Clinical Trials of Mirror Box Therapy

Mirror box therapy has been found to be highly effective in both small clinical trials (McCabe et al 2003a) and placebo controlled cross over studies on 48 patients (Caccio et al 2009).  After four weeks of therapy for 30-60 minutes each day, the 24 subjects on mirror box therapy all showed substantial decrement in pain (from 8.1 to 5.6 on a 10 point visual scale) whereas the 24 subjects on non-reflecting mirrors showed either no decrease or slight increase in pain. These results are especially important because most treatments for RSD are largely ineffective and because of the the fact that mirror box therapy is inexpensive, non-invasive, and can be self administered at home. A recent meta-analysis by Dohle also confirms its efficacy and clinical utility (Dohle et al 2008).

Cacchio et. al. (2009) Mirror Therapy in Complex Regional Pain Syndrome Type 1 of the Upper Limb in Stroke Patients

Dohle et. al. (2008) Mirror Therapy Promotes Recovery From Severe Hemiparesis: A Randomized Controlled Trial

Broken Windows Theory of Autism Explored by Dr. Enticott's New Research

The recent study by Dr. Peter Enticott et al. found a diminished activation of the mirror neuron system amongst individuals with autism spectrum disorders. In their new study, Dr. Peter Enticott at Monash University and his colleagues used transcranial magnetic stimulation to stimulate the brains of individuals with ASD and healthy individuals while they observed different hand gestures.  This allowed the researchers to measure the activity of each individual's mirror neuron system with millisecond precision in response to each observed action.  


They found that the individuals with ASD showed a blunted brain response to stimulation of the motor cortex when viewing a transitive hand gesture. In other words, the mirror neuron system in the ASD individuals became less activated when watching the gestures, compared to the healthy group. In addition, among people with ASD, less mirror neuron activity was associated with greater social impairments. This finding adds to the evidence that deficits in mirror neuron system functioning contribute to the social deficits in ASD.

Several new articles examine CBC hypotheses

A number of recent articles have been published which provide new evidence confirming several hypotheses put forward by CBC researchers over the years.

A recent study by Dr. Peter Enticott et al. found a diminished activation of the mirror neuron system amongst individuals with autism spectrum disorders.  The mirror neuron theory of autism ("The shattered mirrors theory") was initially proposed and confirmed experimentally by CBC researchers Ramachandran, Altschuler, Hubbard  and Pineda and presented at the Society for Neuroscience in 2000.  Subsequently confirmed by Oberman, Ramachandran, Altschuler, and Pineda  in 2005.
(http://www.icare4autism.org/news/2012/03/deficiency-in-mirror-neuron-system-connected-to-autism/)


Another recent study, by Lindsay Oberman (a CBC alumnus), conducted a meta-analysis of five previous studies and found that  the MNS (mirror neuron system) is deficient in ASD but rate of  maturation occurs similarly in both ASD and neurotypical individuals. 
(http://sfari.org/news-and-opinion/in-brief/2012/cognition-and-behavior-mirror-neurons-age-normally-in-autism)

Another CBC hypothesis which has received significant attention and has seen multiple confirmations is the hypothesis that mirror visual therapy provides relief for a variety of neurological conditions, including phantom limb pain, Complex Regional Pain Syndrome (RSD), and paralysis from stroke.

• Grünert-Plüss (2008) Mirror Therapy in Hand Rehabilitation: A Review of the Literature, the St Gallen Protocol for Mirror Therapy and Evaluation of a Case Series of 52 Patients 
• Thieme et al. (2012) Mirror therapy for improving motor function after stroke.
• Lamont et al. (2011) Mirror Box Therapy – Seeing is Believing
• Lee et al. (2012) The Mirror Therapy Program Enhances Upper-Limb Motor Recovery and Motor Function in Acute Stroke Patients.

Crick's Pragmatism

From Dr. Ramachandran:

In the next few blogs I'll tell you about some of my early encounters with Francis Crick. Although the quotes are from Crick, it may well be that in some cases he was quoting others. They are also from my memory, which isnt always 100% reliable.

When Crick began his foray into the field of consciousness in the early 1980's he would sometimes give informal seminars on the topic to small groups. I remember one such occasion when Crick had barely started his seminar and a philosopher in the audience raised his hand saying " Dr Crick, what exactly do you MEAN by the word consciousness? Can you first define it before you start talking about it?" Crick's reply was, " No, not at this stage. There was never a time in the history of biology when a group of us sat around the table saying 'Lets first DEFINE life before studying it.' We just went out there and found out what it was—a double helix. We leave matters of semantic hygiene to you philosophers."

