Graded Motor Imagery

Mirror Therapy

If you put your left hand behind a mirror and right hand in front, you can trick your brain into believing that the reflection of your right hand in the mirror is your left. You are now exercising your left hand in the brain, particularly if you start to move your right hand. Sounds tricky!

Mirrors can sometimes be used by themselves but often it is best to do once you have a good ability to discriminate your Lefts from your Rights and imagine movements, i.e. the first two stages of GMI.

p.s. mirrors are cheap and you may not need drugs.


Training Tips

  1. 'Mirror boxes' are relatively easy to build and large, custom mirrors may be required for pain states in the lower limbs and shoulders. NOI recommends using sturdy Perspex mirrors to avoid any glass injuries.
  2. Start with exercises involving no or little movement – just watch your unaffected hand. Gradually increase the difficulty of exercises in front of and behind the mirror. See the video and our posters for more detail.
  3. Take care with mirror therapy. Remember it is the final part of the entire GMI process and offers potent brain stimulation. You may need to consult a health professional.

A basic guide on how to use a mirror box

  1. It is important to be guided by a clinician who understands brain function.
  2. For illustrative purposes we have chosen to use a hand as the subject inside the box. This could also be a foot, leg, shoulder or arm but may require a larger mirror box. Sit comfortably with the injured/painful hand in the box, keeping it hidden from view.
  3. Place the other hand in front of the mirror. Leaning forward and comfortably centred, look at the image created in the mirror. Your brain is now 'seeing' the injured/painful hand. If you wriggle the non-painful hand it will feel a little bit odd. This is just your brain trying to decide what is going on.
  4. Presuming there is no jewellery on the affected side, remove any wrist watches and rings from your unaffected side. If you have any tattoos or scarring, try to cover this up to make a total illusion.
  5. Depending on the pain and disability state, decide on an appropriate activity(ies) to perform with the good hand. This could range from just looking at the mirror image to finger movements, or taking weight through the hand. See suggestions in the table below.
  6. In general, the more severe the problem (such as CRPS), small movements, performed often, may be more appropriate.
  7. Feel comfortable with your selected movements – 'conquer the movement' before progressing to a more challenging movement. Once you feel comfortable with a movement, try and perform it in a different context. For example, do it with a song in your head, when you are feeling different emotions, in the morning or at night.
  8. Overall, you will need to repeat movements, grade the movements from easy to more difficult and then enrich the movement with different contexts for best neurone health.
  9. Take care. If the hand in the box hurts or sweats, you may have taken the brain exercises too far even though the hand has not been harmed. Don't worry though, just take a break and try something a little less challenging next time.
  10. Move the painful hand in the box to the point where it starts to hurt a little (e.g. a loose fist) and then move the good hand which is outside the box a little bit further (e.g. a tight fist).
  11. By placing a mirror between the feet, a similar therapy can be performed for the foot.

Ideas on how to progress through mirror therapy

For more information see The Graded Motor Imagery Handbook, Moseley, Butler, Beames, Giles, Noigroup Publications, 2012