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. The first version of this protocol for mirror therapy was developed by andreas rothgangel and susy braun together with students of zuyd university of applied. Mirror therapy is often given by occupational therapists and physiotherapists but any health professional can administer it. Spiegeltherapie praxisleitfaden neurologie leitfaden johanna genius saskia ro. Principle of mirror therapy mirror theory is based on evidence that action observation activates the same motor areas of the brain as action execution. The effectiveness of mirror therapy with stroke patients in. Mirror therapy practical protocol for stroke rehabilitation 20 1. Mirror therapy offers an interesting method for regaining mobility after a stroke even if the hand and arm are paralyzed. It is suitable to treat conditions such as complex regional pain syndrome crps, phantom limb pain, stroke and other chronic pain conditions. How to implement mirror therapy treatment materials. The client then positioned their intact extremity next to the mirror to produce an image which takes the place as the affected extremity, while the. It can also be given by a family caregiver or be selfadministered following a brief explanation of how to do it and after receiving tools to do the therapy at home user guide, written explanations, photos or videos of the movements to be done. Mirror therapy is especially useful for people who have very little movement of their arm and hand after a stroke. These findings can enhance implementation of mirror therapy and protocol development.
In recent years mirror therapy has been used in stroke rehabilitation, both to ease motor e. To understand how this process works, youll need to know about mirror neurons and neuroplasticity. In mirror therapy, we use movements of the stronger hand and arm to trick our brain into thinking that the weaker arm is moving. Mirror therapy, or mirror box therapy, is a physiotherapyphysical therapy and occupational therapy technique used to help increase movement and. Mirror therapy for improving motor function after stroke. In contrast to varied therapy approaches, mirror therapy mt can be used even in completely plegic stroke survivors, as it uses visual stimuli for producing a desired response in the affected limb. Virtual reality mirror therapy for stroke full text view. During mirror box therapy, people place their affected arm inside a box, where they are unable to see it.
Mirror therapy for improving motor function after stroke stroke. Mirror therapy is a specific therapy designed to strengthen arms and hands weakened by a stroke. However, a positive effect on visuospatial neglect was neglected. Pdf mirror therapy protocols for improving motor function. A touchobservation and taskbased mirror therapy protocol. There is moderate evidence that mirror therapy is as. The aim of this randomised controlled study is to investigate the effectiveness of mirror therapy supported by telerehabilitation on the intensity, duration and frequency of phantom limb pain and limitations in daily activities compared to traditional mirror therapy and care as usual in people following lower limb amputation. You are now exercising your left hand in the brain. Many variations in applying mirror therapy exist whereas detailed information and a stan dardized, evidence based treatment protocol for mirror therapy in. Mirror therapy has been shown to be an effective intervention for the hemiparetic upper extremity.
Mirror therapy was specific toward those who have had a stroke and currently. The main reason to develop a practicebased protocol was because mirror therapy is still inconsistently used in clinical situations and many physical and occupational therapists expressed a strong need for some form of guidance to structure therapy and support imple. Mirror therapy has various titles including mirror imagery, mirror therapy, mirror visual feedback, imagery therapy, mirror image therapy essentially it is a non invasive, completely drug free alternative therapy to help you and your crps, phantom limb pain or chronic neuropathic pain. Mirror therapy practical protocol for stroke rehabilitation andreas rothgangel susy braun prot ocol. Lorimer moseleya, alberto gallaceb, charles spencec adepartment of physiology, anatomy and genetics and pain imaging neuroscience group, le gros clark building. In amputees, this creates the illusion of having two intact limbs. On this basis, it was first used to aid in the recovery of upper limb ul hemiparesis following stroke a decade ago altschuler et al. Touchobservation and taskbased mirror therapy is an effective but lowcost treatment protocol to optimize sensorimotor control and functional capability of the upper limb in patients with peripheral nerve injury. Observed actions lead to the generation of intended actions, engaging motor planning and execution. This study suggests that gross motor activities and movements yield the most realistic mirror therapy protocols. In mirror therapy, we use movements of the stronger hand and arm to trick our. Physiotherapy management of complex regional pain syndrome. How to use mirror therapy for crps burning nights crps.
