MIRROR THERAPY WORKSHOP HELD AT DR. MIROSLAV ZOTOVIC REHABILITATION CLINIC, BELGRADE, SERBIA 3/03/2018

Physiotherapists certified for Mirror Therapy at Dr. Miroslav Zotović Rehabilitation Clinic

Mirror Therapy Adria instructor, Jasmin Avdović, in conjunction with head therapist Anđelka Pjanović and colleagues, Smiljka Pavlović and Milan Kecman of the Physiotherapy Department of Dr. Miroslav Zotović Rehabilitation Clinic, organized a successful, full day MT Workshop at the clinic in Belgrade-Republic of Serbia, on March 03, 2018.

 

Instructor Jasmin Avdović Guiding MT Workshop Participant

As always, the main educational target was phantom limb pain and phantom limb sensation and how the method of Mirror Therapy based on ETPP guidelines, deals with those problems. Spasticity affecting limb function and CRPS in persons suffering from hemiparesis, as n.fecialis paralysis, were also shown be helped with Mirror Therapy to achieve rehabilitation goals.

The outcome was that twenty-five Serbian physiotherapists were certified as Mirror Therapists, Seventeen attendants were from within the clinic, and the remainder from northern and central Serbia. Three of these physiotherapists were from the near-by Prosthetic Clinic.

Workshop Participants Involved in MT Procedures

Congratulations are in order for the following new mirror therapists: 

1. Milan Kecman 2. Smiljka Pavlović 3. Nina Lačanski 4. Jelena Mucić 5. Branko Lazić 6. Vladimir Klačar 7. Dragomir Trninić 8. Ivana Trbojević 9. Branka Vučković 10. Milena Stojković 11. Jelena Jovanović 12. Zoran Gligorić 13. Slavica Gligorić 14. Nevena Vuković 15. Vesna Krstić 16. Branka Iljoska 17. Marjan Drobnjaković 18. Nina Karanov 19. Anđelka Pjanović 20. Sanja Spasić 21. Jovana Filipović 22. Vesna Kuljić 23. Nataša Cvetković 24. Nataša Stevović 25. Mirjana Vitaz

Since 2016, the time of the last Mirror Therapy Workshop held in Serbia, the number of certified Mirror Therapy practitioners in the country has jumped from six to thirty-one. This rise might be partially credited to the costs of the education unexpectedly becoming available as government scholarships.

First Mirror Therapy Training Workship in Macedonia

Šejla Imamovic

Mirror Therapy Adria member, Šejla Imamovic, recently conducted a Mirror Therapy Training Workshop  as part of the official First Physiotherapy Congress of the Republic of Macedonia in the capitol city of Skopje.

Macedonian physiotherapists at Mirror Therapy Training Workshop

All twenty-five attendant physiotherapists participated interactively during this workshop, showing great enthusiasm for using this technique with both amputees suffering phantom limb pain and clients suffering hemiparesis.

Physiotherapists experience Mirror Therapy for themselves

Though the Republic of Macedonia suffered a only a brief time of conflict in the 90's, numerous land minefields were laid down, which caused some Macedonians to lose limbs.

According to its director, Jasmin Avdovic, Mirror Therapy Adria plans to certify physiotherapists from the Republic of Macedonia starting this this year, so that mirror therapy as initiated by End The Pain Project can continue to be spread throughout the former Yugoslavia.

Inspiring Amputee Peer-To-Peer First Review Meeting, Hai Lang, Vietnam

Amputee Peer-To-Peer 1st Review Meeting, Hai Lang, Vietnam

One month after a peer-to-peer group in Hai Lang, Vietnam, learned how to use mirror therapy at home to relieve the symptoms of phantom pain, they met to share their progress and the impact of the therapy on their lives.

The impact was profound; a solid model for a network of other peer-to-peer amputee groups to meet in Quang Tri Province, Vietnam.

Most of the amputees said that their pain was improved or reduced from at least 30% up to  80% and are thankful for the therapy. 

Several people revealed that they had drank a lot of alcohol to forget their pain, while others stated that their pain would drive them to anger easily when relating to family and friends. Now, they said, practice with the mirror has helped them in these matters. 

All of the participants look forward to further progress and are highly committed to remain in the project until it is completed in March, 2015. 

