Journal of Psychology & Psychotherapy
Open Access

Mirror mirror on the ward: Mirror box therapy for dissociative motor disorder in a child

Joint Event on 24^th International Conference on psychiatry & psychosomatic medicine & 2^nd International Congress on forensic science and psychology

October 12-14, 2017 London, UK

Matthew Rinaldi, Daniel Ilzarbe and Marinos Kyriakopoulos

King��?s College London, London, UK
Bethlem Royal Hospital, UK

Posters & Accepted Abstracts: J Psychol Psychother

Abstract :

Statement of the Problem: Dissociative motor disorder (DMD) is a clinical condition of medically unexplained symptoms of altered voluntary motor function. Evidence for interventions is limited in children, focusing on behavioural management and physiotherapy. We present the first case of a child with DMD affecting one hand and Mirror Box Therapy (MBT) added to her treatment. Methodology & Theoretical Orientation: The brainâ�?�?s tendency to recognize visual feedback before proprioceptive or somatic feedback and neuronal plasticity suggests that MBT may challenge the motor unawareness of DMD. The mirror box was constructed so that the unaffected hand only and the mirror image of it were visible to the patient, giving the visual impression that both hands moved symmetrically. A weekly programme was designed that would escalate through a hierarchy of perceived difficulty of a range of hand movements. The Brief Illness Perception Questionnaire (BIPQ) and Perceived Physical Ability Scale (PPAS) were completed pre-and post-intervention as was passive and active hand extension. Qualitative feedback was collected from the patient. Findings: The BIPQ score globally improved (53 to 44 out of 70) in how severely the hand affected her life and her level of worrying. She continued attributing symptoms completely to biological causes without differences in PPAS results (16 to 17 out of 24). The range of passive extension of hand joints improved, but active extension reduced due to secondary contractures which required splint intervention. Qualitatively, the young person was initially enthusiastic but later fed back that the treatment was â�?�?unhelpfulâ�?. Conclusion & Significance: MBT is a well-tolerated intervention in an under-researched area of paediatric mental health. Our method can be used alongside treatment-as-usual for future research in DMD populations where MBT is employed earlier in the disease process. This intervention may validate a biological understanding of the condition

Biography :

Matthew Rinaldi is a core Trainee Psychiatrist on the Maudsley training programme. He has interests in psychosomatic conditions, the psychotherapeutic understanding and multi-disciplinary management of them. A trainee who works for bottom-up service improvement, his work stems from under-researched problems that he encounters in clinical practice.