Mirror Therapy

Mirror therapy is an innovative, evidence-based therapy method of occupational therapy. Developed by Dr. Vilayanur S. Ramachandran in the 1990s, mirror therapy is used to treat patients with complex neurological conditions, including severe arm paresis, complex regional pain syndrome, and phantom limb pains. Mirror therapy is a very active and intensive therapy that challenges patients mentally and in terms of time. This therapy requires a high level of attention and concentration from the patient.
The primary aim of mirror therapy is to help patients regain control of their affected limbs, reducing pain through the power of visual illusions.

How does it work?

In the case of various diseases, such as after an amputation, certain assigned areas of the brain can shrink in terms of perception, and our body schema is demonstrably altered. As a result, we feel less and perceive less. Mirror therapy utilises our brain’s learning ability and malleability for the recovery process.

When patients engage in mirror therapy, the optical illusion gives the impression that their missing or affected limb is present and functioning correctly. In the brain, this visual stimulus activates the visuomotor region, which controls movements and coordinates sensory input with motor output.

Activation of the visuomotor region helps promote neuroplasticity, the brain’s ability to reorganise, rewrite, and adapt in response to new experiences, stimuli, and challenges. Through mirror therapy, the patient’s brain is tricked into believing the affected limb functions normally, stimulating recovery and encouraging new neural connections.

In addition to neuroplasticity, mirror therapy also reduces pain – a problem particularly associated with phantom limb syndrome. The mirror neurons are involved in recognising and imitating movements and motor learning. They can reprogramme our movement patterns. The mirror helps ‘overwrite’ the painful sensations experienced by the brain, as it shows a more accurate representation of the patient’s limb, reducing the severity and frequency of painful episodes.

The mirror’s size, placement, and stability are key for mirror therapy to succeed. The illusion must be sufficiently ‘real’ to ensure the brain is tricked. The mirror should neither wobble nor distort nor allow a view of the other sides of the body.

Expected Results

Mirror therapy is an effective treatment for various conditions, and patients can expect to see an improvement in their symptoms. By creating an optical illusion that gives the impression that a missing limb is still present, mirror therapy stimulates and activates the visuomotor brain areas, leading to changes in the brain that can improve function and reduce pain.

Several studies have shown mirror therapy to be an effective treatment for various conditions. In a 2011 systematic review, mirror therapy was found to be moderately effective as an additional intervention to improve arm function recovery. Evidence for stroke and complex regional pain syndrome was, however, low quality.

Combining mirror therapy with conventional rehabilitation in stroke patients achieved the most positive outcomes. A Cochrane Review analysing the efficacy of mirror therapy for improving motor function in stroke patients concluded that mirror therapy improves the affected limb and the ability to conduct daily activities. It also reduces pain after stroke in patients with complex regional pain syndrome.

In phantom limb syndrome, mirror therapy reduces pain. As a 2018 review concluded: ‘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.’

Mirror therapy can be effective training with a low likelihood of side effects. Initially, it is better to do the exercises in small units of 5-10 minutes with regular breaks during the therapy sessions. Later, different materials like balls, towels, or everyday objects can be integrated into the therapy session. The occupational therapists at Kliniken Schmieder use mirror therapy to relieve pain and promote movement.