MIRROR THERAPY COMBINED WITH REHABILITATION INTERVENTIONS FOR POST-STROKE UPPER LIMB MOTOR DYSFUNCTION: CURRENT EVIDENCE, MECHANISMS, AND FUTURE DIRECTIONS

Abstract

Post-stroke upper limb motor dysfunction is a common cause of long-term disability. Mirror therapy (MT) is a generally safe, accessible, and low-cost rehabilitation intervention, and its combination with other rehabilitation modalities has attracted growing clinical interest. This narrative review synthesized targeted literature available up to September 2026 on MT combined with electrical stimulation, non-invasive brain stimulation, task-oriented training, acupuncture, robot-assisted therapy, and electromyographic biofeedback. Higher-level clinical evidence and relevant mechanistic studies were prioritized, while no PRISMA-style systematic screening, de novo risk-of-bias assessment, or meta-analysis was undertaken. Across the six combined approaches, evidence suggests potential additional benefits for upper limb motor function and activities of daily living (ADL), but certainty varies substantially. Moderate-quality evidence supports major motor and ADL outcomes for robot-assisted MT, whereas evidence for several electrical stimulation outcomes remains low-certainty. Recent meta-analyses also support potential benefits of MT combined with tDCS and acupuncture, although protocol heterogeneity remains substantial. Patient selection, intervention dose and sequencing, and adverse-event reporting remain inconsistent across studies. MT combined with other rehabilitation interventions is a promising adjunctive strategy for post-stroke upper limb recovery, but current evidence does not support uniform superiority across all modalities or patient groups. Future studies should prioritize standardized reporting, stronger comparative trials, patient stratification, safety monitoring, and clinically meaningful outcome measures.