Papers on Mirror Box

Executive Summary of Papers concerning Mirror Visualization Therapy and Mental Imagery

I suggest that the best starting point to look at why mirror box therapy and image visualization therapy works is to read :-

VS Ramachandran’s article in Clinical Medicine vol 5 no 4 July August 05. (PDF File)

This article is a good introduction to the medicine and concepts, it covers mirror visual feedback and why it theoretically can help for phantom, stroke and crps.

I have split the papers into the clinical problems mirror therapy can be used for. Clearly the area requires significant further research.

My personal view on the therapy is that it certainly doesn’t help everyone (what does?) however it can be very effective in the right patient. The therapy is very easy to teach and use, it has minimal side effect and the costs are solely down to the box costs and therapist’s time.

I urge all my patients to do their normal physiotherapy using a mirror box. The have nothing to lose in doing so and certainly much to gain.

CRPS Papers

Randomized Controlled Trials

Graded Motor Imagery for pathological pain G.Lorimer Moseley (PDF File)

Neurology 2006; 67:2129 2134

Positive result for motor image therapy program in CRPS

Sensibly constructed trial by well known investigators published in good journal.

They used a graded program of visualization therapy (siding hands first, visualization of movement and then mirror therapy).

Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomized controlled trial G.L. Moseley (PDF File)

Pain 108 (2004) 192–198

Positive result published in well-respected journal from sensible investigators.

Controlled Pilot Studies or Case Reports

A controlled pilot study of the utility of mirror visual feedback in the treatment of complex regional pain syndrome (type 1) (PDF File)

Rheumatology 2003;42:97–101

C. S. McCabe, R. C. Haigh, E. F. J. Ring, P. W. Halligan,

P. D. Wall and D. R. Blake

Trial showed positive result in early but not late CRPS, the P.D. Wall in this group is the late and great Patrick Wall of “Gate Theory of Pain Control” fame.

Mirror box therapy added to cognitive behavioral therapy in three chronic complex regional pain syndrome type I patients: a pilot  study (PDF File)

International Journal of Rehabilitation Research 2007, 30:181–188

Y.I.G. Vladimir Tichelaara, Jan H.B. Geertzenb,c, Doeke Keizerd

This paper describes mixed results in 3 patients in who mirror therapy was tried.


Review Articles

Motor Imagery a Backdoor to the Motor System After Stroke? (PDF File)

Stroke. 2006;37:1941-1952.

Nikhil Sharma, MB, ChB, MRCP(UK); Valerie M. Pomeroy, PhD; Jean-Claude Baron, MD, FRCP, FmedSci

This article if somewhat technical explains why imagery may help in stroke rehabilitation.

Motor Imagery and Stroke Rehabilitation: A critical Study (PDF File)

J Rehabilitation Medicine 2007; 39: 5–13

Sjoerd de Vries and Theo Mulder

Another article that explains why imagery may help in stroke rehabilitation.

Stroke Case Reports

Using Motor Imagery in the Rehabilitation of Hemiparesis (PDF File)

Arch Phys Med Rehabil 2003;84:1090-2.

Jennifer A. Stevens, PhD, Mary Ellen Phillips Stoykov, MS

Positive result case report of mirror visualization therapy in a stoke patient.

Doing It with Mirrors: A Case Study of a Novel Approach to Neurorehabilitation.  (PDF File)

Neurorehabilitation and Neural Repair 2000;14:73-76

Sathian, MD, PhD, Arlene. Greenspan, DrPH, PT and Stephen L. Wolf, PhD, FAPTA, PT

An interesting case report of the combination of CBT with mirror therapy describing a positive result.

Phantom Pain

Case reports

Mirror treatment of lower limb phantom pain: A case study (PDF File)

Disability and Rehabilitation, 2004; Vol. 26, No. 14/15, 901–904

Malcolm Maclachlan

Positive case report of mirror therapy for lower limb phantom limb pain.

Limb Rehabilitation after Surgery

Case Report

Training with a mirror in rehabilitation of the hand (PDF File)

Scand J Plast Reconstr Surg Hand Surg, 2005; 39: 104/108

Birgitta Rosen & Goran Lundborg

3 positive case reports, from an internationally respected hand surgeon, of mirror therapy use in rehabilitation following hand surgery