5. INTRODUCTION
Graded motor imagery is a sequential
process of rehabilitation which provides
essentially a series of brain exercises.
Mirror therapy is the final stage of
graded motor imagery.
6. DEFINITION
Mirror therapy is ground breaking
non invasive treatment, in which mirror
is used to present the reverse image of a
body part to the brain.
7. Cont…
Form of motor imagery in which a mirror
is used to convey stimuli to brain through
observation of one’s unaffected body part as
it carries out a set of movement.
8. Unveiled by Vilayanur S. Ramachandran &
Rogers –1996
Help to recognize & integrate mismatch
between proprioception &visual feed back of
the removed / paralysed body.
14. MIRROR NEURON
Frontal & parietal lobes
Rich in motor
command neurons
Fires to orchestrate
sequence of muscle
twitches to produce
simple skilled movements
17. Cont…….
Subject seeing
reflected image
of good hand
moving
Kinesthetic
sensations
Stimulation of
one sensory or
cognitive
pathway leads
to automatic
,involuntary
experiences in
a second
sensory or
cognitive
pathway
ARTIFICIAL VISUAL FEED BACK
18. Use the observation of movement to
stimulate motor process
Individuals mentally imagine movements
rather than observing the reflection of a
movement in a mirror
ARTIFICIAL VISUAL
FEED BACK
Cont…….
21. One can view
healthy limb &
image of another
healthy limb
Instructs
information that
no amputation
has occurred
Perform 20- 25
minutes daily
Cont....
33. REVIEW-I
Mirror therapy for improving
motor function after stroke.
Cochrane Database of Systematic Reviews
2012,Issue 3.
34. Background
Mirror therapy is used to improve motor
function after stroke. A mirror is placed in the
patient’s mid sagittal plane, thus reflecting
movements of the non-paretic side as if it were the
affected side.
35. Cont…
Objectives
To summarize effectiveness of mirror therapy compared
with no treatment, placebo or sham therapy.
To summarize effectiveness of mirror therapy for
improving motor function, activities of daily living, pain &
visuospatial neglect in patients after stroke.
36. Cont…
Methods
Randomised controlled trials & randomised
cross-over trials comparing mirror therapy with any
control intervention for patients after stroke.
Type of participants
Paresis of upper or lower limb, or both, caused
by stroke aged over 18 yrs.
37. Cont…
Types of outcome measures
Post-intervention (or change scores between pre- and post
intervention measures) & at follow up after six months or
longer.
Primary outcomes - Motor function
Secondary outcome - Measures of ADL
38. Cont…
Data collection and analysis
Independently selected trials based on the
inclusion criteria, documented methodological quality
of studies and extracted data. Analysed the results as
standardised mean differences (SMDs) for continuous
variables.
39. Cont…..
Results
Included 14 studies with a total of 567
participants that compared mirror therapy with
other interventions.
post-intervention data: SMD 0.61; 95%
confidence interval (CI) 0.22 to 1.0; P = 0.002;
change scores: SMD 1.04; 95% CI 0.57 to 1.51; P <
0.0001
40. Cont….
Additionally, mirror therapy may improve ADL
(SMD 0.33; 95% CI 0.05 to 0.60; P = 0.02). They
found a significant positive effect on pain (SMD -
1.10; 95% CI –2.10 to -0.09; P =0.03) & limited
evidence for improving visuospatial neglect (SMD
1.22; 95% CI 0.24 to 2.19; P =0.01).
Effects on motor function were stable at
follow-up assessment after six months.
41. Mirror therapy for phantom
limb pain--a systematic review
Seidel S, Kasprian G, Sycha T, Auff E
Universitätsklinik für Neurologie, Medizinische
Universität Wien, Wien, Austria.
REVIEW-2
42. Cont…..
Background & objectives
• To evaluate the evidence for the treatment of phantom
limb pain with mirror therapy.
Material & method
Randomised controlled studies by systematic search
strategy in the databases "Medline" & "The Cochrane
Library". Studies were evaluated using the quality
criteria of the JADAD-scale.
43. Cont…..
Results
Three small-sized randomised controlled studies
were identified.
One of them found a significant decrease of
phantom pain after four weeks of daily mirror
therapy sessions.
Two other studies could not find a significant
difference in the reduction of phantom limb pain
between intervention- and control-groups.
44. Cont…..
Conclusion
More sufficiently powered randomised
controlled studies with high methodological quality
are mandatory to investigate the analgesic effect of
mirror therapy in phantom limb pain
45. Mirror therapy for Complex Regional
Pain Syndrome— A literature review
and an illustrative case report
Scandinavian Journal of pain, Oct 2013, Volume 4,
Issue 4,
REVIEW-3
46. Cont…..
Background and purpose
A case of a 42 year old woman with lower
extremity Complex Regional Pain Syndrome
(CRPS) after a twisting injury of the ankle,
effectively treated with the addition of mirror
therapy to a rehabilitation programe.
47. Cont…..
Materials and methods
The PubMed database up to September 26,
2012 was reviewed using four search word groups:-
“CRPS mirror therapy”, “mirror CRPS”, “reflex
sympathetic dystrophy OR Complex Regional Pain
Syndrome AND mirror” and “reflex sympathetic
dystrophy OR Complex Regional Pain Syndrome
AND mirror + RCT”.
48. Cont…..
Results
The patient in this case report had failed many of
the adjunctive therapies and rehabilitation had been
unsuccessful until the addition of mirror therapy. She
then could progress with physical rehabilitation and
return to a more normal life.
Conclusions
Use of mirror therapy to be included in the
multidisciplinary treatment of CRPS types 1 and 2
with a positive effect on both pain and motor
function.
49. Cont…..
Implications
Mirror therapy is a newer technique, easy to
perform and can be a useful adjunct to aid
physical rehabilitation and decrease pain in this
population.
