Mirror Therapy: The Basics

In order to do this therapy, we use a large mirror (about 3 feet across) that had been mounted on the wall, and one smaller one held in David's hand (more like 12'' x 18".) He sits in a chair right up close to the large mirror, with his knees pretty much touching the wall, but at about a forty-five degree angle to it (angled towards the right) and far enough to the left of the large mirror that he cannot see his own reflection directly in it. (Or else he would tape a piece of paper on the mirror to cover where the reflection would land. His AD is on the left side of his face, which is why he would face towards the right, so that that side would be most visible. But we later found out that it works equally well for him to sit on the right side of the mirror and face to the left, since almost the whole face is reflected in it either way.) We then make a pile of pillows on his lap that are about as high as the bottom of his chin. He holds the smaller mirror at the height of his face, and at a just slightly less than ninety-degree angle to the mirror on the wall, but touching the wall mirror. The pillows are to support his arm so that he can keep it there as long as we are doing the therapy, which eventually got to be as long as 15 minutes at a time.

We are going to take some pictures of all this that will show it. I imagine it is hard to visualize just from reading this.

Once we have the whole thing set up, David can look either into the mirror in his hand, or into the reflection of that mirror in the mirror on the wall, and in both of them he sees a non-reversed image of himself (unlike a regular mirror image, in which the image is reversed.) The therapy depends upon the brain not realizing that the images it sees are non-reversed images, but assuming that they are regular, reversed mirror images. We did what we could to avoid interrupting that illusion, but that involves details I will go into later.

We found that the therapy worked best when the smaller mirror he held was large enough and high enough that I could see his entire face when I stood right behind the chair. More on that later as well.

I set the timer on my watch for the length of the session. (At first we could not stand to do it for more than 10 minutes, but as we got used to it and as we reduced the Neurontin, we worked our way up to 15 minutes per session.) I also usually asked him what his pain level was when we started.

Then, standing behind the chair, I would reach around and touch/massage the right side of David's face for the length of the session while he watched in the non-reversed mirrors. Yes, you read that correctly. The affected side is the left, but I would massage the right side, the one that still has feeling. Since David’s brain thought it was looking into a mirror, it saw me massaging the left side of the face and so actually experienced sensation in that left side when I was actually touching the right side. In this way, it contradicted the brain’s theory that since it was not getting any signals from the nerves, something must be terribly wrong, so that it needed to invent pain signals to alert David to its state. Or that is how the theory goes, anyway. All I can tell you is that it works!

I will go into specific techniques I used more later. I will mention briefly, though, that I had a massage class once, and I tried to remember what kinds of things you do in a facial massage. Beyond that, I just made things up, trying to create as many different sensations as possible with feedback from David about what seemed to work. I don't know that technique particularly matters, but I did work on developing one simply so as not to go batty with boredom standing around touching someone's face for 15 minutes 4 times a day.

When the timer went off, we would stop. I would ask him what his pain level was when we finished. Usually, if his pain was mild when we started, it might be gone when we finished. It was also typical that if he didn't have any pain, then his face felt more active, or his pain went up. I would set my timer for the length of another session (but not continue to do the therapy) and then ask him again after that amount of time what his pain was. It was almost always much lower or gone by that time, unless we were going through a harder transition, when sometimes it would take a half-hour or more. Once we did the therapy twice, half-an-hour apart, and that brought down the worst pain he'd had to zero. It was unbelievable. In a sense, it still is.