Mirror Therapy for Stroke Hemiplegia and Phantom Limb Pain

Mirror Therapy for Stroke

Mirror therapy for stroke rehab helps improve hand and arm movement.

Mirror therapy for stroke rehab is utilized to trick the brain that the affected arm is moving like the unaffected arm by using a reflective illusion. It is a form of motor imagery technique. A visual stimulus of an unaffected area (mainly the arm or hand) is provided to the brain in order to stimulate movement to the affected area. Mirror therapy can be used in the treatment of hemiplegia or phantom limb pain. It has shown tremendous positive results in stroke recovery as it helps rewire the brain through neuroplasticity. And, studies support that mirror reflection can facilitate motor learning.

Using Mirror Therapy During Treatment

When using mirror therapy for stroke rehab (hemiplegia), a tabletop or box mirror is needed. To work on hand recovery, make sure the mirror is facing the unaffected arm. The affected arm should be positioned behind the mirror (where you see the reflection of the unaffected arm in the mirror and the affected arm is out of view). The patient should be attempting the same movement with both the affected and unaffected arms or hands. The idea is to trick the brain into believing that the same movement is happening on the unaffected arm as the affected arm because the mirror will reflect no deficits. The patient can choose the speed of the movement, and a rehab professional may have to assist the movement on the affected arm. Mirror therapy works similarly on phantom limb pain. Performing movement of the joints on the unaffected leg in front of the mirror can calm down the phantom limb sensation and phantom limb pain.

How Mirror Therapy Works

There are conflicting theories about exactly how mirror therapy works; however, studies demonstrate that mirror therapy in stroke rehab leads to functional recovery by providing a cerebral reorganization and cortical activity (brain mapping) via “mirror neurons” that build imitative skills. Mirror neurons account for about 20% of all the neurons present in a human brain. These mirror neurons are responsible for laterality reconstruction i.e. ability to differentiate between the left and the right side. When using mirror therapy, the mirror neurons get activated and help in the recovery of the affected parts. Several studies analyzed areas where the mirror neuron system participates in the brain. In particular, the majority of the experiments found mirror neurons in frontal and parietal lobes in tasks involving manual action observation. Moreover, other experiments identified the activation of mirror neurons, specifically in the inferior frontal gyrus and premotor cortex. Some studies combine mirror therapy with functional electrical stimulation or task-specific training in a stroke recovery program with a positive result in functional independence. In the case of phantom limb pain, mirror therapy exploits the brain’s preference to prioritize visual feedback over somatosensory/proprioceptive feedback concerning limb position. It is also suggested that unilateral training using mirror therapy may be more effective than bilateral training. This would support the theory of brain rewiring and neuroplasticity.

Benefits of Mirror Therapy

There are no contraindications of using mirror therapy, and it can have several tremendous benefits:

  • Aids in stroke recovery by improving range of motion of the upper extremity
  • Improves functional independence
  • Reduces phantom limb pain
  • Reduces the need for pain medicines after amputation
  • Decreases stress and improves quality of life

In closing, mirror therapy for stroke rehab or phantom limb pain is an inexpensive way to improve functional independence, and definitely worth trying.

This article was written by Bijal Shah, Clinical Educator

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