Folding Mirror Therapy Box (Hand/Wrist)

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Working with patients with various complex regional pain syndromes can also be challenging. Pharmacological therapies are frequently associated with a variety of side effects. Mind-body modalities are thought to recreate a role. Mirror therapy triggers neuroplasticity by improving the relationship between neurons in the brain and thereby enhances communication between the motor and the sensory cortex. Since the patients receiving mirror therapy are stroke patients, some of them may react emotionally to the thought of seeing their affected arm intact. Bondoc, S., Booth, J., Budde, G., Caruso, K., DeSousa, M., Earl, B., … Humphreys, J. (2018). Mirror Therapy and Task-Oriented Training for People With a Paretic Upper Extremity. American Journal of Occupational Therapy, 72(2), 7202205080p1. doi:10.5014/ajot.2018.025064, accessed May 6, 2018. Rothgangel and Braun have written a detailed protocol on the use of mirror therapy with stroke patients: Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseoglu F, et al. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil 2008; 89: 393–398. ↑

When utilizing the mirror box, these mirror neurons get activated, which assists in the recovery of affected parts. This system is thought to utilize the observation of movement to stimulate the motor processes which would be concerned with that movement. Similarities have been drawn with motor imagery whereby the individual will mentally imagine movements rather than observe the reflection of a movement in a mirror.Limakatso K, Madden VJ, Manie S, Parker R. The effectiveness of graded motor imagery for reducing phantom limb pain in amputees: a randomised controlled trial. Physiotherapy. 2020 Dec;109:65-74. doi: 10.1016/j.physio.2019.06.009. Epub 2019 Jun 28. PMID: 31992445. ↑ 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 Traditional mirror box therapy has been demonstrated to be a very simple and interesting method to assist with the phantom limb phenomenon. Nevertheless, the utilization of mirror therapy is limited to simple movements affecting a single arm or leg. Because of this limitation, we have diverted to new strategies and technologies. VR has shown promise in this domain and has become more than merely a tool for gaming and entertainment. VR has many benefits, including the ability to create realistic, interactive, and modifiable environments to preoccupy the brain from the other senses. Likewise, VR allows scientists to contain other senses into the experience, like hearing or touch. VR could be used, for instance, to design serious games Wu CY, Huang PC, Chen YT, Lin KC, Yang HW. Effects of mirror therapy on motor and sensory recovery in chronic stroke: a randomized controlled trial. Arch Phys Med Rehabil 2013; 94: 1023–1030. ↑

Mirror size and placement: The mirror should sit on the table top and should be large enough to reflect the entire unaffected arm. Rothgangel and Braun (2013) recommend a 20 x 25-inch mirror on a stand. The mirror should be placed at the patient’s midline. If the patient has trouble seeing the mirror or has visual field neglect, the mirror can be placed closer to the patient’s affected limb and angled slightly to facilitate ease of viewing. Depending on the observation that phantom limb patients were much more likely to commentary paralyzed and painful phantoms if the actual limb had been paralyzed before amputation (for instance, due to a brachial plexus avulsion), Ramachandran and Rogers-Ramachandran suggested the “learned paralysis” hypothesis of painful phantom limbs. Accomplish Mirror Therapy three to five times per day. Originally, you may only be able to observe the image of the mirrored hand and perhaps make small movements. With time, try to make more extensive and smoother movements with both arms. Your initial sessions may be quite short (two to three minutes), but gradually improve the duration of each session. Once the movements feel quite easy, do the exercises in different situations such as in a noisy room, when you are hot, when you are tired, when you are not in a good mood, etc. Again, please reach out to us if you are looking for a therapist to help you begin your work with Mirror Therapy. If you have forced Mirror Therapy and would want to tell your peers about your knowledge of it, please leave a comment below. Principle of Mirror Therapy Louie, DR; Lim, SB; Eng, JJ (2019). "The Efficacy of Lower Extremity Mirror Therapy for Improving Balance, Gait, and Motor Function Poststroke: A Systematic Review and Meta-Analysis". J Stroke Cerebrovasc Dis. 28 (1): 107–120. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.017. PMID 30314760. S2CID 52976760. Seventeen RCTs involving 633 participants were included. Thirteen studies reported a significant between-group difference favoring mirror therapy in at least one lower extremity outcome. Mohanty, P. (2017). Effectiveness of Mirror Therapy in Rehabilitation of Hand Function in Sub-Acute Stroke. Palliative Medicine & Care: Open Access, 4(2), 1-8. doi:10.15226/2374-8362/4/2/00135, accessed May 6, 2018.

