Graded Motor Imagery: Mirror Therapy Explanation and Steps

Mirror Therapy, one of the steps of Graded Motor Imagery (GMI), is a relatively new technique for treating phantom limb pain. GMI can also help with control of a myoelectric prosthetic device for those with an upper limb amputation. All the steps of Graded Motor Imagery are based on the neurology of the brain and its ability to change and adapt. The steps are:

1.  Laterality Reconstruction (left/right discrimination exercises)
2.  Motor Imagery
3.  Mirror Therapy

Mirror Therapy involves viewing the unaffected limb in a mirror, while keeping the residual limb out of sight. To start, the individual observes the sound limb in the mirror, and then gradually begins to move the hand while continuing to watch in the mirror. These actions can cause the brain to “re-think” the pain response that it has been experiencing since the amputation and adopt the image of the healthy hand in place of the injured limb. The phrase “seeing is believing,” is sometimes dramatically demonstrated by a sudden pain reduction of the affected limb. However, most times this technique requires an ongoing commitment of 10-20 minutes several times per day to be effective.

Our patient Diane working with her occupational therapy on Mirror Therapy.

We are including the steps below to give you an idea of what mirror therapy looks like — but the first several sessions should be performed with the help of an experienced clinical therapy specialist guiding you through the steps. If you are looking for a therapist to work with, please contact us. It's not unusual to experience an unexpected emotional reaction when trying mirror therapy. A therapist can help you navigate those feelings as well, and assist you in finding additional support, if needed.

Mirror Therapy

1. Perform the exercises in a quiet room, ideally at the same time of day and in the same location.
2. Sit, stand or lie down in a comfortable, supported position so that you can concentrate without having to pay attention to your posture or position.
3. Use a mirror box or place the side of a mirror against your chest so that the reflective side faces your unaffected hand/arm and your affected hand/arm is hidden behind the mirror.
4. Lean forward so that you can see the reflection of your unaffected arm in the mirror. Study the reflected arm for several minutes without moving and imagine the reflection to be your affected hand/arm in its previous intact state.
5. Begin to slowly move your unaffected arm while looking at the reflection and keeping the affected arm relaxed. Again, imagine that the reflection of the moving limb is actually your affected hand/arm in its previous intact state.
6. Next move both the unaffected and affected arm simultaneously while focusing on the reflected arm and imagining it to be your affected arm moving in a normal way.
7. Begin with simple, non-painful movements. Simple movements may include turning your palm up and down, making a fist, flattening the hand, moving each finger, touching thumb to each finger, tapping fingers on a surface, and then progress to more complex tasks such as drawing the alphabet with a finger in the air, writing, cutting, using tools etc. Think of such movements as opening your hand to allow a butterfly to fly away, dropping stones in a river, or throwing a ball. Do not do any movements that produce pain in your phantom limb. It may be helpful at some point to touch your face with your unaffected hand while making the same movement with your affected arm.
8. Do Mirror Therapy three to five times per day. Initially, you may only be able to observe the image of the mirrored hand and perhaps make small movements. With time, try to make larger and smoother movements with both arms. Your initial sessions may be quite short (two to three minutes), but gradually increase the duration of each session.
9. Once the movements feel quite easy, do the exercises in different situations such as in a noisy room, when you are hot, when you are tired, when you not in a good mood, etc.

Again, please reach out to us if you are looking for a therapist to help you beginning your work with Mirror Therapy. If you have tried Mirror Therapy and would like to tell your peers about your experience with it, please leave a comment below.

For more information, see related articles here:

• Introduction to Graded Motor Imagery: Reducing Phantom Limb Pain
• Motor Imagery: Using Visualization to Help Mitigate Phantom Limb Pain
• Introduction to Myoelectric Prostheses
• Your Guide to Out-of-Network Care
• Introduction to Phantom Limb Pain and Phantom Sensations