Mirror visual feedback – mirror therapy in neurorehabilitation

Cover Page

Cite item

Full Text


Mirror is a well-established tool in the movement rehabilitation, providing real-time visual feedback to assist in the retraining. However, mirror visual feedback may be used also in therapy in its own right. The “mirror therapy” (MT) is a method based on creating artificial visual feedback. MT was proposed for treating pain syndrome, such as phantom pain and complex regional pain syndrome of type 1 and 2, as well as for motor rehabilitation in stroke patients with hemiparesis and in patients after arm surgery. The main principle of MT is thought to be restoration of damaged feedback from ill/amputated limb. One of possible mechanisms of MT is activation of “mirror neurons”, acting both during execution and observation of action. Clear advantages of MT are its simplicity, availability and, most importantly, its patient-directed character.


About the authors

M. A. Nazarova

Research Center of Neurology

Author for correspondence.
Email: chantante@gmail.com
Russian Federation, Moscow

Michail A. Piradov

Research Center of Neurology

Email: chantante@gmail.com
ORCID iD: 0000-0002-6338-0392

D. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Director

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Lyudmila A. Chernikova

Reseach Center of Neurology

Email: chantante@gmail.com
Russian Federation, Moscow


  1. Altschuler E.L., Wisdom S.B., Stone L. et al. Rehabilitation of hemiparesis after stroke with a mirror. Lancet 1999; 353: 2035–2036.
  2. Altschuler E.L., Ramachandran V.S. A simple method to stand outside oneself. Perception 2007; 36: 632–634.
  3. Bach-y-Rita P. Sensory plasticity. Applications to a vision substitution system. Acta Neurol. Scand. 1967; 43: 417–426.
  4. Cattaneo L., Rizzolatti G. The mirror neuron system. Arch. Neurol. 2009; 66: 557–560.
  5. di Pellegrino G., Fadiga L., Fogassi L. et al. Understanding motor events: a neurophysiological study. Exp. Brain Res. 1992; 91: 176–180.
  6. Ertelt D., Small S., Solodkin A. et al. Action observation has a positive impact on rehabilitation of motor deficits after stroke. Neuroimage 2007; 36 (Suppl. 2): 164–173.
  7. Fink G.R., Marshall J.C., Halligan P.W. et al. The neural consequences of conflict between intention and the senses. Brain 1999; 122: 497–512.
  8. Fukumura K., Sugawara K., Tanabe S. et al. Influence of mirror therapy on human motor cortex. Int. J. Neurosci. 2007; 117: 1039–1048.
  9. Funase K., Tabira T., Higashi T. et al. Increased corticospinal excitability during direct observation of self-movement and indirect observation with a mirror box. Neurosci. Lett. 2007; 419: 108–112.
  10. Garry M.I., Loftus A., Summers J.J. Mirror, mirror on the wall: viewing a mirror reflection of unilateral hand movements facilitates ipsilateral M1 excitability. Exp. Brain Res. 2005; 163: 118–122.
  11. Gibson J.J. Observations on active touch. Psych. Rev. 1962; 69: 477–491.
  12. Gygax M.J., Schneider P., Newman C.J. Mirror therapy in children with hemiplegia: a pilot study. Dev. Med. Child Neurol. 2011; 53: 473–476.
  13. Iacoboni M., Dapretto M. The mirror neuron system and the consequences of its dysfunction. Nat. Rev. Neurosci. 2006; 7: 942–951.
  14. Johnson S.H. Imagining the impossible: intact motor representations in hemiplegics. Neuroreport 2000; 11: 729–732.
  15. Johnson S.H., Sprehn G., Saykin A.J. Intact motor imagery in chronic upper limb hemiplegics: evidence for activity-independent action representations. J. Cogn. Neurosci. 2002; 14: 841–852.
  16. Kakei S., Hoffman D.S., Strick P.L. Muscle and movement representations in the primary motor cortex. Science 1999; 285: 2136–2139.
  17. Lotze M., Halsband U.J. Motor imagery. Physiol Paris. 2006; 99: 386–395.
  18. Matsuo A., Tezuka Y., Morioka S. et al. Mirror therapy accelerates recovery of upper limb movement after stroke: a randomized cross-over trial. In: Sixth World Stroke Conference. Vienna, 2008 (Abstract).
  19. Matthys K., Smits M., Van der Geest J.N. et al. Mirror-induced visual illusion of hand movements: a functional magnetic resonance imaging study. Arch. Phys. Med. Rehabil. 2009; 90: 675–681.