Studies by Pandian et al and Thieme et al 52, 54 reported recovery in visuospatial neglect in post-stroke patients with MT for 4 and 5 weeks respectively. The patients showed improvement in neglect in the near extrapersonal space and representational neglect. It is important to note that both of these studies intervened during the acute–sub-acute phases post stroke. The study by Thieme et al 52 studied effects of MT in visuospatial neglect only in a small percentage of their sample and the outcome was not blindly assessed. The MUST trial by Pandian et al 54 reports improved mean scores for star cancellation, line bisection, and picture identification tests at the 6th-month follow-up. This article also reports a 2-study meta-analysis concluding that MT was effective in treating unilateral neglect after stroke. Michielsen ME, Smits M, Ribbers GM, Stam HJ, van der Geest JN, Bussmann JB, et al. The neuronal correlates of mirror therapy: an fMRI study on mirror induced visual illusions

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] A recent Cochrane Review [10] summarised the effectiveness of mirror therapy for improving motor function, activities of daily living, pain and visuospatial neglect in patients after stroke. 14 studies with a total of 567 participants that compared mirror therapy with other interventions were compared. At the end of treatment, mirror therapy improved movement of the affected limb and the ability to carry out daily activities, it reduced pain after stroke, but only in patients with a complex regional pain syndrome and the beneficial effects on movement were maintained for six months, but not in all study groups. [10] Mirror Therapy in Complex Regional Pain Syndromes [ edit | edit source ]Rothgangel, A. S., Braun, S. M., Beurskens, A. J., Seitz, R. J., & Wade, D. T. (2011). The clinical aspects of mirror therapy in rehabilitation. International Journal of Rehabilitation Research, 34(1), 1-13. doi:10.1097/mrr.0b013e3283441e98, accessed May 3, 2018. If a specific region of the brain is damaged (from a stroke, disease, or trauma from an accident), that brain area can no longer send specific commands to the body. Yet, because neuroplasticity allows the brain to modify its organization, some individuals with brain damage can still regain some of their movements, thanks to the creation of new connections between neurons. These new connections offer new ways to send details, the same way a new bridge permits individuals to cross a river when the old bridge has collapsed. Prevalent, being young is a strong benefit in recovering movement after a brain injury, because neuroplasticity is at its peak when the brain is still developing. The younger you are, the sufficiently you can recover. Rothgangel, Andreas & Braun, Susy. (2013). Mirror Therapy: Practical Protocol for Stroke Rehabilitation. 10.12855/ar.sb.mirrortherapy.e2013, accessed May 6, 2018. Neuroplasticity is the brain’s capability to heal and rewire itself after a neurological injury like a stroke. It is best activated through increased repetition of therapeutic exercises, or massed practice. Neuroplasticity strengthens existing neural pathways (connections) and constructs new ones. The more vigorous the neural pathways for a specific function become, the higher the chances of restoring that function.

For effective mirror therapy treatment, patients should minimize any identifying or differentiating marks on the hands. Jewelry should be removed, and patients with tattoos, birthmarks, large moles, or scars should cover these areas with makeup or wear a glove during treatment. Mirror therapy is not suggested for patients with severe claustrophobia. Mirror Box Therapy Gets Results

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Significant improvements in tactile sensation were found in a study conducted on the effectiveness of mirror therapy following stroke with severe upper limb impairment (Colomer, et. al. 2016).