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Phantom Sensations (including Phantom Limb Pain)
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
Fortunately, other treatment options do exist. Mirror box therapy is an interesting alternative in which the visual trickery of mirrors is used to create a reflection as if the person's missing body part was still attached (Ramachandran & Blakeslee, 1998). Apparently, seeing is believing, because some amputees report feeling a reduction in pain and duration of painful episodes after looking at a simulated body part that was not visibly being frozen or electrocuted or telescoping in impossible ways (e.g., Finn et al., 2017). In some cases, if the physician uses a mirror and pretends to touch the phantom limb by stroking the reflection, the amputee may actually feel the touch in the missing limb (Ramachandran & Rogers-Ramachandran, 1996). While mirror therapy doesn't work for all phantom pains, it does seem to help improve quality of life for many people (Campo-Prieto & Rodríguez-Fuentes, 2020). There has also been recent research into neuromodulation techniques, such as electrically stimulating the sensorimotor cortex, and early results have been encouraging (Pacheco-Barrios et al., 2020). Overall, phantoms are a lot less mysterious than they used to be, but even with a scientific explanation, these apparitions may continue to greatly affect the lives of those who experience them.
Defence rehabilitation
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
Small studies have also provided evidence supporting significant reductions in PLP with mirror therapy alone,34,35 especially in the upper limb.36 Mirror therapy aims to alleviate pain by correcting cortical reorganisation, a suggested potential mechanism of PLP.37 A pertinent study including 22 US military single lower limb amputees with PLP reported that phantom pain decreased in 100% of participants assigned to the mirror therapy group.34 However, four participants were unaccounted for and potential biases were not fully addressed. At RCDM, although mirror therapy was provided for specific patients – balanced against challenges during the acute phase of rehabilitation, such as the potential for a grief reaction and having a contralateral limb without injury to use – we were unable to reproduce this success rate. Mirror boxes were procured through the charity TroopAid and were readily available for single patient issue. Virtual reality options for bilateral amputees were explored by anaesthetic colleagues at QEHB and research is ongoing in this area.
Pain Management and Assessment
Published in Rachael E. Docking, Jennifer Stock, International Handbook of Positive Aging, 2017
Trevor Thompson, M. Elena Mendoza, Rachael E. Docking
The clinical use of mirror visual feedback is used for managing phantom pain by restoring motor function through plastic changes in the primary motor cortex (Michielsen et al., 2011). In a case series, this therapy was used with older adults after recent lower limb amputation (González et al., 2013) and results showed analgesic effects and benefits as a rehabilitation instrument. Although this study does not provide enough evidence, it suggests that mirror therapy, which has shown good results in other populations, can be promising in geriatric patients.
The Efficacy of Graded Motor Imagery and Its Components on Phantom Limb Pain and Disability: A Systematic Review and Meta-Analysis
Published in Canadian Journal of Pain, 2023
Katleho Limakatso, Aidan G. Cashin, Sam Williams, Jack Devonshire, Romy Parker, James H. McAuley
Mirror therapy was proposed as a treatment for PLP because it purportedly addresses a theorized mismatch between motor command and sensory feedback.18 Mirror therapy involves positioning a mirror in the sagittal plane of the body and moving the intact limb while viewing its reflection in the mirror, such that the reflection appears to be the missing limb. Mirror therapy has also been used as the third component of a three-phase graded motor imagery (GMI) program, which was developed to progressively target cortical motor networks in people with complex regional pain syndrome (CRPS).19 GMI has systematic review evidence supporting its use in patients with CRPS.20,21 The similarities between the cortical changes seen in patients with CRPS and PLP suggest that the GMI program in its entirety could be a viable treatment for PLP.22
Home mirror therapy: a randomized controlled pilot study comparing unimanual and bimanual mirror therapy for improved arm and hand function post-stroke
Published in Disability and Rehabilitation, 2022
Daniel Geller, Dawn M. Nilsen, Lori Quinn, Stephen Van Lew, Claribell Bayona, Glen Gillen
Mirror therapy (MT) was first described by Ramachandran & Rogers-Ramachandran [11] to relieve phantom pain after amputation and later introduced to treat hemiparesis post-stroke [12]. MT is an intervention in which a mirror box is placed in the mid-sagittal plane to the participant between the extremities. The affected hand is placed in the mirror box and the unaffected hand is placed outside of the box facing the mirror. During MT, the person moves the unaffected hand while watching the mirror reflection, giving the visual illusion that the affected limb is moving. MT not only has been shown to improve upper limb recovery post-stroke, but requires minimal supervision, no arm/hand requirements for participation, and low cost, thus can be used as an adjunct to standard stroke care to increase practice dosage [13–15]. Furthermore, MT has been shown to facilitate neuroplastic changes in the brain through 3 possible underlying mechanism: (a) perceptual motor process; (b) direct facilitation of the motor network; and (c) activation of the mirror neuron system [16]. While these are three distinct hypotheses, it is possible that it could be a combination of all three; however, there is still no clear understanding of the underlying mechanism of MT.
Paradoxes in rehabilitation
Published in Disability and Rehabilitation, 2020
Apart from the relief of pain, the other main application of the Mirror Box Illusion or more generally mirror visual feedback has been in the rehabilitation of hemiparesis in stroke patients [48]. It would appear that watching the reflection of self-generated movements in a mirror results in improved self-awareness and spatial attention, and this may directly or indirectly stimulate recovery. Arya et al. [49] found that 40 sessions over an eight week period produced significant gains across several upper limb motor recovery measures in the mirror box therapy group compared to the control group, and in a later study [50] found similar benefits for lower limb recovery and gait. In a systematic review of the use of mirror therapy to aid recovery in stroke, Yang et al. [51] found evidence to support the beneficial effects of mirror therapy on motor function, activities of daily living and relief of pain. Finally, in one study of unilateral visual neglect, therapy that included the Mirror Box Illusion over a four week treatment period resulted in improvement in measures of neglect [52].