Talk:Mirror therapy

Method
The article still doesn´t explain, how and why the Mirror Box works. The link does it at least about, but from an NLP POV. Mami 00:58, 13 January 2006 (UTC)

Merge to phantom limb
This should probably be combined somehow with the phantom limb article. I put a link there to a radio show which contains an interview with Ramachandran explaining this case. M. Stern 03:49, 17 May 2006 (UTC)

Hi everyone. I have been working on both the phantom limbs article and the mirror box example. I have moved the large quote from PiTB that was here to the phantom limbs page, since it really relates more generally to phantom limbs, and less specifically to the mirror box. I have also added a fairly "simple" explanation of how the mirror box works (this is about the level that we give in lectures to undergraduate students). I have also copied many of the links, appropriate references, and external links from my cleaned up version of the phantom limbs page. In addition to explaining how the mirror box is meant to work, I have included just a little information about other clinical applications of the mirror box, although I have noted that a lot of work still needs to be done to explore and test these extensions. Overall, I hope that this new version of the entry both better justifies its existence and inspires other people to add more details. Edhubbard 16:05, 6 August 2006 (UTC)

Two mirrors?
Double-mirrored? There's more than one mirror?


 * Yeah, there are two mirrors, one for each side, since you never can know in advance which limb will have been amputated. The image that the patient sees is only reflected one time, so it's not as if subjects are seeing multiple reflections. "Double mirrored" was in the original version that I cleaned up.  Anyone have a thought for a better way of saying this?  I'm also looking to see if we have an image that is non-published (and therefore non-copyrighted) since it's much easier to understand with a picture.  Edhubbard 05:54, 8 August 2006 (UTC)

Image
The image is interesting. Why is the right hand on the left side and vice versa? 24.177.1.156 17:27, 26 August 2006 (UTC)


 * Uhhhh... because I'm a dumb***... I hadn't noticed, but now that you point it out, I'll fix it right away.  Edhubbard 19:10, 26 August 2006 (UTC)

Um, Ed seems to be...gone. Someone else has to take care of this. And it is ugly. Dang.

-Misha Vargas

216.254.12.114 18:33, 23 March 2007 (UTC)

Herta Flor
The paragraph (currently the last) regarding Herta Flor and colleagues' work on phantom limb pain is confusing. What are "telescoping phantoms"? What is "representation of the lip" and why is it important to this subject? At first I thought "lip" was a typo, but it seems the brain map of the lips of the mouth is near to that of the hands, and the Flor work compared them in some way. See http://brain.oxfordjournals.org/cgi/content/abstract/124/11/2268. I don't understand enough about the subject to fix this. Janeky (talk) 05:20, 10 October 2009 (UTC)

The reference to "Mirror Illusions of Phantom Hand Movements. Brain Activity Mapped by fMRI" leads to a poster from the OHBM 2006 Program and not to published material. This reference should be replaced by something accessible. Falcor84 18:26, 28 April 2010 (UTC)

I guess a proper citation would be this article see http://brain.oxfordjournals.org/cgi/content/abstract/124/11/2268 The article in the reference from Flor 2006 does not seem to exist i.e. it is not possible to find it and the article published at the given source is something else by someone else. —Preceding unsigned comment added by 139.80.123.42 (talk) 01:00, 14 June 2010 (UTC)

Can this help people with one side paralysed?
I remember quite some time ago seeing on TV this could help people regain movement of a paralyzed arm, though perhaps i'm mixing the phantom limb mirror box with a thing about how paralysed people can regain movement by watching other people do sports on TV...can anyone confirm if this really works like that or not please? --TiagoTiago (talk) 21:34, 9 November 2009 (UTC)

Quoting out of context
Neurorel has added the following to the article: "A 2008 review of the published literature on mirror therapy by researchers at Oxford (Centre for fMRI of the Brain) concluded that "the overwhelming majority of positive data comes from anecdotal reports, which constitute weak evidence at best. Only two well described and robust trials of mirror therapy in isolation exist, on the basis of which we conclude that mirror therapy per se, is probably no better than motor imagery for immediate pain."

As an article that touches on medical issues, we have a duty to get this right (see WP:MEDMOS and WP:MEDRS). However, Neurorel's addition is taking the quote out of context, so as to be misleading and to appear more negative than the overall tenor of the review. Indeed, the material Neurorel has added includes only the end of one sentence and the beginning of another, without any indication that it is an incomplete quote (e.g., "..." to indicate the ellipsis).

