Daniel Simpson

Mirror therapy and unilateral strength training for enhancing motor function after stroke in the lower extremity: A randomised controlled trial.

Supervisor: Dr Kenneth Monaghan

Funding Body: IOTI


Introduction: Both mirror therapy (Thieme et. al. 2012) and cross-education of strength (Dragert & Zehr 2013) have successfully promoted functional recovery post stroke. A recent systematic review by Zult et. al. (2014) shows evidence for the effectiveness of mirror therapy to enhance cross-education of strength for patients after stroke. Recommendations from this review, propose that a combination of unilateral strength training with mirror training can further accelerate functional recovery post stroke.

Objective: To evaluate the effects of mirror therapy, using motor imagery training, combined with unilateral strength training, on lower-extremity motor recovery and functioning of patients with sub-acute stroke.

Design: Randomized, assessor-blinded, 6-week trial, with follow-up at 3 months.

Setting: Health Science & Physiology Exercise Laboratory in IT Sligo.

Participants: A total of 16 adult (>18years) outpatients (8 men: 8 women) with hemiparesis after stroke who have been discharged from the Sligo General Hospital stroke unit.

Interventions: The combined mirror and unilateral strength training group will receive 5 sets of 5 maximum effort isometric repetitions held for 5 seconds (Dragert & Zehr 2013). The placebo group will receive a similar protocol with the non-reflecting side of the mirror used.

Objectives of the study:

  1. Evaluate the effects of mirror therapy combined with cross education strength on lower-extremity motor recovery and functioning in patients with sub-acute stroke.
  2. Explore how this new combination therapy compares to placebo condition.
  3. Identify any adverse effects of the new combination therapy.


In this study, we hypothesized that congruent visual feedback and motor imagery from the moving non-paretic lower extremity during unilateral strengthening, as provided by a mirror, would help restore the integrity of cortical processing and thereby restore function in the affected lower extremity during gait.



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