Folding Mirror Therapy Box (Hand/Wrist)

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The patient repeatedly practices this technique over time, e.g., daily at home. Patients will benefit more from shorter duration with higher frequency. For example, 5 minute sessions, 5-6x/day, every day. Longer sessions with low frequency, e.g., 30 min sessions once a day or once a week are not encouraged. 25 Before beginning mirror therapy, the patient should be instructed in the purpose of the technique and the expected outcome. Each mirror therapy session should last between 10 and 30 minutes, depending on the patient’s ability to attend to the mirror. A diary where the patient documents time using the mirror, types of movements, symptoms and outcomes can be a useful aid to sustain adherence to the treatment regimen. 25 Some patients may also experience dizziness or nausea when viewing the image of the unaffected arm in the mirror. If this occurs, patients should look away from the mirror and focus on the unaffected arm, then gradually look at the mirror for short periods only until the sensations dissipate. Wilson, Cassandra (2010). The Effectiveness of Mirror Therapy in the Treatment of Post-amputation Phantom Limb Pain.

Mirror therapy exercises are designed to harness neuron mirroring to activate neurons in the affected area of the brain, and eventually increase the dexterity, accuracy, and velocity of impaired limbs. To help a patient begin a structured mirror therapy regimen, a medical professional will first describe mirror box therapy protocol, and then guide the individual in a series of mirror therapy exercises. These exercises have been shown to help individuals with motor deficiencies regain dexterity and strength. These exercises are designed to eventually be self-guided in the stroke survivors home and facilitate continued progress. Retraining the Brain after Stroke According to a 2017 review of fifteen studies that compared mirror therapy to conventional rehabilitation for the recovery of upper-limb function in stroke survivors, mirror therapy was more successful than CR in promoting recovery. [9] Start to slowly move your unaffected arm while looking at the reflection and keeping the affected arm relaxed. Again, imagine that the reflection of the moving limb is your affected hand/arm in its previous intact state.An example of a treatment session may include MT in the beginning, ADL training, followed by facilitation of cognitive strategies such as filling in the daily diary or memory book for ADLs and MT performance, symptoms, and times completed. Overall, promotes the stroke survivor’s occupation of health management with clear set goals, self-monitoring, and empowers them to do their own exercises and daily activities. Collaborative MT practice with an OT such as in ARU can also promote transfer to other environments such as follow-up by a home health OT. See also Mirror therapy has been stretched and has shown promising consequences for the treatment of other health problems, including chronic pain, re-education of the brain after stroke, and even arthritis. Yet, the usage of mirror therapy is still very limited and much remains to be done to enhance this therapy and its use. While traditional mirror therapy only permits small movements and cannot provide a truly natural experience to fool the brain and give it the fantasy of movement, the new technology of virtual reality

Subeyaz,S, Yavuzer,G, Sezer,N, Koseoglu,F, Mirror Therapy Enhances Lower-Extemity Motor Recovery and Motor Functioning After Stroke: A Randomized Controlled Trial, Archives Physical Medicine and Rehabilitation, Vol 88, May 2007 [1] Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15:913–924. doi:10.1016/S1474-4422(16)30073-4 Treatment with mirror therapy soon expanded beyond its origin in treating phantom limb pain to the treatment of other kinds of one-sided pain and loss of motor control, for example in stroke patients with hemiparesis. In 1999 Ramachandran and Eric Altschuler extended the mirror technique from amputees to enhance the muscle control of stroke patients with weakened limbs. A critique article published in 2016 concluded that “Mirror therapy (MT) is a valuable method for improving motor recovery in poststroke hemiparesis.”Mirror therapy can be incorporated into treatment daily, if possible. The more often mirror therapy sessions occur, the more benefit is obtained. Patients having difficulty experiencing the reflection as an additional limb will require OT to cue the patient to imagine ‘looking through a glass instead of a mirror’.

For representative, mirror neurons are not activated if you look at a bird flying. What is more surprising is those mirror neurons are also activated when an individual is imagining an action but not performing it! This is also why you may also sometimes discern what other individuals feel: if you see someone get his fingers caught in a door, you will presumably “feel” that person’s pain, and wince. The brain is not a determined network of neurons set in a given arrangement for life, like an old electrical board. The brain is continuously trying to find more profitable ways to deliver and deal with details by creating or removing connections between neurons. This spectacle of neural changes is called neuroplasticity.

