Mirror Box therapy for Phantom Limb Pain.

 

The paralysis or loss of a limb not only results in an obvious physical disabilities, but in up to 80% of patients it also results in Phantom Limb Pain. (PLP)

PLP can be a severe unremitting pain. The pain can be burning, cramping, crushing or lancinating. It can be intermittent or unrelenting, severely compromising the patient’s life. Some patients become depressed and even contemplate suicide.

Mirror BoxA person with PLP may sense that their phantom muscles are cramping, that the limb is twisted uncomfortably, or that it itches, tingles, or has sharp, shooting pain. [source]

Mirror Box

 

 

It has been found that a remarkably effectively technique called Mirror Therapy can reduce the severity of PLP in as little as 25mins/day of self-therapy.[source]

mirror box  How does it work?

 

The ‘mirror box’ consists of a 2 × 2 foot mirror vertically propped up sagittally in the middle of a rectangular box (Fig. 3). The top and front sides of the box are removed. The patient then places (say) his paralysed left phantom on the left side of the mirror and the intact normal hand on its right. He then looks into the (shiny) right side of the mirror at the reflection of the intact right hand so that its reflection seems visually superimposed on the felt location of the phantom; thereby creating the illusion that the phantom has been resurrected. While still looking into the mirror if he sends motor commands to both hands to make symmetrical movements such as conducting an orchestra or opening and closing the hand, he gets the visual impression that his phantom hand is ‘obeying’ his command.

Results of Mirror Therapy

 

http://www.ncbi.nlm.nih.gov/pubmed/22378591

RESULTS:

A significant reduction in average phantom pain intensity was found at month 1 (n = 31, p = 0.0002) and at month 2 (n = 26, p = 0.002). The overall median percentage reduction at month 2 was 15.4%. Subjects with high education (> 16 years) compared with low education (< 16 years) (37.5% vs 4.1%) had greater reduction in pain intensity (p = 0.01).

CONCLUSION:

These findings support the feasibility and efficacy of home-based self-delivered mirror therapy; this low-cost treatment may defray medical costs, therapy visits, and the patient travel burden for people with motivation and a high level of education. More research is needed to determine methods of cost-effective support for people with lower levels of education.


 

Proc Biol Sci. 1996 Apr 22;263(1369):377-86.

Synaesthesia in phantom limbs induced with mirrors.

He found the return of sensations very enjoyable. 2. Repeated practice led to a permanent 'disappearance' of the phantom arm in patient D.S. and the hand became telescoped into the stump near the shoulder...
... Five patients experienced involuntary painful 'clenching spasms' in the phantom hand and in four of them the spasms were relieved when the mirror was used to facilitate 'opening' of the phantom hand; opening was not possible without the mirror.

How to make your own Mirror Box for PLP

Sources and Further reading

Phantom limb treatment

A slideshare presentation by R A Candra Putra (5718035) Auntouch T (5718036) Harashdeep Grover (5718037) Rina F Rahmawati

Tricyclic Antidepressant (TCAs) • Commonly used for neuropathic pain • Analgesic – inhibition of serotonin-norephineprine uptake blockade • Average dose of 55mg of amitriptyline is effective to control PLP

 

Ramachandranet al. (1995)Series of cases of mirror therapy for phantom limb pain and immobility in upper limb amputees.
MacLachlan et al. (2004)Case study of mirror therapy for a lower limb amputee with phantom pain.
Chan et al. (2007)Randomized controlled trial of mirror therapy for phantom limb pain.
Sumitani et al. (2008)Series of cases examining the effect of mirror visual feedback on qualitative aspects of pain patients with phantom limb pain after amputation, brachial plexus or other nerve injury.
Darnall (2009)Case study of mirror therapy for phantom limb pain.
Altschuler et al. (1999)Pilot study of mirror therapy for hemiparesis following stroke.
Sathian et al. (2000)Case study of mirror therapy in a patient with hemiparesis and sensory loss following stroke.
Stevens and Stoykov (2003)Two case studies of mirror therapy for patients with hemiparesis following stroke.
Stevens and Stoykov (2004)Case study of mirror therapy in hemiparesis following stroke.
Sütbeyaz et al. (2007)Randomized controlled trial of mirror therapy for lower extremity hemiparesis following stroke.
Yavuzer et al. (2008)Randomized controlled trial of mirror therapy for upper extremity hemiparesis following stroke.
McCabe et al. (2003b)Controlled pilot study of mirror therapy for CRPS.
Karmarkar and Lieberman (2006)Case study of mirror therapy for pain in CRPS.
Vladimir Tichelaar et al. (2007)Case studies of mirror therapy for CRPS.
Selles et al. (2008)Case studies of mirror therapy for CRPS.
Sumitani et al. (2008)Series of cases examining the effect of mirror visual feedback on qualitative aspects of pain patients with phantom limb pain after amputation, brachial plexus or other nerve injury.
Rosén and Lundborg (2005)Mirror therapy for hand surgery patients with nerve injuries.
Altschuler and Hu (2008)Mirror therapy for patient after a wrist fracture with good passive, but no active range of motion.

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