Hey, everybody! This is Christina, the Amputee OT. In this video, I’m going to be talking about mirror therapy for amputees. Mirror therapy, or mirror box therapy, is a type of therapy in which an amputee uses a mirror to simulate having two intact limbs. This is a therapy that’s done to alleviate phantom pain. Phantom pain is when you feel pain in the limb you have that has been amputated; and it’s different from phantom sensations. Phantom sensations is simply the sensation that you still have the limb that’s been amputated; whereas phantom pain is pain that you feel in the limb that’s been amputated. So phantom pain is a type of sensation, but it’s a sensation that most people don’t want. Most amputees have some level of phantom pain, and phantom pain can in some cases be really debilitating for people ; and unfortunately, there’s not a whole lot of treatments for phantom pain that are shown to be efficacious. The one therapy that does actually have some pretty good evidence behind it is mirror therapy. Not a lot of amputees know how to do mirror therapy, because most of the time, the protocol to do the therapy has to be taught by a physical therapist or an occupational therapist; so for those of you who don’t have access to those kinds of resources, I’m going to show you the protocol for mirror therapy, so that you can do it yourself. Why mirror therapy works for some people is not fully understood, but scientists hypothesize that it has to do with the way the brain interprets and analyzes bodily movements. There are parts of your brain that control movement and sensation; and each of your legs– like all of the other parts of your body– are mapped out in a particular spot on your brain. Your two feet have a lot of neural connections between them, and those neural connections are responsible for coordinated movements, like walking. In some instances, your brain cannot differentiate between your two legs; which is why a lot of amputees feel like their amputated foot is wet or hot, for example, when their remaining foot gets wet or hot. Also in your brain are mirror neurons, which are neurons that fire both when you perform an action, and and when you WATCH someone else perform that same action. When you have an amputation, even though your foot or hand isn’t present anymore, and the nerves to your foot or hand have been cut, the brain map of your foot is still between your ears. Scientists think that one cause of phantom pain is the difference between the map of your brain and your physical body. Mirror therapy, in part, uses both of these systems to trick your brain into both thinking that you have a complete leg or arm, AND that you can move that leg or arm. So by watching yourself perform movements in a mirror, you’re tricking yourself into believing that your amputated limb is performing those movements. Since I’m a leg amputee, I’m going to show you how to do mirror therapy for leg amputees only; though it works for arm amputees, too. Get your mirror and arrange it so that you can’t see the amputated leg like this; so that by looking into the mirror, it creates the illusion that you’ve got to complete legs. Next, make movements with your intact leg, while imagining and attempting to make those same movements with your amputated leg. I found that starting out by wiggling your legs back and forth– like this–seems to get my brain primed for harder movements. I’ve also found that bigger movements are easier to make them smaller movements, because it sort of feels like my amputated foot is stuck. So I like to start out with bigger movements, and then move on to smaller movements. The goal is to feel like the leg in the mirror is mine. I’ve also found that if I can move my phantom toe a few degrees, I can work at it to be able to move it more degrees if I keep trying to go further and further each time. You should only do symmetrical movements. In the studies I read, doing asymmetrical movements can make the phantom pain worse. It’s worth noting that this is not a therapy that will work instantly or overnight; in fact, most of the studies I’ve read have people doing it for at least 15 minutes a day, for at least a month; and sometimes even longer. It’s also best if you make a list of all the movements you want to do, and do them in the same order for each session. By the way, for all of you non- amputees out there, you can actually get a sense of how this might work for amputees. Get a mirror and put one hand behind it like this. And then, make symmetrical movements with both hands, while looking only at the reflected hand. Do this for about one minute. Now, suddenly stop moving the hidden hand, while continuing to move the visible hand. Most people say this feels really weird for a second, and that’s because your brain is interpreting the hand in the mirror as belonging to you; and when you perform a movement that does not coincide with the hand in the mirror, your brain sort of freaks out. The goal of mirror therapy is to make a person with an amputation feel like they are experiencing movements of their amputated limb, even when it’s not there. This is thought to help reorganize the mismatch between the brain map that you have of your body, and the actual visual feedback that you get when looking down at your amputated leg. It is most helpful for the type of phantom pain in which you feel like there’s a cramp or an unnatural position in your amputated limb; and it’s a little bit less helpful for the type of phantom pain that feels like electrical shocks. Okay, everybody that’s all for now! If you have any questions, you can leave them in the comment section below; you can subscribe if you like– I put out new videos every Wednesday. You can follow me on Facebook. That’s facebook.com/AmputeeOT. And… Have a good day! See you later! Bye!