A 2018 literature review of phantom limb pain stated that, in randomized controlled trials, mirror therapy reduced pain. [6] Post-stroke hemiparesis [ edit ] Neuroplasticity is the brain’s capability to heal and rewire itself after a neurological injury like a stroke. It is best activated through increased repetition of therapeutic exercises, or massed practice. Neuroplasticity strengthens existing neural pathways (connections) and constructs new ones. The more vigorous the neural pathways for a specific function become, the higher the chances of restoring that function. One treatment that is gaining attention in the field of stroke rehabilitation is mirror therapy. This simple, low tech treatment may be worth your attention as a supplement to the traditional stroke rehabilitation techniques you already use. Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseoglu F, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil 2008; 89: 393–398. ↑

Since Altschuler et al.’s study which documented the first use of MT as a possible method to promote motor function in CVA survivors 5, there have been further studies that report its positive effect on motor function in the upper extremities. 6 7 8 9 10 11 12 13 14 This article will explain what mirror therapy for stroke intervention is, what evidence supports its use, and how to begin using this treatment. First, What is Mirror Therapy? A majority of the studies (92.8%) used either mirror boxes or mirror frames to deliver MT training. A mirror box is a 3-D structure with the facility to place the affected limb within it to avoid direct viewing of it by the patient, whereas a 2-D mirror frame is placed between the 2 arms either vertically or inclined in such a way so that the patient is able to view the reflection of the normal arm in the mirror without viewing the affected arm. The dimensions varied based on which part of the body was being treated: upper or lower extremity. Among the studies using the above-mentioned mode of MT, 13 studies included bilateral symmetrical movements of the limbs 28– 30, 32, 35, 37, 39, 42, 44, 45, 51, 52, 54 as opposed to the remaining 13 studies which intervened with unilateral movement of the unaffected limb. The study by Harmsen et al 40 delivered a modified form of therapy using the participant-specific videos with reaching movements from the unaffected arm that were videotaped and mirrored, creating maximal postural familiarity and the illusion that the affected arm performed the reaching movements in a normal movement pattern. This form of action-observation mode showed improved speed of upper limb movements, although the long-term effect was not measured. A study by In et al used Virtual Reality Reflection Therapy (VRRT) in treating balance and gait after stroke. This is a technically enhanced version of MT training where the patients in a high sitting position placed their affected lower extremity into the VRRT box and observed the projected movement of the unaffected limb without visual asymmetry otherwise causing tilting of the head and trunk. The movements of the unaffected limb were captured through the camera and displayed over the affected limb as the virtual reality reflection. This study reported improved balance scores both in static and dynamic tests, decreased anteroposterior sway with eyes open, and decreased mediolateral sway with eyes open and closed, as well as improved walking speed on a 10-metre walk test. MT also belongs to a set of treatments called Graded Motor Imagery (GMI). GMI uses a top-down paradigm to treat pain. Traditional examples of GMI are for targeting complex regional pain syndrome in the upper extremities 3 and phantom limb pain (PLP). Diers M, Christmann C, Koeppe, C, Ruf M, Flor, H. Mirrored, imagined, and executed movements differentially activate sensorimotor cortex in amputees with and without phantom limb pain. PAIN. 2010;149(2):296–304.

How Mirror Therapy Can Help Improve Mobility After Stroke

Jacobs, Benjamin; Creamer, Katharine (July 30, 2015). "Not all smoke and mirrors: mirror therapy for Complex regional pain syndrome". BMJ. 351: h2730. doi: 10.1136/bmj.h2730. PMID 26224572. S2CID 15705979. Mirror therapy (MT) and graded motor imagery programmes (GMIP) are two specific modalities of physical therapy which are especially promising options for managing CRPS. Future studies should involve a larger sample size and more homogeneous distribution in relation to sensory impairment or motor paresis. 38 Further on, new studies ought to be executed on optimal duration, intensity, and content 38 while also focusing on ADL. 53 Mirror therapy was first described as a successful treatment for phantom pain by Dr. Vilayanur Ramachandran in the mid-1990s. Since then, several case reports have described similar success with the treatment. In 2007, results from a randomized controlled trial of mirror therapy was published in The New England Journal of Medicine. The findings from this study showed that mirror therapy was effective for reducing phantom pain after 4 weeks of regular practice. Mirror therapy was also shown to be superior to placebo and mental visualization comparison groups. Currently, global outreach efforts are underway to educate physicians and practitioners who treat amputees in developing countries about mirror therapy and its ease of use. The End the Pain Project is a nonprofit organization that is providing mirror tool kits containing printed instructions for mirror therapy and nonbreakable mirrors – all free of charge to medical organizations and patients in Vietnam, Cambodia and Somalia. Due to the limited availability of medical resources in many regions of these countries, self-delivered mirror therapy may help people with phantom pain from limb loss of all etiologies (causes), including the large percentage of people in these countries who are survivors of landmines, military conflicts or other trauma. Related Resources Consider such movements as opening your hand to permit a butterfly to fly away, dropping stones in a river, or throwing a ball. Do not do any activities that deliver pain in your phantom limb. It may be helpful at some point to touch your face with your unaffected hand while making the same movement with your affected arm.