 
Double Helix, courtesy James Gaither

A pithy way of saying science is an intensely pragmatic affair. Of course it's a good idea to know roughly what you are talking about, but sometimes precise definitions FOLLOW conceptual clarity—not vice versa. Crick's advice is well taken but should not be used as an excuse for shoddy thinking. (I expand on this theme in several endnotes in my new book Tell Tale Brain)

Crick would also often point out that one must scrupulously avoid getting caught up in the elegance or technical sophistication of an experiment; what matters most of all is if you end up proving what you set out to prove: so what?—what is its broader significance? He often quoted someone as having said "If an experiment is not worth doing, it's not worth doing well."

In fact, on one occasion, a rather pedantic experimental psychologist was telling him about a long complicated experiment he had done, incorporating all the proper controls and using considerable technical virtuosity. When he saw Crick's exasperated expression he said "but Dr. Crick, we have got it RIGHT—we know its right," Crick's response was, "The point is not whether it's right. The point is: does it even MATTER whether its right or wrong?"

Here again, that intense pragmatism.

Crickisms

From Dr. Ramachandran:

Hi guys! This is VS Ramachandran from the Center for Brain and Cognition at UCSD, in La Jolla, California.

I have never blogged before, but have finally decided to bow to the dictates of fashion. I am not entirely sure how its different from just periodic updates on my university website . I guess its meant to have a more informal conversational slant.

Narcissistic reasons aside, what's the purpose of blogging ? Education is one practical goal; the instant dissemination of knowledge. But a more philosophical goal might be that it provides an immortality of sorts—as your mind merges into the world-wide web.

Anyone who has stumbled his/her way into this blog—Ramachandran Blog—probably already knows that I do research on how the human brain works, studying syndromes such as phantom limbs and synesthesia. Much of that has been widely—perhaps too widely—publicized, so I thought I'd talk about something else instead.

I will begin with the late Francis Crick, who had an honorary appointment at our center (in addition to his main appointment at the Salk and adjunct appointment at the UCSD Psychology Department) There's no particular reason for choosing him as a blog topic, he just popped into mind. Perhaps because I often quote his wise and witty maxims at lab meetings and often tell my students "Crick Stories," which deserve to become widely known. And what better vehicle than a blog? (See also my Obituary of Crick, "The Astonishing Francis Crick")

Caricature of Francis Crick by David Levine

Francis Crick's name has become synonymous with modern biology. His discovery of the double helical structure of DNA with Watson, and subsequently the genetic code, marks the birth of molecular biology in the early fifties . Rather late in his career, in the late seventies, I believe, Crick moved permanently from Cambridge to La Jolla. Having solved the riddle of heredity, he set his sights on the next big problem in biology: how the activity of neurons in the brain gives rise to consciousness. (He was joined in this by Christof Koch). At around that time I had been working on human vision and (later) in neurology at Caltech and University of California at Irvine. It so happened, coincidentally, that his two interests at that time were in visual perception and consciousness and so he became instrumental in facilitating my move to the University of California, San Diego. It was a turning point in my career. ( It's astonishing how single individuals can have a huge impact on ones' research style and interests; the other two scientists who influenced me were the late Richard Gregory and Jack Pettigrew). Soon after, the Churchlands and Terry Sejnowski moved to UCSD/Salk; and we were all fortunate, as it soon became the world's leading center for cellular as well as cognitive neuroscience (Gerry Edelman also moved his empire from Rockefeller to La Jolla). La Jolla soon earned the title of the "neuron valley," which, though not matching Silicon Valley in dollar output, quickly outpaced it intellectually in terms of its collective impact in neuroscience (with exceptions like Stanford, maybe?).

Crick and Patricia Churchland and I had lunch at UCSD almost every fortnight during the last three years of his life (except during summer). Pat and I always enjoyed these; we knew we could expect several Crickisms sprinkled among his scientific insights and jokes. He detested pomposity in science and took great delight in deflating self-important individuals, whether face to face or during question time at seminars. In my next blog I'll mention some little known incidents. During his not infrequent visits to my lab he would regale me and my students with 'generic' advice on how to do science. I like to think—at the risk of seeming immodest—that some of his style (but alas not his stature!) rubbed off on us. And we have now been passing these on to the next generation

I'll transmit these to you, dear reader, in my next blog so you can in turn pass them on to several friends, ad infinitum so Crickisms become as immortal as DNA. And if anyone else has stories I invite them to join me.