Open Access Capstone
Doctor of Occupational Therapy (OTD)
Mirror box therapy has been found to be effective in changing motor and sensory outcomes in patients with cerebrovascular accident (CVA). It has many benefits to use for occupational therapists such as ease of use, ease of transportation, capability to be used across practice settings, and ability to be incorporated into conventional therapy treatment. However, therapists included in this study may not have been using the intervention due to lack of knowledge or availability of the intervention equipment.
The purpose of this capstone project was to determine the impact education would have on occupational therapists’ attitudes and behaviors towards the use of mirror box therapy. It also served to determine the impact the use of mirror box therapy would have on changing functional outcomes individuals recovering from across occupational therapy practice settings. This study utilized a mixed methods approach and was divided in to two parts. Part A utilized a two-part educational series for occupational therapists analyzed by a quantitative pre-test/post-test assessment of learning. This was followed by a qualitative focus group to determine impression of the learning. Part B included using mirror box therapy with seven patients with acute CVA during admission stays over the course of four weeks to collect pre-test/post-test data on changes in range of motion, muscle strength, sensation of the affected limb, and Functional Independence Measure (FIM) levels. This was followed by a qualitative focus group for therapists who had implemented mirror box therapy. Part A of this study found significant changes in learning about mirror box therapy by occupational therapists. Through the educational series, they identified how they learned, what motivates them to learn, barriers to job performance due to the environment, and overall excitement to learn. Part B of this study found changes in occupational performance for all seven patients with acute CVA. Patients identified sensory changes throughout the use of the mirror box and presented with changes in motor function resulting in improvements in FIM scores. Using mirror box therapy with patients with CVA facilitated growth by the therapists in their confidence to use, motivation to use to continue to help patients, evolution of becoming leaders in their respective practice settings, motivation to utilize evidence-based practice and critical thinking about changes in their environment that would be needed to successfully incorporate mirror box therapy into daily practice. Education that addresses preferences in learning, motivates the therapist to want to learn, and provides support for adaptation of the person, the environment, and the occupation can be successful in creating changes in occupational performance of occupational therapists. Learning to use mirror box therapy by incorporation into practice increased confidence of use in occupational therapists. As confidence improved, the therapists evolved into leaders in their practice settings by modeling the use of the mirror box and sharing an understanding of the benefits to use of the intervention with their peers. Utilizing mirror box therapy also changed impressions of use of evidence-based practice with demonstrated future desire to use and support treatment. Using mirror box therapy with patients with acute CVA can lead to changes in functional outcomes by improving motor function and sensory awareness resulting in improved occupational performance. Short periods of use of the intervention can be effective throughout occupational practice settings to initiate recovery of the affected limb.
Camille Skubik-Peplaski, PhD, OTR/L, FAOTA
Dana Howell, PhD, OTD, OTR/L, FAOTA
LaRue, Nicole Y., "THE IMPACT OF EDUCATION ON IMPLEMENTATION OF MIRROR BOX THERAPY ACROSS OCCUPATIONAL THERAPY PRACTICE SETTINGS" (2019). Occupational Therapy Doctorate Capstone Projects. 42.
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