Mirror Therapy, Laterality & Their Applications to Pain Management and Upper Limb Retraining

Treating Phantom Limb Pain with Mirror Therapy, Motor Imagery & Laterality

Michelle Wykes

Occupational Therapy Department

2014

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Phantom Pain

Stump Pain

Phantom Sensation

Phantom Limb Pain (PLP) vs. Phantom Limb Sensation

Pain in the cramping, burning, stabbing or electric pain felt in the phantom limb.

Sensation is the feeling that the phantom limb still exists following the amputation

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Causes of PLP:

The exact causes are unknown but MRI scans have shown that the pain is largely due to signals being misinterpreted by the brain, rather than by the peripheral nerves1.

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Treatment of PLP

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PLP

Hot/Cold Therapy

Mirror Therapy

Motor Imagery

Laterality

Compression

Medication

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Guided Motor Imagery

Laterality

Mirror Therapy

What is Guided Imagery?

Place your hands on your lap palm up.

Close your eyes.

Slowly open and close both hands.

Open your hands.

Slowly bring your thumbs in.

Now your index finger.

Now slowly bring in each of your other fingers until you have made a fist.

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What is Laterality?

LEFT

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LEFT

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LEFT

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RIGHT

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LEFT

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The body schema is based on an intact cortical body representation. Its disruption is indicated by delayed reaction times (RT) and high error rates when deciding on the laterality of a pictured hand in a limb laterality recognition task. This suggests the involvement of complex central nervous system mechanisms in the disruption of the body schema.

Reinersmann, A. et al. (2010) Left is where the L is right. Significantly delayed reaction time in limb laterality recognition in both CRPS and phantom limb pain patients. Neuroscience Letters.

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What is Mirror Therapy?

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Foundations of Mirror Therapy

Developed by Dr. V.S. Ramachandran for the treatment of phantom limb pain in amputees.

Based on the principle of neurplasticity and reorganisation of the motor cortex.

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Evidence Surrounding Mirror Therapy: PLP & CRPS

The two studies that investigated the effects of MT (Chan et a., 2007) and graded motor imagery (Moseley, 2006) on PLP in patients following amputation of the upper or lower limb or brachial plexus avulsion, found positive results regarding patient-specific functions (Moseley, 2006) and pain intensity and number and duration of pain episodes.

Rothgangel, A. et al. (2011). The clinical aspects of mirror therapy in rehabilitation: a systematic review of the literature. International Journal of Rehabilitation Research, 34(1).

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Moseley, L., Gallace, L. & Spence, C. (2008). Is mirror therapy all it is cracked up to be? Current evidence and future directions. Pain, 138.

The relative dominance of visual input over somatosensory input suggests that mirrors might have utility in pain management and rehabilitation via multisensory interactions. Indeed, mirrors may still have their place in pain practice, but we should be open-minded as to exactly how.

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Research Project:

Does increased task complexity improve the effects of mirror therapy on pain in lower limb amputee patients?

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References:

Flor, H. (2002). Phantom-limb pain: characteristics, causes, and treatment. Lancet Neurology. 1(3), 182-9.

Ephraim PL, Wegener ST, MacKenzie EJ, Dillingham TR, Pezzin EJ. Phantom pain, residual limb pain, and back pain in amputees: results of a national survey. Arch Phys Med Rehab. 2005 Oct;86(10):1910-9.

Richardson C, Glenn S, Nurmikko T. Incidence of Phantom Phenomena Including Phantom Limb Pain 6 Months After Major Lower Limb Amputation in Patients With Peripheral Vascular Disease. Clin J Pain. \2006 May;22(4):353-358.

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Questions?

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