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Reflecting on Experiences with Mirror Therapy

Updated: Apr 28

Those who do not want to, or cannot, use painkillers to control their Phantom Limb Pain often seek out non-pharmacological alternatives. One which comes up time and time again is Mirror Therapy.

The principle of mirror therapy (MT) is the use of a mirror to create a reflective illusion of an affected limb in order to trick the brain into thinking movement has occurred without pain, or to create positive visual feedback of a limb movement. It involves placing the affected limb behind a mirror, which is sited so the reflection of the opposing limb appears in place of the hidden limb.

Clinicians can create this illusion with a mirror box. This device is simply a box with a mirror in the centre allowing hands to be placed on either side of the mirror. The affected limb is kept always covered and the unaffected limb is kept on the other side whose reflection can be seen on the mirror.


Mirror therapy was first proposed as a potential therapeutic intervention by Vilayanur S. Ramachandran to help alleviate Phantom limb pain; a condition in which patients feel they still have a pain in the limb after amputation.

Ramachandran first devised the technique in an attempt to help those with phantom limb pain resolve what they termed a ‘learned paralysis’ of the painful phantom limb. The visual feedback, from viewing the reflection of the intact limb in place of the phantom limb, made it possible for the patient to perceive movement in the phantom limb. Their hypothesis was that every time the patient attempted to move the paralyzed limb, they received sensory feedback (through vision and proprioception) that the limb did not move. This feedback stamped itself into the brain circuitry through a process of Hebbian learning, so that, even when the limb was no longer present, the brain had learned that the limb (and subsequent phantom) was paralyzed. To retrain the brain, and thereby eliminate the learned paralysis, Ramachandran and Rogers-Ramachandran created the mirror box.


This approach exploits the brain’s preference to prioritise visual feedback over somatosensory/proprioceptive feedback concerning limb position. In conditions such as phantom limb pain (PLP) where neuropathic processes cause issues with pain, related or unrelated to movement, this approach is thought to offer potential relief.

It is thought that the brain's natural inclination to prioritise visual feedback over all others would make MT a more powerful tool. However, research evidence is currently lacking in support of this hypothesis. It is to be noted that the major difference in the neuronal reorganisation while using a mirror box is that the ipsilateral hemisphere's neurons give connection to the same side affected limbs rather than the conventional therapies which target the neuronal reorganization of the contralateral hemisphere.


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