;;41((6))::304-11.
31. Shumway-Cook A, Woollacott MH. Normal postural control. Motor control theory and Practical Application 2nd ed Philadelphia:. Philadelphia: LWW. 2001:163-91.
32.  Toh S F, Fong K N. Systematic review on the effectiveness of mirror therapy in training upper limb hemiparesis after stroke. Hong Kong Journal of Occupational  Therapy. 2012; 22(2):84-95.
33. Paik Y.-R, Kim S-K, Lee J-S, B.-J. J. Simple and Task-oriented Mirror Therapy for Upper Extremity Function in Stroke Patients: A Pilot Study. Hong kong Journal of Occupational Therapy 2014;24((1)):6–12.
34. Nakhostin Ansari N, S N. Rehabilitation techniques for stroke. Tehran: Arjmand; 2014.
35.  Holmes N P, Crozier G, Spence C. When mirrors lie: “Visual capture” of arm position impairs reaching performance. Cogn Affect Behav Neurosci. 2004; 4:193-200
36. Reynolds JE, Licari MK, Billington J, Chen Y, Aziz-Zadeh L, Werner J, et al. Mirror neuron activation in children with developmental coordination disorder: A functional MRI study. Int J Devl Neuroscience. 2015; 47::309–19.
37. Mattys K, Smits M, Van der Geest JN, Van der Lugt A, Seurinck R, Stam HJ, et al. Mirror induced visual illusion of hand movements: a functional magnetic resonance imaging study. Arch Phys Med Rehabil. 2009;90:675-81.
38.  Ramachandran V S, Rogers Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proceedings of the Royal Society B. Biological Sciences. 1996; 263:377–386.
39.  Saeif A, kianersi F. Mirror Neurons and Observational Learning. Educational Psychology. 2011;6(19):89-114.
40. In T, Lee K, Song C. Virtual reality reflection therapy improves balance and gait in patients with chronic stroke: randomized controlled trials. Med Sci Monit. 2016;28(22):4046-53.
41. Cha H-G, Oh D-W. Effects of mirror therapy integrated with task-oriented exercise on the balance function of patients with poststroke hemiparesis: a randomized-controlled pilot trial.. Int J Rehabil Res. 2016;39((1)):70-6.
42  Radajewska A, Opara J, Bilinski G, Kaczorowska A, Nawrat-Szoltysik A, Kucinska A, et al. Effectiveness of Mirror Therapy for Subacute Stroke in Relation to Chosen Factors. Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses. 2017;42(4):223-9.
43. Hung GKN, Li CTL, Yiu AM, Fong KN. Systematic Review: Effectiveness of Mirror Therapy for Lower Extremity Post-Stroke. Hong Kong Journal of Occupational Therapy. 2015;26:51-9.