Graded Motor Imagery – Step 3: Mirror Therapy For Treating Strokes

Learn how you can use mirror therapy (step 3 in the graded motor imagery continuum) in your treatment sessions for your patients with a stroke! | OTflourish.com

Ever have a patient with a stroke and wonder if mirror therapy intervention would work? I remember as a new occupational therapy grad watching other OTs using a mirror in treatment, wondering what the purpose was and if it truly helped our patients make progress.

I made it a mission to find out:

📌 what it is

📌 the benefits

📌 what do OT practitioners need to do in order to utilize this with their patients

📌 how to have patients do this as a home exercise program

Let me share what I found:

In my experience, many OTPs, and that included me until I knew better 😬, jump straight to mirror therapy (step 3 in the Graded Motor Imagery continuum) with the patient before they were able to achieve the first two steps:

Step 1: Left-Right Discrimination 

Step 2: Explicit Motor Imagery 

 

Learn how you can use mirror therapy (step 3 in the graded motor imagery continuum) in your treatment sessions for your patients with a stroke! | OTflourish.com

 

What is Graded Motor Imagery?

Graded Motor Imagery a set of 3 different, sequential (but flexible) treatment techniques using “top down” cortical central processing to improve movement difficulties or complex pain.

What’s the Best Way to Use Mirror Therapy? The Graded Motor Imagery Continuum!

Remember we talked about the 3 steps of graded motor imagery and that it must be done in order to achieve optimal results?

Here are the steps:

  1. Laterality Training (aka Left-Right Discrimination)
  2. Explicit Motor Imagery Exercises
  3. Mirror Therapy

So basically how mirror therapy works, is it gives the illusion that the impaired limb is moving as the person is looking at the unaffected extremity in the mirror, which helps create new neural connections for motor system recovery.

Ever heard the saying, “seeing is believing?” 😮

Check out the OT Flourish Membership for step-by-step instructions and research on how to exactly use both Laterality Training and Imagery Training in your OT practice here.

Not feeling confident working with older adults in your OT practice? If you are new to working in SNF or Home Health, we are here to level up your practice! Join the OT Flourish Membership today!

How Does It Work and What Patients are Appropriate To Use This Intervention?

It is typically used with patients who present with motor function deficits with loss of function of a body part and usually left-right discrimination difficulties are noted. Research supports the effectiveness of mirror therapy with use for patients with stroke, chronic pain and/or impaired sensation. 

Mirror therapy  for stroke rehabilitation is based on visual stimulation. A mirror is placed in the patient’s midsagittal plane with the purpose of reflecting the movement of the mobile side as if it were the affected side. It is meant to give the illusion of “normal” movement on the affected side in order to stimulate adequate brain regions for movement.

How Do I Use It With My Patients That Have Had a Stroke?

1️⃣  Make sure your patient is in a supported position so they can focus on the task at hand.

2️⃣  Use a mirror box or mirror facing the unaffected extremity with the affected extremity hidden behind the mirror.

3️⃣  Have your patient observe the unaffected extremity in the mirror without moving and imagining it is the affected extremity. Start with little to no movement.

4️⃣  Have your patient slowly begin to move the unaffected extremity while watching the reflection and relaxing the affected extremity. 

5️⃣  Then have your patient move both the unaffected and affected extremity simultaneously while focusing on the reflection.

6️⃣ Gradually increase the difficulty of the exercises.

This treatment method is beneficial three to five times per day.

Review of the Benefits of Mirror Therapy in the Graded Motor Imagery Continuum

Mirror therapy is an easy and low cost intervention technique that can be used for stroke patient with left-right discrimination or loss of limb function (either total or partial). It technically “tricks” the mind into thinking that the affected extremity is moving. It stimulates the brain neurons and can jump start your motor system recovery!

It is step 3 in the graded motor imagery continuum and don’t for-go the first two steps or you’ll miss out on the incredible results it can provide when done correctly.

Another great thing about this technique is that it’s an intervention that can easily be generalized to home use. Patients can easily incorporate this intervention into home life to increase benefits and potential outcomes.

Try making a mirror box with your patients and sending it home!

How Do I Make a Mirror Box For My Patient?

At its most basic form, it is just a box with a mirror on the side. It has a space for each extremity on either side. The affected side will be covered and the unaffected extremity will be reflected in the mirror.

I also ❤️ that mirror visual feedback therapy can easily be generalized to home use, is a great home exercise program and will increase benefits and potential outcomes.

If you are an OT Flourish member, be sure to check out the Mirror Therapy Mini Video Course here to get step-by-step instructions in guiding your patient through the graded motor therapy continuum!

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6513639/

https://www.armdynamics.com/upper-limb-library/mirror-therapy-explanation-steps

https://www.neofect.com/us/blog/stroke-exercises-using-mirror-therapy-and-mirror-neurons

http://www.gradedmotorimagery.com/mirror-therapy.html

Not feeling confident working with older adults in your OT practice? If you are new to working in SNF or Home Health, we are here to level up your practice! Join the OT Flourish Membership today!

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