Do- advise your patient to:

• Perform in a quiet room to encourage concentration and attention
• Remove jewellery if possible
• Place the affected limb behind the mirror and ensure it is not visible
• Place the unaffected limb in front of the mirror remove out of line of vision
• Lean forward & look at the reflected limb (not the actual limb), without moving either limb
• Concentrate on the reflection until they feel comfortable with it
• Slowly start congruent movement of both limbs whilst looking at the reflection
• Start with larger, pain free, smooth, bilateral movements, performed slowly with conscious attention
• Progress as able to smaller movements, more complex movements
• Exercise for at least 5 mins, no longer than 10, as the regime requires a lot of concentration and can be tiring if performed correctly
• Note whether and for how long pain is relieved
• Repeat as pain is returning or more often if able (this may be 3-10 times per day to start with)
• Record response; changes in colour, swelling & feelings and pain

Don’t

• Advise to perform unsynchronised or unilateral movement as this may evoke an unpleasant response

Top Tips

If pain, stiffness or nausea become a problem whilst exercising, then advise to stop & look at the limb in the mirror without moving either limb until the pain settles, then recommence as able.

If the patient is unable to start with the area that is affected by CRPS then advise to start instead with general proximal limb movements, e.g. for an affected hand they may need to start with shoulder or elbow movements.

Patients should perform a session of MVF just before going to bed – this ensures reinforcement of the virtual image.

To see visual guidance of this please click here.