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WELCOME

Archimedes and the Battle of Syracuse

Using mirrors to burn the Romans ships

The Reflecting Pool

Aswathi.P 1st Yr Msc NursingAl Shifa College Of Nursing MIRROR THERAPY

INTRODUCTION

Graded motor imagery is a sequential process of rehabilitation which provides essentially a series of brain exercises.

Mirror therapy is the final stage of graded motor imagery.

DEFINITION

Mirror therapy is ground breaking non invasive treatment, in which mirror is used to present the reverse image of a body part to the brain.

Cont Form of motor imagery in which a mirror is used to convey stimuli to brain through observation of ones unaffected body part as it carries out a set of movement.

MIRROR THERAPYUnveiled by Vilayanur S. Ramachandran & Rogers 1996

Help to recognize & integrate mismatch between proprioception &visual feed back of the removed / paralysed body.

USESStrokeComplex regional pain syndromePhantom limb painFocal dystonia

Cont.

USESTrigeminal neuralgiaDejerrine Roussy syndromeParkinson disease

GOAL

Correct misinterpretations in body map

EQUIPEMENT

Mirror box

PRINCIPLE

MIRROR NEURON Frontal & parietal lobes

Rich in motor command neurons

Fires to orchestrate sequence of muscle twitches to produce simple skilled movements

MIRROR NEURON cont Increase cortical & spinal motor excitability

Responsible for laterality reconstruction

TECHNIQUEArtificial visual feed back

Cont. ARTIFICIAL VISUAL FEED BACK

ARTIFICIAL VISUAL FEED BACK Cont.

HOW TO PERFORM

Take a standard mirror & sit comfortably

Place mirror across midline of body

Cont....

One can view healthy limb & image of another healthy limb

Instructs information that no amputation has occurred

Perform 20- 25 minutes daily

Cont....

MIRROR THERAPY & STROKE

Cont.

Cont

MIRROR THERAPY &PHANTOM LIMB PAIN

Cont

Cont

Cont

MIRROR THERAPY & CRPS

con Cont

Cont

Painful arm is moving

REVIEW OF LITERATURE

REVIEW-I Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews 2012,Issue 3.

Background Mirror therapy is used to improve motor function after stroke. A mirror is placed in the patients mid sagittal plane, thus reflecting movements of the non-paretic side as if it were the affected side.

ContObjectivesTo summarize effectiveness of mirror therapy compared with no treatment, placebo or sham therapy.

To summarize effectiveness of mirror therapy for improving motor function, activities of daily living, pain & visuospatial neglect in patients after stroke.

ContMethods Randomised controlled trials & randomised cross-over trials comparing mirror therapy with any control intervention for patients after stroke.

Type of participants Paresis of upper or lower limb, or both, caused by stroke aged over 18 yrs.

ContTypes of outcome measures Post-intervention (or change scores between pre- and post intervention measures) & at follow up after six months or longer.

Primary outcomes - Motor function

Secondary outcome - Measures of ADL

ContData collection and analysis Independently selected trials based on the inclusion criteria, documented methodological quality of studies and extracted data. Analysed the results as standardised mean differences (SMDs) for continuous variables.

Cont..Results Included 14 studies with a total of 567 participants that compared mirror therapy with other interventions. post-intervention data: SMD 0.61; 95% confidence interval (CI) 0.22 to 1.0; P = 0.002; change scores: SMD 1.04; 95% CI 0.57 to 1.51; P < 0.0001

Cont. Additionally, mirror therapy may improve ADL (SMD 0.33; 95% CI 0.05 to 0.60; P = 0.02). They found a significant positive effect on pain (SMD -1.10; 95% CI 2.10 to -0.09; P =0.03) & limited evidence for improving visuospatial neglect (SMD 1.22; 95% CI 0.24 to 2.19; P =0.01). Effects on motor function were stable at follow-up assessment after six months.

Mirror therapy for phantom limb pain--a systematic review

Seidel S, Kasprian G, Sycha T, Auff E Universittsklinik fr Neurologie, Medizinische Universitt Wien, Wien, Austria. REVIEW-2

Cont..Background & objectives To evaluate the evidence for the treatment of phantom limb pain with mirror therapy.

Material & methodRandomised controlled studies by systematic search strategy in the databases "Medline" & "The Cochrane Library". Studies were evaluated using the quality criteria of the JADAD-scale.

Cont..Results

Three small-sized randomised controlled studies were identified.

One of them found a significant decrease of phantom pain after four weeks of daily mirror therapy sessions.

Two other studies could not find a significant difference in the reduction of phantom limb pain between intervention- and control-groups.

Cont..Conclusion More sufficiently powered randomised controlled studies with high methodological quality are mandatory to investigate the analgesic effect of mirror therapy in phantom limb pain

Mirror therapy for Complex Regional Pain Syndrome A literature review and an illustrative case report

Scandinavian Journal of pain, Oct 2013, Volume 4, Issue 4,REVIEW-3

Cont..Background and purpose

A case of a 42 year old woman with lower extremity Complex Regional Pain Syndrome (CRPS) after a twisting injury of the ankle, effectively treated with the addition of mirror therapy to a rehabilitation programe.

Cont..Materials and methods The PubMed database up to September 26, 2012 was reviewed using four search word groups:-CRPS mirror therapy, mirror CRPS, reflex sympathetic dystrophy OR Complex Regional Pain Syndrome AND mirror and reflex sympathetic dystrophy OR Complex Regional Pain Syndrome AND mirror+RCT.

Cont..Results The patient in this case report had failed many of the adjunctive therapies and rehabilitation had been unsuccessful until the addition of mirror therapy. She then could progress with physical rehabilitation and return to a more normal life.

Conclusions Use of mirror therapy to be included in the multidisciplinary treatment of CRPS types 1 and 2 with a positive effect on both pain and motor function.

Cont..

Implications

Mirror therapy is a newer technique, easy to perform and can be a useful adjunct to aid physical rehabilitation and decrease pain in this population.

Small spark to ignite thousands of hope among stroke survivors & amputees