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MIRROR THERAPY ppt.pdf
- 2. CONTENTS ANATOMY MIRROR NEURONS MECHANISM MIRROR THERAPY PROCEDURE MECHANISM INDICATIONS PRECAUTIONS ITS EFFECT ON VARIOUS CONDITIONS
- 5. MIRROR NEURONS MIRROR NEURONS are also called VISUOSPATIAL NEURONS They were first discovered in monkey’s brain by Rizolatti, an Italian neurophysiologist. Mirror neurons are involved in understanding actions and interactions . Located in pre-motor cortex, primary motor cortex, supplementarymotor cortex, inferior parietal lobule Brains internal mirror – role in introspection and self consciousness.
- 6. MECHANISM OBSERVATIONAL LEARNING The action-observation facilitates cortico-spinal pathway, improves motor function.
- 7. MNS accelerates the recovery of motor ability Activatedwhen observing, imagining and attempting to execute movements Identified for hand, mouth, foot actions
- 8. EVIDENCE OF EXISTENCE Electro Encephalo Gram Magneto Encephalography Transcranial Magnetic Stimulation
- 9. NETWORKS WITH MIRROR PROPERTIES PARIETO-FRONTAL MIRROR SYSTEM- parietal lobe, pre-motor cortex, caudal part of inferior frontal Gyrus. Recognition of voluntary behavior LIMBIC MIRROR SYSTEM- Insula, anterior medial frontal cortex Recognition of affected behavior
- 11. MIRROR THERAPY
- 12. INTRODUCTION MIRROR THERAPY is defined as the therapeutic approach for functional motor recovery bycreating illusoryvisual feedback of involved hand Unaffected hand mimics affected hand
- 13. Non invasive treatment that helps in neuro plasticity of brain Final stage in graded motor imagery Graded motor imagery- sequential process of rehabilitation that provides a sequential brain exercises Only treatment that uses unaffected side alone Cost effectivetreatment. Conveysstimuli to the brain.
- 14. Artificial visual feedback Patient seeing good hand is moving Kinesthetic sensation Stimulation in cognitive and sensory pathways Automatic movement in the affected hand
- 15. HISTORY Invented byV.S RAMA CHANDRAN, Neuroscientist. He proposed the concept virtual reality by maintaining psycho-physicalparallelism.
- 16. DIMENSIONS OF MIRROR Big enough to cover the entire limb and allows to see all the movements Size of 25x20 inches for upper limb 35x25 inches for lower limb
- 17. PROCEDURE MIRROR – Para sagittal mirror midline to the body infront of the body Affected limb – behind the mirror Unaffected limb- outside the mirror
- 18. The reflection of unaffected hand in the mirror gives illusion of movement in the affected hand Mimics the movement 2 types- covered mirror, uncovered mirror. -Alternativelydone
- 21. Closing and opening fist
- 22. Pincer grasping
- 23. Tapping fingers: num / min
- 24. Volar and palmar flexion
- 25. Exhibits – synaptic plasticity Hebbian theory- it is called hebbian learning or associative learning. postulated about brain’s synaptic plasticity. -- Cells that fire together, wire together.
- 26. progression 1st week- supination- pronation, wrist flexion- extension 2nd week- fingers flexion- extension, counting numbers, tapping and opposing 3rd week- simple tasks, picking up coins 4th week- plugging, unplugging, drawing etc
- 27. PATIENT SHOULD HAVE MOTOR ABILITIES- veryeffective in patients who have severe paresis COGNITIVE ABILITIES- patient should have sufficient cognitive abilitiesand verbal abilities to understand the instructions and to focus atleast for 15 mins. VISION- visual ability to the patient is necessary to view the limb in the mirror fully.
- 28. TRUNK – Should be able to sit in erect position during the session CARDIO-PULMONARY- Patients with C-P abnormalities are not eligible. Unaffected hand should be pain free and in normal range of motion.
- 29. INDICATIONS Phantom limb pain Upper limb dysfunctions Lower limb dysfunctions Altered sensations Pain after stroke Visuo spatial neglects Cerebral palsy Parkinson’s Complexregional pain syndrome Trigeminal neuralgia Autism Dejerrine -roussy syndrome Alien hand syndrome Focal dystonia
- 30. NEURONAL CIRCUIT MOVEMENT OBSERVATION REDUCTION OF EXCITABILITY OF INTRA CORTICAL CIRCUIT INHIBITION REDUCED ICI INCREASE IN MEP AMPLITUDE
- 31. Mechanism for therapeutic benefit of mirror therapy Unaffected hand makes smoother movements than affected hand Any overlap occur in neuronal circuit best suited to perform smooth movement using mirror Ipsi lateral limb movement effects primary motor cortex excitability Optimizepractice induced neuro plasticitywithin M1
- 32. MECHANISM VISUAL FEEDBACK ACTIVATION OF MIRROR NEURONS ENHANCES MOTOR CORTEX EXHIBITS PLASTICITY
- 33. benefits Patient enjoys the treatment Enhances muscle strength Increases motor speed Improves motor activity Accuracy of both hands Improves cordination
- 34. Stroke and mirror therapy Stroke incomplete lesion residue of mirror neurons areas are temporarily inactive visual feedback activationof mirror neurons normal movements
- 35. PHANTOM LIMB PAIN and MT Amputation vivid presence of limb feels and thinks pain immobilisation visual feedback mirror neurons activated start to imitate action performance free from pain
- 36. CRPS and MIRROR THERAPY Too much pain while moving suddenly Mirror visual feedback Learning of affected hand moving Activating mirror neurons
- 37. AUTISM AND MIRROR THERAPY Behavioural problems repeated actions or involuntary movements delay in intention understanding Mirror visual feedback
- 38. PARKINSON’S AND MT Bradykinesia Mirror therapy Recieves proprioception and motor training Activationof mirror neurons
- 39. DEJERRINE ROUSSY SYNDROME Thalamic pain syndrome- infarction in thalamus Leads to motor disturbancesand sensation alteration
- 40. ALIEN HAND SYNDROME and MT Involuntary purposeful movements done by limbs Mirror visual feedback Controlling involuntary movements
- 41. FOCAL DYSTONIA and MT Involuntary or unusual movements especiallyin fingers and hands Mirror visual feedback
- 42. PRECAUTIONS Should provide coherent mirror image There should be no risk of injury Frequency should be in comfortableto patient (minimum 15 mins) Inform to patient aboutside effectsand aims Jewelleryshould be removed Environment is free from distraction
- 43. NEGATIVES DIZZINESS NAUSEA SWEATING Can be panic bycontinuous reflection NECK PAIN ( rare)
- 44. THANK YOU