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Mirror Box Therapy Exercises for Hands & Legs

Mirror box therapy is often used by physiotherapists or occupational therapists for rehabilitation of the hands and legs. Mirror therapy for hands is often favored as hands can fit inside a mirror box with a good view of the opposite limb more easily than legs. Mirror therapy has been shown to enhance lower limb motor recovery and motor functioning. It is also often used to reduce phantom limb pain which is common in amputees. For lower limb mirror therapy, the therapy mirror box needs to be bigger and should be placed on the floor.

Before carrying out any exercises, remove all jewelry so both limbs look the same. If you have any tattoos or scarring you might want to cover them to help with the illusion. To start a session, place both hands or legs in similar positions on either side of the mirror. Before exercising, visualize the reflection as your affected hand or leg. If there is a person to assist they can touch both limbs simultaneously to further the mirror illusion. Mirror therapy exercises should start with small and simple movement and then progress to more complex movement.

Session Aim: Motor Function

Depending on the aim of the session, different mirror therapy exercises for the hands or legs can be used. If the aim is for motor function, functional movements should be practiced. This can start with unilateral movement on the unaffected side and progress to bilateral as more activity is achieved.

Mirror box therapy for hands could start with simple finger flexion and extension and progress to functional tasks such as gripping a cup. Mirror box therapy for legs could start with small movements of the toes or ankles and progress to rolling a ball forwards and back.

Session Aim: Correct Neglect

If the aim is to help correct neglect or reduced sensation following a stroke, you should work on observation of the limb and bilateral sensory stimuli. Different tactile materials can be used to provide different sensations to the skin.

Examples of things to use are plastic bowls filled with rice, hedgehog balls, hot or cold stimuli, toothbrushes and sandpaper. It is important that the same sensations are applied to both limbs at once so an assistant will be needed for this.

Session Aim: Improve Tone

If the aim is to improve tone, unilateral motor exercises with the unaffected limb can be performed. This could focus on just observing the limb in relaxed positions. Similarly, if the aim is to reduce pain, the exercises should start with unilateral motor and sensory exercises with the unaffected limb.

*Do note that pain or tone may both be too severe to allow movement of the affected limb to start with but this can be introduced gradually in time.

Session Aim: Reduce Phantom Limb Pain

If the aim is to reduce phantom limb pain, it is best to do clenching and relaxing exercises of your unaffected limb. Start with something small like clenching and unclenching your toes and progress to bending and straightening your knee.

For any of these exercises, once you are able to perform them easily, try to do it in a different context. This could include signing a song at the same time, using a prop such as a cup or ball or adding in a more distracting environment.

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Neuro Orthopaedic Institute (NOI) accessed 29/9/17
Ramachandran VS. (1994). Phantom limbs, neglect syndromes, repressed memories, and Freudian psychology. Int Rev Neurobiol 37: 291-333
Rothgangel AS, Braun SM. (2013). Mirror therapy: Practical protocol for stroke rehabilitation. Munich: Pflaum Verlag. doi: 10.12855/
Sutbeyaz S, Yavuzer G, Sezer N, Koseoglu BF. 2007. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil 88: 555-9