Mirror box

Mirror box therapy is a form of rehabilitation therapy that uses a mirror to create a reflective illusion of an affected limb in order to alleviate phantom limb pain, improve motor function, and treat other conditions such as complex regional pain syndrome (CRPS) and stroke-related impairments. This technique was first described by Vilayanur S. Ramachandran, a prominent neuroscientist, in the early 1990s.

History

The concept of using mirrors for therapeutic purposes was pioneered by Dr. Vilayanur S. Ramachandran, who hypothesized that the visual feedback provided by the mirror could "trick" the brain into perceiving movement in a paralyzed or missing limb. This approach was initially developed to address phantom limb pain, a condition where amputees experience sensations, often painful, in the limb that is no longer present.

Mechanism

Mirror box therapy involves placing the affected limb (or its stump) inside a box with a mirror down the center, oriented parallel to the patient's midline. The patient then places the unaffected limb in front of the mirror, creating a reflection that appears to be the missing or affected limb. By moving the unaffected limb, the patient sees the reflection and perceives it as movement in the affected limb, which can help "retrain" the brain and reduce pain or improve function.

Neuroplasticity

The effectiveness of mirror box therapy is thought to be due to the brain's ability to undergo neuroplasticity, which is the capacity of the brain to reorganize itself by forming new neural connections. The visual feedback from the mirror can help rewire the brain's representation of the affected limb, reducing pain and improving motor control.

Applications

Mirror box therapy is used in various clinical settings, including:

• Phantom limb pain: To alleviate pain in amputees by providing visual feedback that "restores" the missing limb.
• Stroke rehabilitation: To improve motor function in patients with hemiparesis by encouraging movement in the affected limb.
• Complex regional pain syndrome (CRPS): To reduce pain and improve function in patients with CRPS by normalizing sensory and motor processing.

Procedure

The typical procedure for mirror box therapy involves the following steps:

1. The patient sits comfortably with the mirror box placed on a table. 2. The affected limb is placed inside the box, out of view. 3. The unaffected limb is placed in front of the mirror. 4. The patient performs movements with the unaffected limb while observing the reflection in the mirror. 5. Sessions typically last 10-15 minutes and are repeated several times a week.

Effectiveness

Research has shown that mirror box therapy can be effective in reducing phantom limb pain and improving motor function in stroke patients. However, the degree of effectiveness can vary depending on the individual and the specific condition being treated. Ongoing research continues to explore the mechanisms and potential applications of this therapy.

Limitations

While mirror box therapy can be beneficial, it is not suitable for all patients. Some individuals may not respond to the treatment, and others may find the visual illusion disconcerting. Additionally, the therapy requires active participation and motivation from the patient.

Also see

• Phantom limb
• Neuroplasticity
• Complex regional pain syndrome
• Stroke rehabilitation
• Vilayanur S. Ramachandran