Whether you’ve used it in your occupational or physical therapy practice, seen it in an article or heard about it on television, the words “mirror therapy” likely aren’t unfamiliar to you. But unless you’re a therapist with all of the answers (and if you are, please reach out to me. I have questions) there’s a good chance you’ve had less than amazing success with this technique or are just fuzzy on the details for using it. I mean, the concept is great, right? But when you get to the nitty gritty…how and why does this technique work?
Mirror Therapy is just one aspect of something called Graded Motor Imagery
Graded motor imagery is a rehabilitation program that has been shown to be effective in treating complex/chronic pain and movement issues including stroke. It is broken down into three aspects – laterality, explicit motor imagery, and (you guessed it) mirror visual feedback (better known as mirror therapy). That’s right – if you’re trying mirror therapy & not seeing results, it might be because you’re missing the other two pieces! This top-down treatment approach aims to normalize central processing, correct cortical changes that occur secondary to complex and chronic pain, and decrease the patient’s experience of pain with the added benefit of normalized movement patterns.
This is left versus right discrimination. Research has shown that people experiencing pain have decreased accuracy when identifying an image or body part as being right versus left. As you may have seen in practice, patients with neglect are often challenged to correctly identify their left side versus right side or to attend to task items on the left versus right.
- You can assess your patient’s skills with laterality by asking them to identify their own body parts as right versus left, images of body parts as right versus left, and ability to locate right or left task items correctly when cued.
- Laterality cards showing images of right and left body parts can be correctly identified and sorted – upgrade this activity by requiring increased speed. Be sure to mark how many your patient was able to sort correctly and how long it took them as this makes a great goal!
Explicit Motor Imagery
This is creating a clear mental picture of a movement or activity – actively envisioning the affected body part completing without pain or restriction.
- This step has been postulated to activate mirror neurons – these neurons help us learn through observation and imagination and have been even shown to activate with auditory cues! This is thought to stimulate the motor cortex in a meaningful way – almost as if the movement was actually occurring successfully and without pain.
- Have your patient imagine a very particular task – you can assess their skill with this by asking them to verbalize what they are envisioning with detail. Demonstration may be effective for your patients here as well to help them independently envision the task at hand.
Mirror Visual Feedback
(Mirror Therapy) Using a mirror to “trick” your brain into thinking the affected limb is moving without pain/restriction by moving the unaffected limb. This is most effective if the affected limb is moving as well.
- Begin with having the patient observe their functional limb complete a movement or task through the mirror. If the patient is able to do this without pain or discomfort – progress to moving the affected limb while looking at the unaffected limb in the mirror.
- This aspect of graded motor imagery is thought to provide strong sensory input that reteaches the brain how to move without pain or limitation.