#50 Mirror Box Therapy-Retrain the Brain

Mirror Box Therapy (also known as Mirror Therapy) was created by Villayanur S. Ramachandran initially to assist in the alleviation of phantom limb pain.  The principle of mirror box therapy is the use of a mirror to create a reflective illusion of an affected limb in order to trick the brain into thinking the movement has occurred in the affected limb, and without pain. Mirror Therapy is also used in the treatment of complex regional pain syndrome, post-stroke hemiparesis, carpal tunnel syndrome, arthritis, and post-surgical rehab.

Complex Regional Pain Syndrome (CRPS) is relatively rare, resulting from damage or malfunction of the peripheral and central nervous systems.  It generally occurs after an injury, but may also present after an infection, stroke, heart attack or surgery. It typically affects one limb, either an arm, leg, hand or foot. It has been documented the pain can spread, affecting the opposite limb.

The primary symptoms are prolonged severe neuropathic pain, changes in skin color, temperature change, and often swelling of the affected area.  Weakness, abnormal sweating, skin and bone atrophy, hair loss on the affected limb and contractures are commonly seen in CRPS.  Frequently, there is an increase in sensitivity here even a light touch of the limb results in excessive pain.

Mirror Therapy is believed to be effective in reducing pain and increasing movement of the affected limb. Mark Butler explains an expanded four phase technique for Mirror Therapy.

Phase 1 – Laterality:  Recognize R and L

1. Have a magazine, set a timer, 3, 5 or 10 minutes depending on persons tolerance Mark a R or L on each shoulder, hand and foot of the people in the pictures.
2. Do 3-5 x every day at a level you can tolerate.  May need to start at 2 minutes.
3. Do not over do it. When you have pain you are rewiring pain back into your problem.

• Minimum of 2 weeks, continue on every other day

Phase 2 – Mental manipulation of your affected extremity 

1. Imagined Hand/Limb Movements; assuming the hand position you are seeing.
2. Mental images of movements of your hand.
3. Sit in front of a mirror, pictures of hands in your good hand, injured hand is behind the mirror look at each image and imagine the well hand.

• Minimum 2 weeks looking at images 5-10 minutes 3-5 times a day

Phase 3  – Uninjured hand moves while injured hand is behind the mirror.

1. Look at a picture of a hand/limb and move the unaffected hand in and out of the same position either repeatedly or just hold the position like in the image.
2. Focus on the mirror’s reflection  of the uninjured hand, the brain sees both hands as a healthy and functioning.

• Minimum 2 weeks, 5-10 minutes 3-5 times a day

Phase 4 – Have the injured hand match

1. Have the well hand/limb moving, while the injured hand/limb behind the mirror also moves.

 Notes

• If pain occurs at any phase, stop and go back to the previous phase tolerated
• Use the same concept on any body part
• Please consult with your health care provider before initiating Mirror Box Therapy

References

• Based on the presentation by Mark Butler, PT, MPT, OCS, Cert. MDT
• Physical therapist at Nova Care in Medford, NJ.
• National Institute of Neurological Disorders and Stroke: Complex Regional Pain Syndrome Fact Sheet.
• Mayo Clinic: mayoclinic.org