Here is the entire paragraph: "Despite widespread support of mirror therapy for pain relief in the peer-reviewed [2,4,12,19,23,24, 25,30,33,35], clinical (e.g. [20] (and popular (e.g. [5]) literature, the overwhelming majority of positive data comes from anecdotal reports, which constitute weak evidence at best. Only two well described and robust trials of mirror therapy in isolation exist, on the basis of which we conclude that mirror therapy per se, is probably no better than motor imagery for immediate pain relief, although it is arguably more interesting and might be helpful if used regularly over an extended period. Three high quality trials indicate positive results for a motor imagery program that incorporates mirror therapy, but the role of mirror therapy in the overall effects is not known. Obviously, more robust clinical trials and experimental investigations are still required. In the meantime, the relative dominance of visual input over somatosensory input suggests that mirrors might have utility in pain management and rehabilitation via multisensory interactions. Indeed, mirrors may still have their place in pain practice, but we should be open-minded as to exactly how." (p. 9)

As can be seen, the quote, and the entire review, is more balanced. The review focuses on a couple of key issues.
 * The first, (a distinction which is missed by taking the quote out of context) is the role of mirror feedback for "...immediate pain relief..." [emphasis added] vs. being "...used regularly over an extended period".
 * The review also raises questions about the specificity of mirror therapy on its own versus motor imagery, as the experimental trials that have provided the most compelling positive evidence include both imagery and MVF.
 * The review calls for larger, well-controlled double blind trials, that focus on the main issues raised above (immediate vs. long-term relief and the comparison with motor imagery).

Earlier in the article the authors make a similar, but shorter, summary when they state, "The most parsimonious conclusion of the data published to date would therefore appear to be that mirror therapy does not provide any greater immediate pain relief than motor imagery alone [3], but that a program of daily mirror therapy might [4,25], particularly if it constitutes part of a wider graded motor imagery program [28]. In short, the assertion made over a decade ago, that robust experimental trials are required to determine if the visual feedback is indeed an important part of mirror therapy [30], still holds true today."

I have already pointed out to Neurorel on the Vilayanur S. Ramachandran talk page that quoting out of context is inappropriate and violates wikipedia's policy on no original research. Specifically the portion which states: ":*Take care not to go beyond what is expressed in the sources, or to use them in ways inconsistent with the intention of the source, such as using material out of context.
 * Even with well-sourced material, if you use it out of context, or to advance a position not directly and explicitly supported by the source, you are engaging in original research; see below." Talk:Vilayanur_S._Ramachandran

Finally, if we are to add information on overall literature reviews, it is inappropriate to add only one, older (2008) review when three reviews have been published since, ,. These were identified by searching pubmed for "mirror therapy phantom limb" and then selecting only reviews by clicking on the "Review" filter on the right.

For now, I am reverting this addition, in the hopes that Neurorel and others will come discuss. Edhubbard (talk) 11:05, 26 July 2011 (UTC)

Mirror Therapy: recent reviews and research
PLEASE DO NOT MAKE HASTY REVERSIONS. Your tendency to make reversions within minutes of seeing new material that you disagree with makes it very difficult for other editors to participate in building an article. I intend to expand the discussion with multiple sources. I think it is important to mention that several researchers (including Lorimer Moseley at Oxford) have stated that there is no clear consensus as to the effectiveness of mirror therapy.Neurorel (talk) 17:07, 26 July 2011 (UTC)Neurorel

Herta Flor: 2002 statement about mirror therapy
Herta Flor has not advocated the use of mirror box therapy or endorsed its effectiveness. In general, she has been very cautious about endorsing or recommending any of he currently available treatments for phantom limb pain. Below is a recent statement on the effectiveness of mirror therapy:

"Ramachandran and Rogers- Ramachandran described another behaviourally oriented approach: a mirror was placed in a box, and the patient inserted his or her intact arm and the residual limb. He or she was then asked to look at the mirror image of the intact arm, which is perceived as an intact hand where the phantom used to be, and to make symmetrical movements with both hands, thus suggesting real movement from the lost arm to the brain. This procedure seems to re-establish control over the phantom limb and to alleviate pain in some patients, although controlled data are lacking. Owing to the paucity of controlled studies, a reasonable approach is to base the treatment of phantom pain on recommendations for neuropathic pain in general, such as antidepressant medication and calcium-channel blockers including carbamazepine. Opioids, calcitonin, ketamine, TENS, and sensory discrimination training can also be used." (Phantom-limb pain:characteristics, causes, and treatment,THE LANCET Neurology Vol 1 July 2002 http://neurology.thelancet.com)

I have removed the paragraph that implies that Herta Flor supports or endorses mirror box therapy because it is misleading.Neurorel (talk) 23:39, 1 September 2011 (UTC)Neurorel
 * Both of the studies cited in that paragraph were conducted and published after this statement (2004 and 2006), suggesting that, based on new data that Flor and her group have collected, she may have changed her opinion. Scientists can and do change their opinions when new data becomes available.  Most importantly, the passage does not say anything about her own opinions, but rather the results of the scientific studies the Flor group has conducted.  These are factual matters, and are not matters of opinion.  Edhubbard (talk) 00:18, 2 September 2011 (UTC)

