Mirror Therapy, Neuroplasticity and Pain

Having my first physio appointment, the only treatment known for my condition was Mirror Box Therapy. The concept of tricking your brain through visualization and imagery seemed a bit unrealistic [to me]; but, in fact, I noticed improvement after the first try.”

After suffering a wrist fracture, Norma Giffin was diagnosed with complex regional pain syndrome (CRPS) – a form of chronic pain affecting a limb, typically after an injury. Giffin was told by physicians that the only treatment available was Gabapentin (a medication used to treat neuropathic pain) and time.

The concept of Mirror Box Therapy (MT) is to create the reflected illusion of an affected limb. In the reflection, the brain ‘sees’ the side of the body where it knows the damaged arm or leg normally resides. It sees the affected appendage moving with apparent ease and is effectively tricked into thinking correct movement has occurred, without pain.

Dr. Sabina Khan G. is a Doctor of Occupational Therapy, based in South Florida, West Palm Beach. Working in a long-term, acute care hospital she treats patients with a variety of conditions. Once focus of her doctorial research is hemiparesis – paralysis of one side of the body. She uses MT to treat a variety of conditions including: cerebrovascular accident (CVA – a stroke: when blood flow to a portion of the brain is stopped by a blockage, or a ruptured blood vessel.), phantom limb pain after amputation, apraxia ( the inability to perform certain physical movement, as a result of brain damage, and to improve general motor recovery.

Mirror Therapy utilizes neuroplasticity – The brain’s ability to form new neural connections throughout life. Khan says viewing the reflected image of the healthy limb is thought to retrain the brain; rewiring it to believe the problem appendage is functioning normally. This change certain impulses in the brain and reduces, or even eliminates, feelings of pain and discomfort.

The therapy is effective, in part, because it triggers our brain’s ‘mirror neurons’ – neurons that fire when we observe an action performed by another person. These neurons “mirror” the behavior of the other person, as though the observer, themselves, were moving. 

“When you observe someone move, your “mirror neurons” are actually firing, and when you imitate the movement, your “motor neurons” are firing. Mirror therapy triggers the mirror neurons when you see the illusion of your affected extremity moving in the mirror. Although it may just be a reflection of your unaffected extremity, studies have proven that your brain perceives it as your affected arm – your mobility can improve as a result.”

Khan has found MT improves motor function, reduces pain and makes improvements in the area of visuospatial neglect – When a patient fails to be aware of one side of the body.

She says, initially, the treatment requires a licensed clinical occupational, or physical, therapist. However, once trained by a therapist, clients and caregivers are able to carry out mirror therapy, independently. She adds patients will often see immediate results.

“Improvements can be noted as soon as the first session. MT is patient centered and depends on the medical history of the patient – how long the patient has had the CVA, or symptoms or condition, their age, along with other factors. The intervention itself, generally speaking, is 4 weeks.”

Giffin has observed noteworthy home-therapy success. “I practiced the first time with the physiotherapist and have been doing it at home ever since.  In the beginning, twice a day for 10 minutes was recommended. But research has shown ‘the more the better’…up to 6 times a day.”

Kahn says, “Mirror therapy is commonly used in present day. It is a simple, drug-free and cost-effective therapy for motor recovery – with the goal of maximizing function in daily life.”