Mirror Therapy for Phantom Limbs

Phantom limb syndrome has always been intertwined with war. It was first discovered by Silas Weir Mitchell after the Battle of Gettysburg, when the hospitals of Philadelphia were overwhelmed by soldiers with amputated limbs. Many of these soldiers said that they still felt their missing arms and legs, even though they were clearly gone. As Weir Mitchell put it, the soldiers were afflicted with "sensory ghosts".*

After the Civil War, Weir Mitchell's clinical observations fell into obscurity. Because phantom limbs had no material explanation, medical science continued to ignore the phenomenon. However, the syndrome was eventually rediscovered by the neurologist J. Babinski, after he spent time with the maimed soldiers of WW I.

Now we have another war, and phantom limbs are again in the news. This time, though, the news is good:

On the morning of July 2, 2006, Sgt. Nick Paupore was driving the lead Humvee in a convoy near Kirkuk, in northern Iraq, when a roadside bomb blew off his right leg above the knee.

Within 48 hours, he was at Walter Reed Army Medical Center in Washington, where he has spent the past 18 months recovering. Soon after arriving, Paupore began to feel excruciating pain - in his missing leg.

"It felt like someone was shocking me, like someone was putting an electrode on the back of my ankle," says Paupore, 32.

He tried several painkillers, including methadone, but the pain didn't let up. Then a Navy neurologist, Dr. Jack W. Tsao, asked him to try a new approach that requires patients to move the intact limb while watching the action in a mirror.

Not surprisingly, Paupore was skeptical, and said no thanks.

He's not skeptical now.

Tsao eventually persuaded Paupore to try the therapy. After several weeks the shocks had almost disappeared.

"As soon as I started the treatment, I noticed a remarkable change," says Paupore, who has stopped taking painkillers. "I could see really big improvement, really fast."

The mirror treatment was pioneered by V.S. Ramachandran, although Walter Reed Army Medical Center is the first hospital to actually conduct a trial study of the treatment. The results so far are encouraging:

The soldiers were divided into three groups of six: One group received mirror treatment; another underwent treatment using a covered mirror, while the third didn't use a mirror, but visualized moving the amputated limb.

Those who used an uncovered mirror had significant pain relief. Few in the other groups got relief, and some actually got worse. When the covered-mirror and visualization patients tried the mirror, almost all improved.

Tsao has published his results in the New England Journal of Medicine.

*I discuss the discovery of sensory ghosts in my book, and talk about how Herman Melville was actually the first person to really describe the phenomenon in detail.

Thanks for the tip Steve!

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I'm fascinated by this topic, as it intersects with another interesting one: Body Dysmorphic Disorder. I'd love to read your thoughts on BDD and mirror therapy.

I'd be pretty surprised if that's the 'first discovery' of phantom limb syndrome. Humans have been missing limbs throughout history and I'm sure the issue has come up. What about the Greeks or Romans, even.

One wonders if the act of imagining moving the missing and intact limbs might have been more successful if the amputees who were in that group had had more practice. Is it not true that imagining some activity is the same as doing it to some part of the brain? I recall a world champion bull rider who became a champion through meditating on 'becoming one with the bull', telling the story on NPR of how he trained an actor to ride a bull for the movie "8 Seconds" without the actor getting on a real bull. The actor imagined the ride. It was too risky for him to actually ride but he had to fake it for close ups. After the movie was in the can, the actor tried a real bull and had a good ride.

I agree with Whitman with his poetry and intuition on the synergy between the brain and body, but I also disagree. There is a strange thing in meditation when a near dissociation happens. I imagine it having to do with chemicals being secreted in the brain due to the electrical activity related to the state. I hypnothesize that some kind of serotonin or the likes is being heavily secreted causing anesthetic properties.

I would imagine the ghost limb syndrome being a perceptual muscle memory that causes tension to muscles and the likes that aren't there.

At any rate, I question whether are bodies are just transports for our heads/perceptions/souls/whatever you want to call them.

Very interesting post Jonah. For more on the subject, the Neurotopian, a German Physiotherapist, has written an excellent series on mirror therapy in his blog.

By Eric Matheson (not verified) on 04 Jan 2008 #permalink

I agree, It's a fascinating subject! I saw a show about tests and studies at the U of Wisconsin with people who had lost the ability to maintain their balance. I believe their physical mechanisms had irreparable damage.
They used an electrode, with multiple touch points to perceive a mild electric shock, placed in their mouths to get feedback about their spatial positions. Through training with this their brains rewired themselves to be able to maintain perfect balance and went beyond that to use other clues for balance. To the point where the patients were weaned off the electrode in larger increments and I think some eventually were finished with it completely.
I think brain physiology is in the infant stages of being understood. As a trainer of professional bodybuilders I saw some extremely starling and amazing things. It seems only fair to expect even more from the most impressive organ of the body! The brain!
I think brain physiologist need to start reaching for the stars in their expectations because there is more likely to be astronomical results than we have allowed ourselves to believe.
Dave Briggs :~)