  20. Meister I.G., Krings T., Foltys H. et al. Playing piano in the mind–an fMRI study on music imagery and performance in pianists. Brain Res. Cogn. Brain Res. 2004; 19: 219–228.
  21. Michielsen M.E., Smits M., Ribbers G.M. et al. The neuronal correlates of mirror therapy: an fMRI study on mirror induced visual illusions in patients with stroke. J. Neurol. Neurosurg. Psychiatry 2011; 82: 393–398.
  22. Michielsen M.E., Selles R.W., van der Geest J.N. et al. Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil. Neural. Repair 2011; 25: 223–233.
  23. Moseley G.L., Parsons T.J., Spence C. Visual distortion of a limb modulates the pain and swelling evoked by movement. Curr. Biol. 2008; 18: R1047–R1048.
  24. Nikolajsen L., Ilkjaer S., Christensen J.H. et al. Pain after amputation. Br. J. Anaesth. 1998; 81: 486.
  25. Page S.J., Levine P., Leonard A. Mental practice in chronic stroke: results of a randomized, placebo-controlled trial. Stroke 2007; 38: 1293–1297.
  26. Ramachandran V.S., Rogers-Ramachandran D., Cobb S. Touching the phantom limb. Nature 1995; 377: 489–490.
  27. Ramachandran V.S., Altschuler E.L. The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain 2009; 132: 1693–1710.
  28. Ramachandran V.S. Behavioral and magnetoencephalographic correlates of plasticity in the adult human brain. Proc. Natl. Acad. Sci. USA. 1993; 90: 10413–10420.
  29. Ramachandran V.S. Plasticity and functional recovery in neurology. Clin. Med. 2005; 5: 368–373.
  30. Rock I., Victor J. Vision and touch: an experimentally created conflict between the two senses. Science 1964; 143: 594–596.
  31. Rossini P.M., Altamura C., Ferreri F. et al. Neuroimaging experimental studies on brain plasticity in recovery from stroke. Eura Medicophys. 2007; 43: 241–254.
  32. Sacco R.L., Adams R., Albers G. et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Stroke 2006; 37: 577–617.
  33. Sathian K., Greenspan A.I., Wolf S.L. Doing it with mirrors: a case study of a novel approach to neurorehabilitation. Neurorehabil. Neural. Repair 2000; 14: 73–76.
  34. Sharma N., Pomeroy V.M., Baron J.C. Motor imagery: a backdoor to the motor system after stroke? Stroke 2006; 37: 1941–1952.
  35. Sharma N., Simmons L.H., Jones P.S. et al. Motor imagery after subcortical stroke: a functional magnetic resonance imaging study. Stroke 2009; 40: 1315–1324.
  36. Simmons L., Sharma N., Baron J.C. et al. Motor imagery to enhance recovery after subcortical stroke: who might benefit, daily dose, and potential effects. Neurorehabil. Neural Repair 2008; 22: 458–467.
  37. Spinks R.L., Kraskov A., Brochier T. et al. Selectivity for grasp in local field potential and single neuron activity recorded simultaneously from M1 and F5 in the awake macaque monkey. J. Neurosci. 2008; 28: 10961–10971.
  38. Stevens J.A., Stoykov M.E. Using motor imagery in the rehabilitation of hemiparesis. Arch. Phys. Med. Rehabil. 2003; 84: 1090–1092.
  39. Stevens J.A., Stoykov M.E. Simulation of bilateral movement training through mirror reflection: a case report demonstrating an occupational therapy technique for hemiparesis. Top Stroke Rehabil. 2004; 11: 59–66.
  40. Sutbeyaz S., Yavuzer G., Sezer N. et al. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch. Phys. Med. Rehabil. 2007; 88: 555–559.
  41. Tominaga W., Matsubayashi J., Deguchi Y. et al. A mirror reflection of a hand modulates stimulus-induced 20-Hz activity. Neuroimage 2009; 46: 500–504.
  42. Touzalin-Chretien P., Dufour A. Motor cortex activation induced by a mirror: evidence from lateralized readiness potentials. J. Neurophysiol. 2008; 100: 19–23.
  43. Yang T.T., Gallen C., Schwartz B. et al. Sensory maps in the human brain. Nature 1994; 368: 592–593.
  44. Yavuzer G., Selles R., Sezer N. et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch. Phys. Med. Rehabil. 2008; 89: 393–398.

Supplementary files

Supplementary Files

Copyright (c) 2012 Nazarova M.A., Piradov M.A., Chernikova L.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-83204 от 12.05.2022.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies