Transcript Mirror Therapy, Laterality & Their Applications to Pain

Treating Phantom Limb
Pain with Mirror Therapy,
Motor Imagery & Laterality
Michelle Wykes
Occupational Therapy Department
2014
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
3
2
2
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.
Treatment of PLP
Hot/Cold
Therapy
Mirror
Therapy
Laterality
PLP
Motor
Imagery
Compression
Medication
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.
What is Laterality?
LEFT
LEFT
LEFT
RIGHT
LEFT
“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.
What is Mirror Therapy?
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.
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).
“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.”
Moseley, L., Gallace, L. & Spence,
C. (2008). Is mirror therapy all it is
cracked up to be? Current evidence
and future directions. Pain, 138.
Research
Project:
Does increased
task complexity
improve the
effects of mirror
therapy on pain in
lower limb
amputee
patients?
References:
1. Flor, H. (2002). Phantom-limb pain: characteristics,
causes, and treatment. Lancet Neurology. 1(3), 182-9.
2. 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.
3. 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.
Questions?