Mirror Theory
In order to understand how mirror box therapy works one first
needs to understand a little bit about how the body senses the
environment around it. You are familiar with the sensation
of touch but do you realise how the body creates this experience
for you?
The brain has an in built map of the sensory system (a kind
"touchy feely" street map) of the body called the
somatosensory cortex.
This map of the body is feed information about touch, pressure
and pain by sensory nerve fibres which connect to the somatosensory
cortex via a system of junction boxes (synapses) that begin
at the entry of the sensory nerve in the spinal cord and complete in the integration of the ending of the nerve pathway in the
somatosensory in the cortex.
The Sensory Homonculus & Phantom Limb Pain
If a model of a man was made in proportion to how much attention
was devoted in the somatosensory cortex to each part of the
body the hands, for example, would appear to be 5 times their normal size.
 Somatosensory Cortex
Following an amputation the sensory map of the body becomes
"upset" and this upset manifests its self in the experiences
of phantom pain and phantom sensation.
Mirror box therapy as proposed by VS
Ramachandran works by utilising the visual input of the mirror
image of the good limb to replace that of the missing limb to
suppress the "upset" in the somatosensory cortex and thus
reduce phantom pain and sensation.
Complex Regional Pain Syndrome & Neuropathic Pain
Mirror box therapy has also been shown to help and aid recovery
from Complex Regional Pain Syndrome CRPS, also know as Reflex
Sympathetic Dystrophy RSD, Sudeks Atrophy or Causalgia. In this
condition it is now felt that part of the disease process occurs
in the somatosensory cortex. When a limb becomes immobile it
is thought that there is a disruption in sensory input to the
somatosensory cortex which in turn begins to behave as it does
in the phantom situation. By performing your rehabilitation
exercises within the mirror box using both limbs (one within
the box and one in front of the mirror) and seeing a mirror
image ( instead of the injured extremity ) working normally
the somatosensory cortex is encouraged to normalise and the
pain signals reduced.
Patients recovering from surgery following trauma particularly
involving the hand may find moving that hand difficult, part
of this difficulty is thought to be due to the immobilisation
upsetting the somatosensory cortex. Recent work has shown that
using a mirror box as part of the rehab program can facilitate
recovery.
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