According to Nguyen Thanh Phu, the next step for Project Renew is to team up with the Quang Tri Provincial Disabled People's Association to seek resources for expanding the model into the Association's grassroots networks, so that more and more amputees can benefit from this effective, inexpensive treatment. 

MIrror Therapy Presented At 1st International Physiotherapy Congress in Montenegro by Jasmin Avdovic

Jasmin Avdovic training Congress participant

Mirror Therapy trainer Jasmin Avdovic from Sarajevo, Bosnia and Herzegovina, presented a one hour Mirror Therapy workshop as part of the official program of The 1st International Physiotherapy Congress on 10/09/14 at Institute Dr.Simo Milosevic in Igalo, Montenegro. The Institute, one of the largest and the most famous institutions for multidisciplinary spa treatment on the Balkan peninsula, is a pioneer of modern physical and preventive medicine, rehabilitation, talasotherapy and wellness and a leading international rehabilitation center.


Over 120 Congress participants were introduced to the Mirror Therapy technique by Avdovic through interactive presentations and demonstrations that allowed participants to feel for themselves the basic principles of Mirror Therapy and body reactions to it.

Besides the large number of health professionals attending this workshop, national physiotherapy associations and certain health institutions from Slovenia, Croatia, Bosnia and Herzegovina, Serbia, Montenegro, Macedonia, Kosovo, Albania, United Kingdom and others participated as official representatives of their national associations. Many representatives expressed interest in organizing full-day Mirror Therapy workshops.

Mirror therapy in the Balkans is important because of the high number of limb amputations, primarily in Bosnia and Herzegovina, as land mine fields were the worst  in world, followed by Croatia and Kosovo.

Jasmin Avdovic also explored the importance of using Mirror therapy for stroke, aneurism, traumatic brain injuries and others neurological disorders and conditions) with the participants. This Mirror Therapy workshop successfully left a huge imprint for future MT education in south-east Europe.

Mirror-Adria a registered Bosnian organization to offer Mirror Therapy Training Workshops

 Mirror-Adria, a rehabilitation training group  has been registered by physiotherapist Jasmin Adovic to address the problem of phantom limb pain for Bosnian amputees. Sarajevo alone, has over 50,000 people with permanent disabilities as a direct consequence of injuries from 1992-1995. This data does not include the numbers of wounded soldiers, including amputees who suffer with phantom limb pain.

Mirror-Adria, endorsed by End The Pain Project (ETPP), will bring Mirror Therapy training workshops to rehabilitation therapists in the Adria region as follows:

Bosnia - end of 2014
Montenegro - April 18, 2015
Serbia-May - June 2015
Macedonia - some time at the end of 2015

Graduates of the Mirror-Adria Training Workshops will receive Certificates of Completion issued by ETPP which will allow them to both administer mirror therapy and to train other professional therapists, amputees and family members or friends of amputees who suffer phantom limb pain. 

Jasmin Adovic, founder of Mirror Therapy Adria at far left with graduates of the September 2013 ETPP Mirror Therapy Training Workshop

Adovic recently created a FaceBook group, Mirror Therapy Adria. It has attracted over 500 members and more are coming, all with days of its inception!

Huso, an upper limb Bosnian amputee in mirror session

Huso, an upper arm Bosnian amputee, was introduced to mirror therapy at an End The Pain Project workshop given in the Sarajevo headquarters of Hope '87, September '13. At the time he had been suffering phantom pain for over twenty years, a legacy from the war in Bosnia during the '90s.

Huso practiced the mirror therapy at home for thirty days, following a two times a day for fifteen minutes each session schedule. The outcome as Huso happily reports, is that the pain is reduced about 75% from what he had been experiencing.

ETPP Mirror Therapy Workshop Focuses On Cardiovascular Amputees

Vascular Amputee uses Mirror

A recent Mirror Therapy Training Workshop at Holy Family Hospital, Vancouver, B.C.  for thirteen staff members focused on Mirror Therapy for Cardiovascular amputees.

A physiotherapist at Holy Family noted that her cardiovascular amputee clients usually suffer less intense pain in their phantom limbs than clients who were involved in a traumatic accident, perhaps because they do not carry a 'frozen' image connected to their phantom limb. 

The volunteer, a recent below knee amputee had been experiencing disruptive sleep because of phantom pain. Further investigation determined that he sensed his foot and toes contracted into his knee stump, a situation which would have complicated the mirror therapy treatment. 