A randomized controlled trial was conducted on patients healing from peripheral nerve repair. Mirror therapy group, covered mirror therapy group, mental imagery group mirror therapy group all 6 reported decreased phantom limb pain. Using mirror therapy to reduce pain and improve movement. Graded motor imagery gmi offers a novel three stage synaptic exercise process for neuropathic pain involving leftright discrimination, imagined movements and mirror therapy. Feb 07, 2020 in contrast to varied therapy approaches, mirror therapy mt can be used even in completely plegic stroke survivors, as it uses visual stimuli for producing a desired response in the affected limb. Mirror therapy for improving movement after stroke cochrane. Since then, several case reports have described similar success with the treatment.
An increased effectiveness of mirror therapy compared to late sensory reeducation was not apparent, although clinical improvements were observed. Pdf preface the main reason to develop a practicebased protocol was because mirror therapy is still inconsistently used in clinical situations and. Mirror therapy as part of a patients home exercise program is critical. Psychological treatment of crpsrsd with mirror box therapy. Furthermore, this case report is unique because jonathans mirror therapy was selfdelivered at home without the guidance of a structured exercise protocol. A handbook arising from the last 15 years of neuroscience, clinical trials and clinical reasoning science is here for both clinicians and pain sufferers. Review of specific range of motion exercises or functional tasks in the clinic can help patients know exactly how to carry over the therapy on their own. Mt has been studied to have effects not just on motor impairments but also on sensations, visuospatial neglect, and pain after stroke. To note, mirror therapy is a simple and inexpensive treatment that patients can practice independently and with no significant side effects. This case report adds to the growing body of literature describing successful treatment of lower limb phantom pain with mirror therapy. Lower extremity amputation and prosthetic rehabilitation. Major limitations are small sample sizes and lack of reporting of methodological details, resulting in uncertain evidence quality.
Mirror therapy has also been reported to improve gait in stroke patients. You need to be in a quiet room, free of distractions. Pdf practical protocol mirror therapy phantom limb pain susy. For patients with a complex regional pain syndrome following stroke, mirror therapy seems to be an effective intervention, both for improving motor function and reducing pain. For your brain to believe the optical illusion of the mirror, it needs to focus. A potential intervention for pain management scielo. Author links open overlay panel sharon fong mei toh a b kenneth n. Jul 11, 2018 mirror box therapy is a treatment option that has shown promise for people with difficulty moving their arm after a brain injury, such as stroke. The purpose of mirror therapy is to increase the brains activity and to increase the brains ability to reorganize in the affected area of the brain by giving more feedback to the brain. Mirror therapy efficacy in upper limb rehabilitation early. Description mirror therapy groupthis group followed the same protocol as. Research to support the different approaches varies hugely, with a wealth of research to support the use of some techniques while other approaches have limited evidence to support its use but rely on ancedotal evidence. Jun 28, 2015 mirror therapy practical protocol for stroke rehabilitation 20 1.
Patients should find a quiet place, free from all distractions, to allow for best results when practicing in their homes. Mirror therapy practical protocol for stroke rehabilitation. Brief description mirror therapy groupthis group followed the same protocol as the individual mirror therapy but contained 2 to 6 patients. They then focus their attention on the outside of the box, which has been fitted with a mirror. A wide range of treatment techniques and approaches from different philisophical backgrounds are utilised in neurological rehabilitation.
