Mirror Therapy in Rehabilitation

The power of the mind is truly remarkable however it is not infallible and can be tricked into desired outcomes. Mirror Therapy is an interesting technique used by rehab clinicians to circumvent pain responses and increase mobility in limbs with motor damage. Created by Vilayanur Ramachandran to address phantom pain in amputees, Mirror Therapy (MT) has been adopted to provide significant outcomes in patients after stroke and with Complex Regional Pain Syndrome (CRPS) to name a few conditions. The principal of MT is to create an illusion whereby a mirror is placed in front of an affected limb, misleading the brain to believe the reflection is the opposite limb. A patient can move their ‘healthy’ limb pain free and without any motor deficiencies, however according to the patient’s brain, they are moving and subsequently training the affected appendage.

Looking back to our blog on neuroplasticity, we learnt the brain has the ability to establish new and effective neural pathways after significant trauma through repetition and strengthening. Mirror Therapy is a practice that can stimulate neuroplasticity in the brain and retrain damaged pathways. Essentially, the approach of this intervention is to exploit the brain’s preference to prioritise visual feedback over somatosensory (feel) or proprioceptive (body positioning) feedback. The leading hypothesis as to how Mirror Therapy works has to do with the mirror neuron system which aids us in differentiating between left and right. Mirror neurons account for approximately 20% of neurons in the brain and are stimulated during MT. Observing movement of a reflected limb trains the same motor process that would be involved in the actual movement, leading to better outcomes regarding movement and pain.

When engaging in MT, a mirror box is a tool that clinicians can use as an effective modality for rehabilitation as exhibited in the adjacent. However, a mirror box isn’t always necessary and makeshift techniques will suffice as long as the injured limb is blocked from sight and the healthy one reflected. A positive point of this intervention is that in some cases, the use of medication may not be required to get the desired outcomes. The wealth of evidence supporting Mirror Therapy is anecdotal, however, the reports from patients tend to be overwhelmingly positive. Looking at a case in Australia, a 63-year-old lady presented with CPRS in her upper right limb with medication and traditional methods providing no relief. According to A. Karmarkar (2006), after commencing MT, she experienced an immediate and dramatic improvement in movement in the affected limb accompanied by a reduction in pain scores of more than 50%.

Mirror Therapy may not work for all conditions however it ‘may provide a quick, cheap, effective and relatively painless form of management for conditions that are very resistant to conventional therapeutic strategies’ (A Karmarkar, 2006). Considering the vast amount of treatments and approaches one can take when treating a patient, a little guidance can go a long way. The team at Absolute Balance are the experts in exercise rehabilitation, so if you have any questions regarding an injury or Mirror Therapy, contact us today on 9244 5580 or info@absolutebalance.com.au.

 

Ed Daccache

B.Ex.SpSc, Grad.Dip.Ex.Sc (AEP, AES) (ESSAM)
Accredited Exercise Physiologist

 

References:

Fong Mei Toh, S., Fong. K. (2012). Systematic Review of the Effectiveness of Mirror Therapy in Training Upper Limb Hemiparesis after Stroke. Hong Kong Journal of Occupational Therapy. 22, 84-95. DOI: 10.1016/j.hkjot.2012.12.009

Karmarkar, A., Lieberman, I. (2006). Anaesthesia. The Association of Anaesthetists of Great Brittain and Ireland. 61, 402-414. DOI: 10.1111/j.1365-2044.2006.04605.x

Tichelaar, V., Geertzen, J., Doeke, K., Van Wilgen, P. (2007). Mirror Box Therapy Added to Cognitive Behavioural Therapy in Three Chronic Complex Regional Pain Syndrome Type 1 Pateints: A Pilot Study. International Journal of Rehabilitation Research. 30(2), 181-188. DOI: 10.1097/MRR.0b013e32813a2e4b