page_title: V. S. Ramachandran
section_title: Mirror visual feedback/mirror therapy
hierarchical_section_title: V. S. Ramachandran / Research and theory / Mirror visual feedback/mirror therapy
caption_attribution_description: English: This is the original mirror box that was initially used to create relief withy phantom limbs in amputees. Dr. V.S. Ramachandran discovered the link between visual perception and nerve transmission, particularly with phantom limbs pain.
context_page_description: Vilayanur Subramanian Ramachandran is an Indian-American neuroscientist. Ramachandran is known for his wide-ranging experiments and theories in behavioral neurology, including the invention of the mirror box. He is a Distinguished Professor in UCSD's Department of Psychology, where he is the director of the Center for Brain and Cognition.
  After earning a medical degree in India, Ramachandran studied experimental neuroscience at Cambridge, obtaining his PhD there. Most of his research has been in the fields of behavioral neurology and visual psychophysics. After early work on human vision, Ramachandran turned to work on wider aspects of neurology including phantom limbs and phantom pain. Ramachandran invented mirror therapy which is now used to treat amputees with phantom limb pain and also to help restore motor control in stroke victims with weakened limbs.
  Ramachandran's popular books Phantoms in the Brain, The Tell-Tale Brain, and others describe neurological and clinical studies of people with synesthesia, Capgras syndrome, and a wide range of other unusual conditions.
context_section_description: Writing in 2009, John Colapinto (author of Ramachandran's profile in The New Yorker) said that mirror box therapy for amputees was Ramachandran's most noted achievement.
  Ramachandran thought that phantom pain might be caused by the mismatch between the amputee's different nerve systems: his visual system tells him the limb is missing, but nerve signals to the brain say the limb is still there. The so-called mirror box was a simple apparatus that uses a mirror reflecting an amputee's good arm so that it appears to be the extension of the one missing:
  They put their surviving arm through a hole in the side of a box with a mirror inside, so that, peering through the open top, they would see their arm and its mirror image, as if they had two arms. Ramachandran then asked them to move both their intact arm and, in their mind, their phantom arm—to pretend that they were conducting an orchestra, say. The patients had the sense that they had two arms again.
  Ramachandran found that in some cases restoring movement to a paralyzed phantom limb reduced the pain experienced. In 1999 Ramachandran and Eric Altschuler expanded the mirror technique from amputees to improving the muscle control of stroke patients with weakened limbs. As Deconick et al. state in a 2014 review, the mechanism of improved motor control may differ from the mechanism of pain relief. 
  Despite the introduction of mirror therapy in the late 1990s, little research was published on it before 2009, and much of the research since then has been of contested quality. Out of 115 publications between 2012 and 2017 about using mirror therapy to treat phantom limb pain, a 2018 review, found only 15 studies whose scientific results should be considered. From these 15 studies, the reviewers concluded that "MT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP." Similarly, a 2017 review that studied a wider range of uses for mirror therapy, concluded, "Mirror therapy has been used to treat phantom limb pain, complex regional pain syndrome, neuropathy and low back pain. The mechanism of action of mirror therapy remains uncertain, and the evidence for clinical efficacy of mirror therapy is encouraging, but not yet definitive."
caption: Ramachandran standing next to the original mirror box
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