Power of reflection: Mirror therapy in MS

November 25, 2014 Angeli Mayadev, MD

The great wisdom traditions teach us that internal reflection is a useful means to grow.  Reflecting upon that. I thought that we could spend some time reviewing a technique of external reflection in rehabilitation known as mirror therapy. This was first described in 1995 by Ramachandran and his team who studied phantom limb pain.

Many concepts in multiple sclerosis (MS) rehabilitation come from stroke and pain rehabilitation fields.  There is evidence in these fields that supports the use of mirror therapy to help rehabilitation of the weaker side.  It also helps reduce neuropathic pain in patients who have phantom limb ( arm or leg) pain after an amputation.

There is very limited published research on the use of mirror therapy in MS.  We think that adding this type of therapy in the care of MS patients might be beneficial to reduce pain and weakness, and perhaps reduce "learned disuse" of the limb.

A brief summary of how to perform Mirror therapy is the following:

  • The mirror is placed so that the person’s unaffected limb can easily be seen.
  • The affected limb is not visible and is resting comfortably- an example is in the box below.
  • The person looks at the unaffected limb in the mirror. What they should see is their unaffected limb reflected in the mirror so that it looks like it is the opposite (affected) limb.
  • Then, the unaffected limb goes through a series of movements while the person simultaneously tries to do the same exercises with the affected limb all the while looking at the reflected image of the unaffected limb.

The theory is that by looking at the unaffected limb's visual image, it helps the affected limb.  The exact neural mechanisms are not clear.  It may excite the motor cortex, and/or allow the visual system to send information to the affected limb which is not getting proper sensory input.  Sensory or visual input is important for movement output.

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