Graded Motor Imagery (GMI): Stage 3 Mirror Therapy
Information for patients from the Outpatient Therapy Service
Graded Motor Imagery exercises are not suitable for patients who have dyslexia or for children.
Mirror visual feedback is the third of a three stage program called Graded Motor Imagery. For more information, ask your therapist for a copy of the Graded Motor Imagery (GMI) leaflet.
This leaflet explains the following.
What mirror therapy is.
What the side effects are to doing these exercises.
How to prepare for these exercises.
How the exercises are done.
We hope this leaflet answers some of the questions you may have. If you have any further questions or concerns, please speak to your therapist.
What is mirror therapy?
The representation of the body’s image in the brain can become faulty following an injury or surgery. This can lead to an exaggerated feeling of pain in your affected limb. Mirror therapy helps to correct this mismatch, by providing your brain with the illusion of a normal limb.
Mirror therapy has been found to help some people reduce their pain, swelling, and joint stiffness. It is thought to ‘trick the brain’ into thinking that the painful area is moving normally. By repeating the following exercises each day it is possible to correct the mismatch in your brain.
If your pain gets worse, stop and concentrate on the reflection until you can discuss this with your therapist.
How do I prepare for this exercise?
Ideally you need a mirror that you can see your whole limb in, for example from your shoulder to your hand.
You need to find a quiet space, free from distractions. For mirror therapy to work, it is important that you are able to concentrate while doing these exercises.
Keep a daily diary of each session. Please note the following information.
How many times a day you practiced.
How long you practiced for.
Whether the therapy has had any effect. For example are your symptoms getting better or do you feel any different?
How often should I do mirror therapy?
Aim for 4 to 5 sessions a day.
Do the exercises for 5 to 10 minutes.
Remember ‘little and often’.
It is likely to take several tries before you are used to the technique.
How is mirror therapy done?
Stand (or sit) with your unaffected limb reflected in the mirror. Place your painful limb (or in the case of limb loss, your residual limb) out of sight behind the mirror.
Remove any jewellery or watches. Place your affected / residual limb on the same surface as your unaffected one. This will tell your brain that the reflection in the mirror is your affected limb.
To start with, look at the reflection without moving. Concentrate on the reflection for a couple of minutes.
Once you are engaged with the reflected image, start to move both limbs in exactly the same way. The movements must be slow, smooth, and controlled. Your therapist can give you ideas.
It doesn’t matter if the limb behind the mirror does smaller movements than the one in front, as long as the movement is together.
Try to remain relaxed. Take deep breaths or sing your favourite song.
To start with your hand or wrist may be too painful to move. If so, start with your whole arm at the shoulder or use other less painful joints.
When ready, start to move your more painful joints. It doesn’t matter how small the movements are.
Remember that mirror therapy is a ‘train the brain’ exercise, it is not to give you more movement.
Your therapist can guide you as to the best movements to practice.
If your pain gets a lot worse, stop the movement and simply concentrate on the reflection again. If the symptoms settle, continue with slow small movements.
Examples of exercises
To begin with, simply look at the reflection of your unaffected limb in the mirror until it creates an illusion that the reflection is your opposite limb. Focus on your limb in the mirror.
Once you are comfortable with this, start moving the fingers or toes of your unaffected limb. Keep looking at the mirror. Try to move the fingers or toes of your affected limb at the same time.
Using your unaffected hand, make different shapes with paper clips or cocktail sticks (such as squares, rectangles, and triangles). Look at the mirror at all times.
If you have any uncomfortable feelings in your affected limb, stop mirror therapy and look at both limbs. The uncomfortable feeling should quickly pass.
Further information
If you have any further questions, please speak to your therapist.
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