Introduction to the use of mirrors in rehabilitation. M. Penny Bartzen OTR/L. Graded Motor Imagery Program Gently Rewires the Brain: CRPS. Chronic Regional Pain Syndrome (CRPS) Laterality Reconstruction Restore the brain’s concept of right and left
Introduction to the use of mirrors in rehabilitation
M. Penny Bartzen OTR/L
Chronic Regional Pain Syndrome (CRPS)
(S. Stralka, 2011)
Mirror neurons are a particular class of visuomotor neurons, originally discovered in area F5 of the monkey premotor cortex, that discharge both when the monkey does a particular action and when it observes another individual (monkey or human) doing a similar action.Rizzolatti G, Craighero L, “The mirror-neuron system,” in Annual Review of Neuroscience, issue 27 (2004) p. 1
B. Object related
Red - mouth movements
Green - hand movement
Blue- Foot movements
(G. Blinkofski et al., Eur J Neurosci, 13:400-4, 2001)
Dysfunction responsible for impairments?
Deficits in imitation
Theory of mind
Neural strategies differ
Neural systems interfaces with limbic system
Seemingly not engaged in children with ASD
(Dapretto, Davies, Pfeifer, Scott, Sigman, Bookheimer& Iacoboni, 2005)
(Nyberg, J., n.d.)
(Moseley, Gallace & Spence, 2008)
(Ramachandran & Altschuler, 2009)
( The Cochrane Collaboration, 2012)
Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. (2012). Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews.
Altschuler et al. 1999
Yavuzer et al. 2008
40 inpatients, w/in 12 months of onset
30 min mirror therapy
Sitting with involved hand behind mirror
Wrist and finger flexion and extension movement
Asked to do the same with involved
(Stevens & Stoykov, 2004)
Ramachandran & Altschuler (2009) review of the use of visual feedback in restoring brain function with PLP, CRPS and CVA.
(Ramachandran & Altschuler, 2009)
“ The procedure is not miracle cures by any means, but even if only a small proportion of patients is helped, they would be a enormous value given the high incidence of phantom pain and stroke….Moreover, even if the procedure benefits a minority of patients, it is likely to pave the way for future more completely effective therapies once we understand the variables involved”
(Ramachandran & Altschuler, 2009, p 1694).
"The best thing about mirror therapy is,
… it's cheap, safe, easy and it's fun.“
Dr. Eric LewinAltschuler
Altschuler, E.,L. Wisdom, S.B, Ston, L., Foser, C., Galasko, D., Llewellyn, M. E. & Ramachandron, R.S. (1999). Rehabilitation of hemiparesis after stroke with a mirror. Lancet, 353, 2035-2036.
Dapretto, M., Davies, M., Pfeifer, J., Scott, A., Signman, M., Bookheimer, S., & Iaconboni, M. (2005). Understanding emotions in others: mirror neuron dysfunction in children with autism spectrum disorders. Nature Neuroscience, (9),28-30. doi: 10.1038/nn1611
Dohle, C., Pullen, J, Nakaten, A., Kust, J., Rietz, C., & Karbe, H. (2009) Mirror therapy promotes recovery from severe hemiparesis : A randomized controlled trial. Neurorehabilitation and Neural Repair, 23, 209-217.
Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontier of brain science. New York: Penguin Group, Inc.
Jenson, L, (2009) Critically Appraised Topic (CAT): What is the effectiveness of mirror therapy for improving upper extremity motor recovery and functional use in adults with hemiparesis following stroke? Retrieved from http://ot.creighton.edu/community/EvidenceReviews/OTD541_09/JEnsen
Mosely, G.L & Wiech, K. (2009). The effect of tactile discrimination training is enhanced when patpients watch the relfected image of their unaffected limb during training. PAIN, 144, 314-319. doi:10.1016/j.pain.2009.04.030
Moseley, G. L., Gallace, A. & Spense, C. (2008). Is mirror therapy all it is cracked up to be? Current evidence and future directions. Pain, 138, 7-10. doi: 10.1016/j. pain.2008.06.026.
Nyberg, J. (n.d.). Mirror neurons. Retrieved from http://www.cied.uark.edu/Mirror_Neurons.pptx
Pomeroy, V. M., Clark, C. A., Miller, S., G., Baron, J., Markus, H. S. & Tallis, R. C. (2005). The potential for utilizing the “mirror neurone system” to enhance recovery of the severely affected upper limb early after stroke: A review and hypothesis. Neurorehabilitation and Neural Repair, 19, 4-13. doi: 10.1177/1545968304274351.
Ramachandram, V.S. & Alstchuler, E. L. ( 2009). The use of visual feedback, in particular mirror visual feedback, in restoring brain function. Brain: A Journal of Neurology, 132, 1993-1710. doin: 10.1093/brain/awp135.
Stevens, J. A. & Stoykov, M. E. (2004). Simulation of bilateral movement training through mirror reflection: A case report demonstrating an occupational technique for hemiparesis. Topics in Stroke Rehabilitation, 11, 59-66.
Stralka, S. W. (2011, January 28-29). Graded Motor Imagery Program for upper extremity injuries: Using GMIP to retrain the brain). Presented for Sister Kenny at John Nasseff Conference Center, United Hospital, St. Paul, Minnesota.
TEDindia (2010, January). V.S. Ramachandran: The neurons that shaped civilizations. [Video File]. Retrieved from http://www.ted.com/talks/vs_ramachandran_the_neurons_that_shaped_civilization.html
Thieme H, Mehrholz J, Pohl M, Behrens J, Dohle C. (2012) Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008449.pub2/full
Yavuzer, G., Selles, R., Sezer, N., Sutbeyaz, S., Bussmann, J., Koseoglu, F., Atay, M. & Stam, H., (2007). Mirror therapy improves hand function in subacute stroke: A randomized controlled trial. Achives of Physical Medicine and Rehabilitation, 89, 393-398. doi: 10.1016/j.apmr.2007.08.162.
There are two ways of spreading light: to be the candle or the mirror that reflects it. -Edith Wharton