Folding Mirror Therapy Box (Hand/Wrist)

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Visualization: The therapist should spend some time during the initial session helping the patient to focus on the limb in the mirror and guiding the patient to visualize that limb as the affected limb. 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 Dohle C, Püllen J, Nakaten A, Küst J, Rietz C, Karbe H. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural repair 2009; 23: 209–217. ↑

A small sample size was the prevailing limitation among the included studies. 29, 31, 33, 37, 38, 40, 41, 43, 45, 46, 49, 52, 53, 55 Additionally, the absence of follow-up did not allow assessment of long-term retention of functional improvement in patients after rehabilitation. 28, 31, 34– 37, 41, 43, 44, 46, 47, 49, 53, 55 A number of studies reported difficulties with generalisation of the outcomes due to specific pre-selection criteria 32, 36, 38, 47, 48, 51 or because they included patients with a distinct level of functional impairment and time post ictus. 29, 31, 32, 39, 41, 52 Another complication to the interpretation of the MT effectiveness was that three studies observed a difference in baseline measurements between the experimental and control groups. 37, 50, 54 The impact of MT on changes in cortical reorganisation and neural activation pre and post therapy could not be examined as only one study implemented fMRI in its protocol. 32 Wilson, Cassandra (2010). The Effectiveness of Mirror Therapy in the Treatment of Post-amputation Phantom Limb Pain. A 2018 review, (based on 15 studies conducted between 2012 and 2017, out of a pool of 115 publications) also criticized the quality of many reports on mirror therapy (MT), but concluded that "MT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP." [5]To participate, a patient should have enough postural control to sit independently in a wheelchair or regular chair. The patient should have enough functional vision to be able to see the reflection of the unaffected limb in the mirror. If a patient has visual field neglect, he or she should be able to compensate by turning the head to see 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 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’.

Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the global burden of ischemic and haemorrhagic stroke in 1990–2013: the GBD 2013 study. Neuroepidemiology. 2015;45:161–176. doi:10.1159/000441085 If you are an occupational therapist who works in stroke rehabilitation (no matter the setting), you know that you must constantly update your skills and educate yourself on the latest treatment techniques. There is so much research out there to advance the treatment of stroke patients!

How to Practice Mirror Therapy After Stroke

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 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

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.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). Rehabilitation strategies are required to be repetitive, intensive, and task-specific for neuroplasticity to produce recovery. 20– 22 It is reported that when therapy begins within 16 hrs to 6 months post stroke, there is significant improvement in ADL performance with augmented exercise therapy. 23 In contrast to varied therapy approaches which require some degree of voluntary movement, mirror therapy (MT) can be used even in completely plegic, severely paretic stroke survivors, as MT uses visual rather than somatosensory stimuli for producing a desired response in the affected limb. 24 Mirror therapy is a type of rehabilitation approach where the reflection (visual input) of a moving non-affected limb gives the illusion of movement in the affected limb. This is achieved by placing a mirror between the arms or legs. MT has been studied to have effects not just on motor impairments but also on sensations, visuospatial neglect, and pain after stroke. 25