Working as a team, the trainer and amputee brought the phantom limb down to the level of the intact limb. This adjustment will also help balance when learning to walk with a new prosthetic.

If neuropathy is evident in the 'intact' foot of a cardiovascular amputee, it may present further complications. A possible solution is for the client to wear a plain sock on the intact foot so that the mirror image limb is believable. 

 

Mirror Therapy Introduced To Bosnia

Bosnian Health Professionals

Though the war in Bosnia ended more than twenty years ago, there are still many amputees left who experience debilitating phantom limb pain.

To address this wide-scale problem, five Mirror Therapy workshops were presented in Bosnia during September '13 by Moira Judith Mann, co-founder of End The Pain Project .

The workshops marked the beginning of certified health professionals training other health professionals in Bosnia, with the expectation that Mirror Therapy will eventually reach amputees suffering phantom limb pain throughout the Balkans.

Training with mirror

Two workshops were held at Hope87 headquarters in Sarajevo, arranged by Dr. Amira Karkin-Tais and Dr. Murid Muftic and coordinated by Zana Karkin and Ivana Vujasin of the NGO. Fifteen health professionals received ETPP certificates of completion, which enables them to teach the therapy to other health professionals.

In Banja Luka, two workshops were presented to sixteen staff members of the ZFMR Rehabilitation Hospital through the cooperation of Dr. Natasa Tomic, ZFMR's Medical Director.

Banja Luka amputee using mirror

A workshop presented directly to amputees suffering phantom limb pain was held at the Organization of Amputees UDAS in Banja Luka, organized by Nikola Zec. The results were astounding and included the unfurling of phantom fingers by an amputee who had been experiencing a phantom clenched fist for twenty years after a device exploded in his hand.

Jasmin Avdovic, Physiotherapist/Occupational therapy practitioner, introduced Mirror Therapy training as an idea for future to 260 fellow physiotherapist members of UFFBiH in October, at their 1st Annual Congress. Participants from Bosnia, Serbia and Croatia responded to it with great interest due to high number of people with amputation, especially in Bosnia. He and others mentioned in this post plan to spread the benefits of Mirror Therapy through pan-Balkan workshops.

Your Donation = A Pain-Free Life

Dear Friend,

That's Tanja H. smiling at you -- she's a Bosnian amputee, happy to be free of long-term Phantom Limb Pain after experiencing guided Mirror Therapy!

Over 80% of amputees in third world countries affected by land mines, war, and disease experience pain in the missing limb. This pain is called Phantom Limb Pain and can be agonizing, interfering with all aspects of life.This pain can be experienced decades after the amputation operation. Suffering is the same anywhere in the world.

Phantom Limb Pain can be safely eliminated in just four weeks with Mirror Therapy. The techniques are simple and non-invasive. The mirror's reflection of the patient’s good limb engaged in specific movements retrains the brain’s sensory pathways and releases the pain. Over 1,000 amputees have successfully undergone Mirror Therapy treatment at Walter Reed Army Medical Center.

    End The Pain Project (ETPP) trains and supports small grassroots teams of medical clinicians to deliver these non-invasive Mirror Therapy techniques and related information to amputees in hard-hit third world countries.

     In 2011-12, ETPP trained and certified 100 doctors, physical therapists and prosthetists in Vietnam and 36 physical therapists in Cambodia. This year, End The Pain Project brings mirrors and training workshops to Rwanda and Bosnia, where many survivor-amputees from the 1990 conflicts still suffer Phantom Limb Pain. Your thoughtful contribution to either project goes directly to logistical support, training, tools and other needs and is tax-deductible.

Consider honoring your Mom for Mother's Day with a donation to ETPP -- she'll be proud of you! Just click the yellow button on our ETPP website.

Thank you!

Moira Mann, Co-Founder
End The Pain Project
http://endthepainproject.org

Support End The Pain Project Mirror Therapy Training Workshops in Rwanda * Bosnia

Quadruple Amputee Gets New Hands

In 2012, Lindsay Ess underwent revolutionary hand transplants  after losing her limbs to an infection.

View an inspiring ABC slideshow at http://abcnews.go.com/Health/slideshow/lindsay-ess-quadruple-amputees-hands-18126047.