Is the reference to the Flor et al. publication in 2006 accurate?
So far, I have not been able to find the publication referred to in the article: Flor, H.; Diers, M.; Christmann, C.; Koeppe, C. (2006), "Mirror illusions of phantom hand movements. Brain activity mapped by fMRI", NeuroImage 31: S159 It does not seem to appear on the publications list on Flor's web site.Neurorel (talk) 23:46, 7 September 2011 (UTC)Neurorel

2010 research by Diers and Flor found that mirror therapy does not activate sensori-motor cortex in subjects with phantom limb pain.
The article needs to be revised in light of the more recent research done by Diers et al. In particular, the views of Herta Flor need to be stated accurately.(Diers et al. PAIN 2010, 296-304 "Mirrored movements activated the sensorimoto rcortex contralateral to the hand seen in the mirror in the non-PLP and the HC but not in the PLP." (Abstract, page 296) Neurorel (talk) 00:01, 8 September 2011 (UTC)Neurorel

References to Karl (2004) and Flor (2006) are not accurate or relevant
The reference to Karl et al. does not appear to be relevant to mirror theory. The final sentence of the abstract states "These results extend previous findings of a positive relationship between somatosensory reorganization and phantom limb pain to the motor domain and suggest a potential positive effect of prosthesis use on phantom limb pain and cortical reorganization." The reference to Flor et al. (2006) appears to be inaccurate. As noted by Falcor84 in April of 2010 (see above) and myself the article referred to does not seem to exist. Herta Flor did indeed do reasearch on telescoped phantom limbs but I don't believe it was in the context of evaluating mirror therapy. If someone can find an accurate reference concerning mirror therapy then it can be added back. Neurorel (talk) 18:40, 12 September 2011 (UTC)Neurorel

External links modified (February 2018)
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Requested move 6 June 2020

 * The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion. 

The result of the move request was: Moved  (t &#183; c)  buidhe  01:23, 11 July 2020 (UTC)

Mirror box → Mirror therapy – Mirror therapy (currently a re-direct to "Mirror box") is widely used to treat a wide range of problems. The mirror box, invented by Ramachandran in 1992, was the original way to deliver mirror therapy, but it is no longer the only way to do it. The proposed new title has more general interest and application than the current one. HouseOfChange (talk) 12:37, 6 June 2020 (UTC) —Relisting. buidhe 23:09, 20 June 2020 (UTC)


 * Comment - a bit torn on this one. The article at present does meander in between being about the mirror box invention and mirror therapy, and a bit "puffed-up" with therapy info. I wonder if the therapy and the invention should be handled by two articles. One way to do this would be to merge most of the invention content to the inventor's article V. S. Ramachandran. It should also be noted that the term "mirror box" is in other contexts, such as photographic equipment, the internal mechanism of a kaleidoscope, and in mathematics. If I had to make a suggestion, it'd be to WP:DRAFT a mirror therapy article from scratch and move it to that title when ready. We can then look at what to do with this article afterward, but if its going to continue as a standalone, it needs a lot more information on the invention itself... is there a patent, date of invention, etc.? A lot of basic invention info seems to be missing. -- Netoholic @ 17:42, 6 June 2020 (UTC)


 * I am willing to create a short history section for this article so that the rest of it will be describing mirror therapy's use to treat different kinds of problems and the evaluation of mirror therapy's effectiveness by different groups. Looking for models elsewhere, chemotherapy, psychotherapy, and cancer immunotherapy all have short history sections but immunotherapy does not. This article has a lot about the invention of the mirror box, of which Ramachandran's article section currently has only a little. HouseOfChange (talk) 19:34, 6 June 2020 (UTC)


 * The page was created to be about the invention, so I feel like it should continue as that (either as a separate article, with most of the generic therapy info removed, or as a redirect to the inventor's page, if merged there) mostly to retain a clearer edit history. A Draft:Mirror therapy article, started from scratch, would be less constrained by the handling of this one to date and probably turn out better. -- Netoholic @ 20:12, 6 June 2020 (UTC)


 * Move. Yes, this can be two separate articles, but I don't see that it needs to be.  For now, do the move to the more general name, add a section on the more specific subject, spending time to do it right, and create a separate article when and if that section gets big (which I doubt it will).  --A&#8239;D&#8239;Monroe&#8239;III(talk)  20:29, 3 July 2020 (UTC)

Working to redraft the article
Mirror therapy is used for a number of different things. Three in particular are post-amputation phantom limb pain, post-stroke one-sided weakness, and chronic regional pain syndrome. I propose that each of these should get its own section. MEDRS assessments of its "effectiveness" are not general for all kinds of mirror therapy but specific to its use for specific problems. Therefore, the effectiveness should be considered separately within each section. HouseOfChange (talk) 03:20, 11 July 2020 (UTC)
 * Having divided the article, I am moving existing references into the appropriate section. After I have finished "rescuing" the sources already in the article, I will add more recent review articles if I find some. HouseOfChange (talk) 01:38, 12 July 2020 (UTC)