Mirror Therapy: Specific Techniques

When I was doing the therapy, I tried to address all the kinds of sensation that the left side of David's face might be missing, just as a massage would include a variety of kinds of stimulation. Sometimes, I just worked on the surface of the skin, and other times I would try to massage the muscles underneath the skin, or reach the skull underneath. Early on it occurred to me that we could try things like hot and cold, wetness or lotion or kinds of cloth or things like that. But since it seemed to be working just using my hands, we stuck with that and didn't try other things. Remember that I am massaging only one side of the face, as described in the previous section.

Typically, I would start with what would be called effluerage, a lightly pressing stroke, sometimes circular, all over the face for about a minute, just to get it warmed up.

Then I would do something more like petrissage for about a minute, taking a part of the face, however much I could easily grasp, usually both skin and muscle between my thumb and forefinger and kneading it slightly, and then doing this all over the face. This was one of the more intense techniques, one suggested by David after the first two sessions. He called it “really getting in there and working.” He tends to think things can’t be effective unless they are intense.

Next, I would make a fist and rap the face all over for another minute, sort of in a “percussive” technique as they would say in massage.

Then I would keep the fist, but the knuckle to make broad but deep strokes over the face, across the brow, the cheeks, the jaw and so forth for about a minute. (Again, this was one of the more intense techniques.)

This was typically followed by deepish circular strokes with the knuckle. (Another intense one.)

After this, I would scratch all over the face, at about the intensity of someone who trying to relieve an actual itch. One of the advantages of this technique was that it was one I could control well enough to use it very close to the eye, one of the primary areas David had intense pain.

Then I would carefully use two fingers and press all around the eye socket. If you are careful, you can actually feel an edge where the eyeball fits in the orbit without poking someone in the eye. Again, we felt it was important to convince not just the face, but specifically the eye that it was OK. Then I walked/slid the two fingers all around the face.

Often, I would follow this by making a flat palm and doing something like a tapping or a slapping all over the whole face—another percussive technique. In the beginning, David sometimes would practically fall asleep in the chair, so then it was more like slapping just to keep him awake! Even without that intensity, David would have strong reactions to this technique at times, asking me to do it near the eye.

Generally, I would also stick out my fingers, like making a claw, and jab all of them all over his face, either having the tips of the fingers land all at once, or alternate them so as to make it seem to “rain” all over the face.

Another technique was to brush the face with my fingers. I would pretend that there was sand or flour all over his face and that I was trying to get it off. One of the gentler techniques.

I would also make a flat hand and then rub his face, as if it were made of wood and I had a piece of sandpaper attached to my palm.

Once I had gone through all the techniques, I would go back and start again with circular massaging, making sure to rub down through the skin and muscles around the mouth and jaw so that I could feel the teeth and gums. (David would complain sometimes that his pain felt as if he were the victim of a mad orthodontist. I was trying to counteract these sensations.) Or I would go back to some of the more intense techniques, trying to get them in at least twice. Or I would do a variation on the petrissage where I took the flesh between my thumb and forefinger, but instead of kneading, I would shake it slightly, as if making it vibrate. Or I would use a fist again but vibrate it on the surface of the skin.

Most of the time, I spent the last minute stroking the face, as if it were covered with long fur and I were trying to smooth it. This was also pretty gentle and it felt like a nice way to end.

You can see all this in the video we made.

As I said, I mostly figured out all these techniques and then came up with a “set” of them to use in order mostly to amuse myself. And it just seemed intuitively that a variety of sensations would cause the brain to “reset” itself in a more robust way.