mirror therapy

1. BHUVANA LAKSHMI
MPT
ANDHRA PRADESH

2. CONTENTS
 ANATOMY
 MIRROR NEURONS
 MECHANISM
 MIRROR THERAPY
 PROCEDURE
 MECHANISM
 INDICATIONS
 PRECAUTIONS
 ITS EFFECT ON VARIOUS CONDITIONS

4. CORTICO SPINAL PATHWAY

5. MIRROR NEURONS
 MIRROR NEURONS are also called VISUOSPATIAL
NEURONS
 They were first discovered in monkey’s brain by
Rizolatti, an Italian neurophysiologist.
 Mirror neurons are involved in understanding actions
and interactions .
 Located in pre-motor cortex, primary motor cortex,
supplementarymotor cortex, inferior parietal lobule
 Brains internal mirror – role in introspection and self
consciousness.

6. MECHANISM
 OBSERVATIONAL LEARNING
 The action-observation facilitates cortico-spinal
pathway, improves motor function.

7.  MNS accelerates the
recovery of motor ability
 Activatedwhen
observing, imagining
and attempting to
execute movements
 Identified for hand,
mouth, foot actions

8. EVIDENCE OF EXISTENCE
 Electro Encephalo Gram
 Magneto Encephalography
 Transcranial Magnetic Stimulation

9. NETWORKS WITH MIRROR
PROPERTIES
 PARIETO-FRONTAL MIRROR SYSTEM- parietal lobe,
pre-motor cortex, caudal part of inferior frontal Gyrus.
Recognition of voluntary behavior
 LIMBIC MIRROR SYSTEM- Insula, anterior medial
frontal cortex
Recognition of affected behavior

11. MIRROR THERAPY

12. INTRODUCTION
 MIRROR THERAPY is
defined as the
therapeutic approach for
functional motor
recovery bycreating
illusoryvisual feedback
of involved hand
 Unaffected hand mimics
affected hand

13.  Non invasive treatment that helps in neuro plasticity
of brain
 Final stage in graded motor imagery
 Graded motor imagery- sequential process of
rehabilitation that provides a sequential brain
exercises
 Only treatment that uses unaffected side alone
 Cost effectivetreatment.
 Conveysstimuli to the brain.

14. Artificial visual feedback
Patient seeing good hand is moving
Kinesthetic sensation
Stimulation in cognitive and sensory pathways
Automatic movement in the affected hand

15. HISTORY
 Invented byV.S RAMA CHANDRAN, Neuroscientist.
 He proposed the concept virtual reality by
maintaining psycho-physicalparallelism.

16. DIMENSIONS OF MIRROR
 Big enough to cover the entire limb and allows to see
all the movements
 Size of 25x20 inches for upper limb
 35x25 inches for lower limb

17. PROCEDURE
MIRROR – Para sagittal mirror
midline to the body
infront of the body
Affected limb – behind the mirror
Unaffected limb- outside the mirror

18.  The reflection of unaffected hand in the mirror gives
illusion of movement in the affected hand
 Mimics the movement
 2 types- covered mirror,
uncovered mirror.
-Alternativelydone

20. Phantom limb pain

21. Closing and opening fist

22. Pincer grasping

23. Tapping fingers: num / min

24. Volar and palmar flexion

25.  Exhibits – synaptic plasticity
 Hebbian theory- it is called hebbian learning or
associative learning.
postulated about brain’s synaptic plasticity.
-- Cells that fire together, wire together.

26. progression
 1st week- supination- pronation, wrist flexion-
extension
 2nd week- fingers flexion- extension, counting
numbers, tapping and opposing
 3rd week- simple tasks, picking up coins
 4th week- plugging, unplugging, drawing etc

27. PATIENT SHOULD HAVE
 MOTOR ABILITIES- veryeffective in patients who
have severe paresis
 COGNITIVE ABILITIES- patient should have sufficient
cognitive abilitiesand verbal abilities to understand
the instructions and to focus atleast for 15 mins.
 VISION- visual ability to the patient is necessary to
view the limb in the mirror fully.

28.  TRUNK – Should be able to sit in erect position during
the session
 CARDIO-PULMONARY- Patients with C-P
abnormalities are not eligible.
 Unaffected hand should be pain free and in normal
range of motion.

29. INDICATIONS
 Phantom limb pain
 Upper limb dysfunctions
 Lower limb dysfunctions
 Altered sensations
 Pain after stroke
 Visuo spatial neglects
 Cerebral palsy
 Parkinson’s
 Complexregional pain
syndrome
 Trigeminal neuralgia
 Autism
 Dejerrine -roussy
syndrome
 Alien hand syndrome
 Focal dystonia

30. NEURONAL CIRCUIT
 MOVEMENT OBSERVATION
 REDUCTION OF EXCITABILITY OF INTRA
CORTICAL CIRCUIT INHIBITION
 REDUCED ICI
 INCREASE IN MEP AMPLITUDE

31. Mechanism for therapeutic benefit
of mirror therapy
Unaffected hand makes smoother movements than
affected hand
Any overlap occur in neuronal circuit best suited to
perform smooth movement using mirror
Ipsi lateral limb movement effects primary motor cortex
excitability
Optimizepractice induced neuro plasticitywithin M1

32. MECHANISM
VISUAL FEEDBACK
ACTIVATION OF MIRROR NEURONS
ENHANCES MOTOR CORTEX
EXHIBITS PLASTICITY

33. benefits
 Patient enjoys the treatment
 Enhances muscle strength
 Increases motor speed
 Improves motor activity
 Accuracy of both hands
 Improves cordination

34. Stroke and mirror therapy
Stroke incomplete lesion residue of
mirror neurons areas are temporarily
inactive visual feedback activationof
mirror neurons normal movements

35. PHANTOM LIMB PAIN and MT
 Amputation vivid presence of limb feels
and thinks pain immobilisation
visual feedback mirror neurons activated
start to imitate action performance free from
pain

36. CRPS and MIRROR THERAPY
Too much pain while moving suddenly
Mirror visual feedback
Learning of affected hand moving
Activating mirror neurons

37. AUTISM AND MIRROR THERAPY
Behavioural problems
repeated actions or involuntary movements
delay in intention understanding
Mirror visual feedback

38. PARKINSON’S AND MT
Bradykinesia
Mirror therapy
Recieves proprioception and motor training
Activationof mirror neurons

39. DEJERRINE ROUSSY SYNDROME
 Thalamic pain syndrome- infarction in thalamus
 Leads to motor disturbancesand sensation alteration

40. ALIEN HAND SYNDROME and MT
 Involuntary purposeful movements done by limbs
 Mirror visual feedback
 Controlling involuntary movements

41. FOCAL DYSTONIA and MT
 Involuntary or unusual movements especiallyin
fingers and hands
 Mirror visual feedback

42. PRECAUTIONS
 Should provide coherent mirror image
 There should be no risk of injury
 Frequency should be in comfortableto patient
(minimum 15 mins)
 Inform to patient aboutside effectsand aims
 Jewelleryshould be removed
 Environment is free from distraction

43. NEGATIVES
 DIZZINESS
 NAUSEA
 SWEATING
 Can be panic bycontinuous reflection
 NECK PAIN ( rare)

44. THANK YOU