The Courage of Dr. BJ Miller

We at End The Pain Project are deeply impressed by the compassion and courage of Dr. Miller, a triple amputee and current head of the SF Zen Hospice Project.  Read the full article at SF Gate.

Beth Darnall, PhD, develops self-treatment tool for phantom pain

Beth Darnall, PhD, Assistant Professor, Department of Anesthesiology and Perioperative Medicine, has developed an instructional DVD to enable amputees to self-treat their phantom pain. Do It Yourself Mirror Therapy teaches patients how to use this evidence-based treatment at home, making it a cost-effective non-pharmacologic treatment for phantom pain.

“When mirror therapy is practiced, the brain is exposed to the image of the intact limb repeatedly and receives the message that both limbs are intact and functioning,” said Dr. Darnall. “When mirror therapy is used consistently over the course of one month, phantom pain may lessen or even resolve.”

Functional MRI studies show that positive results from mirror therapy are related to cortical restructuring in the brain. It is thought that a remapping of the body map in the brain reduces or eliminates any distortion that may have been created when the brain tried to reconcile the amputation.

“Our study findings are promising, and self-treatment is especially important where access to pain care is severely limited,” said Dr. Darnall. She is currently working with a global non-profit organization called End the Pain Project to bring mirror therapy tool kits to amputees in Vietnam and Cambodia. HealthSaas has made it possible to evaluate their progress from Portland.

Dr. Darnall recently presented an instructional session on mirror therapy to amputees and caregivers at the national conference of the Amputee Coalition of America. In October, an OHSU N.L. Tartar Trust Fellowship will fund her travel to the annual conference of the Egyptian Society for the Management of Pain where she will present her findings on self-delivered mirror therapy. While she is in Cairo, Dr. Darnall will also meet with researchers at Al-Ahzar University to discuss a collaborative comparative effectiveness study of phantom pain treatments that will include mirror therapy.

From OHSU School of Medicine News 9/9/10

End The Pain Project Ventures Into Vietnam

Friday, December 18, marks the beginning of End The Pain Project activity in Vietnam.  Co-Founder, Moira-Judith Mann arrives on that date to bring information about Mirror Therapy for amputees suffering Phantom Limb Pain to several Vietnamese organizations serving amputees in various capacities. First stop -Hanoi.  Mid-January, she will visit Phnom Penh, Cambodia to establish connections.

Mann will present the ETPP ToolKit; a newly developed unbreakable mirror system prototype and portable PrismGlasses, recently invented by Dr. Jonathan Bannister and Dr. Glyn Walsh of Scotland and marketed by Scottish Health Innovations Ltd., all as non-invasive interventions to reduce or end Phantom Limb Pain.

New Study Shows Amputees Can Mentally Move Missing Limbs In Impossible Ways

Excerpted from the Science News article: An experiment explores the connections between brain and body By Stephen Ornes, Web edition : Thursday, November 19th, 2009

“Phantom” pain is like a ghost in the body — but it’s anything but imaginary. People who have had an arm or leg amputated can often still feel sensations of the missing limb, even though it’s no longer there. These sensations can be painful, and scientists are always looking for new ways to help relieve this phantom pain for amputees. Treatment often involves using mirrors to visually trick the person’s brain. The thinking is that, if a person can “see” his own body in a new way, his brain may stop sending pain messages.
In a new study, a team of neuroscientists have made another surprising discovery about amputees: They can be taught to mentally move their missing limbs in ways that are impossible in the real, physical world. It’s impossible for a person to bend his wrist down and then twist his hand around in a full circle.
Seven people who had had their arms amputated above the elbow participated in the experiment. After extensive mental training, four of the seven were able to feel the sensation of this impossible act, and describe it in detail.
“It is very surprising that anybody — amputees or not — can learn impossible movements just by thinking about it,” Henrik Ehrsson of the Karolinska Institutet in Stockholm, told Science News. Ehrsson is a neuroscientist, which is a scientist who studies the brain and nervous system.

Welcome to the End The Pain Project blog

This blog is where you can learn of the latest developments in Phantom Pain relief for amputees, current treatments Prosthetists and Orthotists are considering for Phantom Limb Pain, experiences of amputees and updates on End The Pain Project programs as well other amputee-related topics.

We welcome your accounts of coping with phantom pain as well as your comments. Thanks for your input!