Mirror Therapy for Complex Regional Pain Syndrome in Stroke Patients

Complex regional pain syndrome (CRPS) is a challenging complication following stroke, characterized by pain, edema, autonomic dysfunction, and impaired motor function. It significantly affects rehabilitation outcomes and quality of life. Despite various treatment approaches, optimal management remains difficult. Mirror therapy has emerged as a non-invasive rehabilitation technique that provides visual feedback and may influence cortical reorganization and pain modulation. Additionally, it may have effects on autonomic function, particularly the sympathetic nervous system.

This prospective, randomized, single-blind study was conducted in the inpatient Physical Medicine and Rehabilitation clinic of Başakşehir Çam and Sakura City Hospital between October 2022 and October 2023. Patients with post-stroke CRPS who met the inclusion criteria were enrolled and randomly assigned to either a mirror therapy group or a control group. Both groups received a standardized conventional rehabilitation program and contrast bath therapy. The intervention group additionally received mirror therapy, while the control group received sham mirror therapy.

The aim of the study was to evaluate the clinical effectiveness of mirror therapy in post-stroke CRPS through a multidimensional approach. Clinical status, functional outcomes, electrophysiological parameters related to sympathetic nervous system function, and ultrasonographic measurements of soft tissue changes were assessed before and after the intervention period.

This study provides comprehensive evaluation of mirror therapy effects by combining clinical assessments with objective electrophysiological and imaging-based measurements. The findings are expected to contribute to the understanding of the role of mirror therapy in the management of CRPS after stroke and to support its use as an accessible and complementary rehabilitation approach.

Inclusion criteria

• Patients with a first-ever ischemic or hemorrhagic stroke
• Time since stroke onset of ≤ 12 months
• Diagnosed with Complex Regional Pain Syndrome (CRPS) Type 1 according to the Budapest criteria
• In the dystrophic stage (Stage 2) of CRPS
• Mini-Mental State Examination (MMSE) score > 24
• Brunnstrom upper extremity-hand stage between 1 and 4
• Age between 18 and 65 years

Exclusion criteria

• Unstable medical condition
• Presence of neglect
• Severe aphasia preventing completion of assessment scales
• Presence of a concomitant lower motor neuron lesion
• History of fracture, surgery, or amputation in the affected limb
• Presence of implanted electronic devices (e.g., cardiac pacemaker)
• Local infection at the application site
• Use of oral steroids or pregabalin/gabapentin within the last 3 months
• History of intra-articular injection, botulinum toxin injection, or suprascapular nerve block within the last 3 months