The results indicate evidence for the effectiveness of mirror therapy for improving upper extremity motor function, motor impairment, activities of daily living, and pain, at least as an adjunct to conventional rehabilitation for people after stroke. This low tech treatment may be worth your attention to supplement the traditional techniques you already use. This treatment was first proposed as treatment for phantom limb pain and stroke and is now being studied in other conditions. The main reason to develop a practicebased protocol was because mirror therapy is still inconsistently used in clinical situations and many physical and occupational therapists expressed a strong need for some form of guidance to structure therapy and support imple mentation of mirror therapy in routine care. Sarah uhr susy braun andreas rothgangel pflaum verlag. Mirror therapy was first described as a successful treatment for phantom pain by dr. The idea behind mirror therapy is to try and trick or retrain your brain into thinking you are moving your limb or digit. They completed a protocol of 6 weeks of additional therapy 30 minutes a day, 5 days a week, with random assignment to either mirror therapy mt or an equivalent control therapy ct.
Wadee,h the objective of this study was to evaluate the clinical. Preface the main reason to develop a practicebased protocol was because mirror therapy is still inconsistently used in clinical. Once you have decided mirror therapy is for you, you can use this mirror therapy protocol. A touchobservation and taskbased mirror therapy protocol to. The control group carried out similar exercises for the same time period but they used the nonreflecting side of the mirror. It may be combined with cognitive behavioral therapy. There is some encouraging evidence that suggests that by using mirror therapy, the part of your brain that is damaged is stimulated, encouraging recovery. Mirror box therapy exercises for stroke recovery saebo. Mirror therapy in unilateral neglect after stroke must trial ncbi. Then, at the end of this article, well show you how to do mirror how mirror therapy helps improve movement after stroke even with. Preface the main reason to develop a practicebased protocol was because mirror therapy is still inconsistently used in clinical situations and many physical and occupational therapists expressed a strong need for some form of guidance to structure. Wadee,h the objective of this study was to evaluate the clinical aspects of mirror therapy mt interventions after stroke.
Mirror therapy promotes recovery from severe hemiparesis. Mirror box therapy is a treatment option that has shown promise for people with difficulty moving their arm after a brain injury, such as stroke. Lorimer moseleya, alberto gallaceb, charles spencec adepartment of physiology, anatomy and genetics and pain imaging neuroscience group, le gros clark building, oxford centre for fmri of the brain, university of oxford, south parks road, oxford oxon ox1 3qx, uk. In 2007, results from a randomized controlled trial of mirror therapy was published in the new england journal of medicine.
The research on how well this intervention works is still quite new. Mirror box therapy, also referred to as mirror therapy, which utilizes visual feedback, has recently been proposed as a treatment for crpsrsd. The clinical aspects of mirror therapy in rehabilitation. Therapist protocol for parkinson disease history focus on history of freezing episodes, tremors, bradykinesia, rigidity, falls during medication on or off times, dropping items, fine and gross motor coordination, difficulty swallowingtalking loud memory, hep, time schedule for meds. Evidencebased information on mirror therapy stroke from hundreds of trustworthy sources for health and social care. Mirror therapy is a therapeutic approach that uses a mirror box to regenerate neural networks that control limbs and other parts of the body. Mirror therapy is gaining attention in the field of stroke rehabilitation. This article will explain what mirror therapy for stroke is, what evidence supports its use, and how to begin this treatment. Ramachandran at university of california san diego to address phantom limb pain, a mirror box utilizes mirrors to give the impression to the users brain that they are moving. Using movements of the stronger body part to trick our brain into thinking that the weaker body part is moving. If you put your left hand behind a mirror and right hand in front, you can trick your brain into believing that the reflection of your right hand in the mirror is your left. Sensory electrical stimulation combined with mirror therapy. Future studies with clear descriptions of intervention protocols. These exercises have been shown to help individuals with motor deficiencies regain dexterity and strength.
Mirror therapy box flat work surface functional objects i. Mirror therapy for the upper limb consisted of 1 therapist treating 26 patients with a mirror 50. There is no standardized protocol for mirror therapy. Selfdelivered homebased mirror therapy for lower limb. Pdf practical protocol mirror therapy phantom limb pain. We hope that this protocol facilitates the tailored treatment of patients after stroke with mirror therapy in everyday care. Techniques showing some promise include mirror therapy, graded motor imagery, tactile discrimination training, and exposure therapy.