OBJECTIVE: To evaluate the effects of mirror therapy, using motor imagery training, on lower-extremity motor recovery and motor functioning of patients with subacute stroke. DESIGN: Randomized, controlled, assessor-blinded, 4-week trial, with follow-up at 6 months. SETTING: Rehabilitation education and research hospital. PARTICIPANTS: A total of 40 inpatients with stroke (mean age 63.5 y), all within 12 months poststroke and without volitional ankle dorsiflexion. INTERVENTIONS: Thirty minutes per day of the mirror therapy program, consisting of nonparetic ankle dorsiflexion movements or sham therapy, in addition to a conventional stroke rehabilitation program, 5 days a week, 2 to 5 hours a day, for 4 weeks. MAIN OUTCOME MEASURES: The Brunnstrom stages of motor recovery, spasticity assessed by the Modified Ashworth Scale (MAS), walking ability (Functional Ambulation Categories (FAC)), and motor functioning (motor items of the FIM instrument). RESULTS: The mean change score and 95% confidence interval (CI) of the Brunnstrom stages (mean 1.7; 95% CI 1.2 to 2.1; versus mean 0.8; 95% CI 0.5 to 1.2; p = 0.002), as well as the FIM motor score (mean 21.4; 95% CI 18.2 to 24.7; versus mean 12.5; 95% CI 9.6 to 14.8; p = 0.001) showed significantly more improvement at follow-up in the mirror group compared with the control group. Neither MAS (mean 0.8; 95% CI 0.4 to 1.2; versus mean 0.3; 95% CI 0.1 to 0.7; p = 0.102) nor FAC (mean 1.7; 95% CI 1.2 to 2.1; versus mean 1.5; 95% CI 1.1 to 1.9; p = 0.610) showed a significant difference between the groups. CONCLUSIONS: Mirror therapy combined with a conventional stroke rehabilitation program enhances lower-extremity motor recovery and motor functioning in subacute stroke patients.

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