Mirror therapy in children with hemiparesis: a randomized observer-blinded trial

AimTo determine the efficacy of mirror therapy in children with hemiparesis. MethodThe design was an observer-blinded parallel-group randomized controlled trial (International Standard Randomised Controlled Trial Number 48748291). Randomization was computer-generated, 1:1 allocation to mirror therapy or comparison groups. The settings were home-based intervention and tertiary centre assessments. Participants were 90 children with hemiparesis aged 7 to 17 years. Intervention was 15 minutes per day of simultaneous arm training, 5 days a week, for 5 weeks. The mirror therapy group used a mirror; those in the comparison group looked at their paretic limb. Assessments comprised measures of upper limb strength, function (Melbourne Assessment 2), daily performance (ABILHAND-Kids), and sensory function at weeks 0 (T-0), 5 (T-1), and 10 (T-2). ResultsThere were no significant differences in outcomes and their progression over time between the mirror therapy and comparison groups. Post-hoc intention-to-treat analyses showed significant improvements in both groups for grasp strength (T-0-T-1+12.6%), pinch strength (T-0-T-2+9.1%), upper limb function in terms of accuracy (T-0-T-2+2.7%) and fluency (T-0-T-2+5.0%), as well as daily performance (T-0-T-2+16.6%). Per protocol analyses showed additional improvements in dexterity (T-0-T-2+4.0%). InterpretationThe use of the mirror illusion during therapy had no significant effect on treatment outcomes. However, 5 weeks of daily simultaneous arm training significantly improved paretic upper limb strength, function, and daily use.