Mirror therapy (Ramachandran)

Domain IX · Biomedical, neuro & digital · V. S. Ramachandran, Rogers-Ramachandran · 1996

What it is

Mirror therapy (also called mirror visual feedback) places a mirror between the limbs so that the person sees the reflection of the intact or less affected limb where the missing, painful or paretic limb should be. Ramachandran and Rogers-Ramachandran built a cardboard "mirror box" for ten…

Format

• Mirror therapy is a rehabilitation technique, not a psychotherapy. The phases below describe the care pathway as the psychotherapist meets it. Session numbers, frequency and length are set by the treating physiotherapist or OT and are deliberately not given here. The sources show that they vary…
• Phase 0: Referral and assessment by the rehabilitation team. Goal: confirm the diagnosis (phantom limb pain, post-stroke paresis, CRPS) and decide whether mirror work or GMI fits. In CRPS, the RCP describes four equally important pillars delivered by an integrated team: education, pain relief,…

Who practises it, and how they are trained or regulated

• Who delivers it. Mirror therapy and GMI are delivered by physiotherapists, occupational therapists, hand therapists and pain teams. In the UK, physiotherapists and occupational therapists are regulated by the Health and Care Professions Council (HCPC) and their titles are protected by law. "Psychotherapist" is not an HCPC-protected title, although practitioner psychologist titles are. The RCP guidelines ask that…

Evidence status, as the guide reports it

• Evidence status in brief. Stroke: the 2018 Cochrane review found moderate-certainty evidence that mirror therapy improves motor function, motor impairment and activities of daily living. For pain the evidence was low certainty, and the benefit was not significant once CRPS-only trials were removed.…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• boom-and-bust cycles around home practice.
• neglect and attention problems that reduce practice.
• consent given out of pressure to be a "good patient".
• self-harm aimed at the limb, or covering and neglecting it.
• prolonged grief, PTSD symptoms related to the injury, and depression.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.