Mirror Therapy

Who was the first to use mirror therapy and for who?

-Dr. Ramachandran -pts who had UE phantom limb pain (PLP)

the effects of mirror therapy is still being determined on the following conditions:

-TBI -Arthritis -Viso-spatial neglect -neuropathic pain

pros of mirror therapy

-emotional -functional -easily taught -low-risk -non-invasive -worldwide applicability -successful treatment

limitations of mirror therapy

-no longitudinal studies have been done to test the long term outcome of mirror therapy -pain is subjective so there could be a placebo effect that occurs -since mirror therapy is still developing and research is limited we need to make it functional for reimbursement purposes

describe mirror visual feedback

-place the affected hand in the box so it is hidden from the visual field -perform movement patterns with both hands, keeping the affected hand hidden and watching the movement patterns with the unaffected hand in the mirror

describe imagined hand movements

-pt visualizes moving his or her hand to match a picture -imagine that you are actually performing the movement

explain what happened with Dr. Ramachandran when using mirror therapy

-pts were unable to move their frozen limbs -he introduced these pts to a mirror that reflects their unaffected limb -this imagery illusion allowed pt to see that their amputated arm is moving again -it resulted in decreased PLP and increased the amputated limb range of motion -this resulted in a rush of other researchers to investigate the effectiveness of mirror therapy

what should pt do during mirror therapy?

-sit comfortably and concentrate on the movement -produce slow, careful movement -perform movement patterns with both hands simultaneously -look at the reflection in the mirror, not either real limb -with phantom limb, start off in position they feel the limb is in.

explain mirror therapy and the brain

-the "mirror neurons" are located in the premotor cortex and inferior parietal lobe. -mirror neurons are the mechanisms that fire with both observation and execution of movement ("monkey see, monkey do") -brain is activated when observing, imaging, and executing movement. ~30% neuron can be recruited just by thinking about the image of the task ~visual imaging recruits neuronal activity

describe laterality training

-the pt identifies pictures of right and left hands in various positions to reestablish laterality -the ability to discriminate between right and left depends on an intact body schema, which is needed for success.

treatment guidelines for mirror therapy

-the standard tx is 20 mins per day -5 days a week for 2-6 weeks -start off with as much mirror therapy the pt can tolerate -gradually work up the pts tolerance slowly and steadily each day -research is limited in this area -dr. butler reported that it can be used 1-2 hrs a day

tips in using mirror therapy

1. explain concept of neuroplasticity to pt beforehand 2. have pt participate in the graded motor imagery 3. have pt seated comfortably 4. use high quality mirror 5. remove jewelry, watches, etc. 6. start with gentle motion that is pain free 7. encourage client

brain reorganization by the mechanisms of ___________ that allow undamaged axons grow new nerve endings to reconnect neurons whose links were injured or severed

axonal sprouting

aims to exploit the brain's huge capacity to adapt without setting off its more protective side (pain). Has been shown to offer substantial gains in pain and disability for people with pathological pain syndromes such as complex regional pain syndrome and phantom limb pain.

graded motor imagery

allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment. The brain's ability to recognize itself by forming new neural connections throughout life.

neuroplasticity

side effects of mirror therapy

some side effects include sensation in hidden limb such as: -increased heat or cold within the limb -a heavier or lighter limb -as if they have an additional limb -reduced sensation or as if the limb is "floating" -stop treatment if have increased pain at rest either during or after

what are the three steps in graded motor imagery?

step 1: laterality training step 2: imagined hand movements step 3: mirror visual feedback

relationship with mirror therapy alone and GMI

there is no research that proves that all 3 stages are needed to see results. therefore, one can start off with just mirror therapy. if the pt is not responding the therapist can revert back to stage 1 and 2.

______ can also sprout nerve endings and connect with undamaged nerve cells, forming new neural pathways to accomplish a needed function

undamaged axons