Here are many research studies on the effect of mirror neurons on
motor activity. Does watching a video of someone doing something help and heal.
In the research they call the videos Motor Imagery. Researchers have found that watching videos of someone doing a movement activates
mirror neurons and can help stroke victims recover. Here are two research
studies and an article that reviews the literature. Please note that
researchers sometimes work with actual mirrors so for example stroke victims
look at their active limb in a mirror, don’t confuse those findings with the
Motor Imagery research (watching videos.) I yellow highlighted the findings for
you.
Study one Abstract
The purpose of this study is to investigate
that effect of action observation training (AOT) on knee joint function and
balance in total knee replacement (TKR) patients. The subjects consisted of
eighteen post-TKR patients. All participants underwent conventional physical
therapy. In addition, patients in the AOT group (n= 9) were asked to observe
video clips showing daily actions and to imitate them afterward. Patients in
the control group (n= 9) were asked to execute the same actions as patients in
the AOT group. Outcome measures Western Ontario and Mc-Master Universities
Osteoarthritis Index (WOMAC) included pain, stiffness, function and Timed Up
and Go (TUG) test. After intervention, patients in the AOT group score better
than patients in the control group. After TUG test, patients in the AOT group
and control group were no significant difference between two groups. In
addition to conventional physical therapy, AOT is effective in the
rehabilitation of post-TKR patients. Action observation training is considered conducive to improving knee
functions and ameliorating pain and stiffness, of patients who underwent TKR. According to the present study’s results, pain, stiffness, and function
improved in patients with musculoskeletal system disease who had undergone
total knee arthroplasty. The gait did not change in those who watched the
videos but the pain stiffness and function did improve.
(Published online: 30 June 2014 DOI: http://dx.doi.org/10.12965/jer.140112The effect of action observation training on
knee joint function and gait ability in total knee replacement patientsSeong
Doo Park1, Hyun
Seung Song1, Jin
Young Kim2, * 1Graduate School of Physical
Therapy, Daejeon University, Daejeon, Korea2Department of
Occupational Therapy, Howon University, Gunsan, Korea*Corresponding
author: Jin Young Kim, Department of Occupational Therapy, Howon University, 64
Howondae 3gil, Impimyeon, Gunsan 573-932, Korea, Tel: +82-10-9348-7058, Fax:
+82-63-450-7480, E-mail: specialkjy@gmail.com Received 09 June 2014
Accepted 15 June 2014
Copyright
© 2014 Korean Society of Exercise Rehabilitation T
Study two - The possibility that plasticity might be induced in the
motor cortex by coupling action observation and execution represents the
theoretical basis of a recent study that examined the effect of an 18-day cycle
of active motor training with the paretic limb in two groups of patients with
chronic stabilized stroke in the middle cerebral artery territory.63 The test group was required to perform hand motor acts prompted by movies
showing similar motor acts, whereas the control group performed the same motor
training without any visual cues. Functional assessment of the upper limb
showed a significant improvement in the test group relative to the control
group. Ertelt D et
al. (2008) Action
observation has a positive impact on rehabilitation of motor deficits after
stroke. Neuroimage 36 (Suppl 2): T164–T173
Study three. I put the entire review of literature here. You can
look at the yellow highlighted portions.
The mirror neuron system in post-stroke
rehabilitation
Diana Carvalho1, Silmar Teixeira1,2, Marina Lucas1, Ti-Fei Yuan3,
Fernanda Chaves1, Caroline Peressutti2,4,
Sergio Machado5,6,7,13, Juliana Bittencourt2, Manuel
Menéndez-González8, Antonio Egidio Nardi5,7,
Bruna Velasques2,4, Mauricio Cagy9, Roberto Piedade2, Pedro
Ribeiro2,4,10 and Oscar Arias-Carrión11,12*
Abstract
Different treatments for stroke patients have been proposed; among
them the mirror therapy and motion imagery
lead to functional recovery by providing a cortical
reorganization. Up today the basic concepts of the current
literature on mirror neurons and the major findings regarding the
use of mirror therapy and
motor imagery as
potential tools to promote
reorganization and functional
recovery in post-stroke patients. Bibliographic research
was conducted based on publications over the past thirteen years
written in English in the databases Scielo,
Pubmed/MEDLINE, ISI Web of Knowledge. The studies showed how the
interaction among vision, proprioception
and motor commands promotes the recruitment of mirror neurons,
thus providing cortical reorganization and
functional recovery of post-stroke patients. We conclude that the
experimental advances on Mirror Neurons will
bring new rational therapeutic approaches to post-stroke
rehabilitation.
Keywords: Imagery, Imitation, Mirror
neurons system, Mirror therapy, Rehabilitation, Stroke
Introduction
Different approaches have been employed to investigate
post-stroke rehabilitation [1,2]. It has been shown that the
human brain is capable of significant recovery after this
type of injury [3,4]. Among its sequels, hemiparesis has
been treated with mirror-therapy which promotes cortical
changes [5,6]. In particular, sensorimotor disorders in
post-stroke patients during the execution or observation
of motor action have induced changes to the adjacent
cortical penumbra area [7]. Moreover, motion imagination
studies have demonstrated
efficacies in treating the poststroke
population [8]. Th
underlying hypothesis is that
“mirror
neurons” have been activated during such trainings.
These cells were firstly discovered in the premotor
cortex of rhesus monkeys by Rizzolatti and colleagues
when they analyzed the monkeys observing the researchers’
act of eating up a fruit. These cells were then named
because of their property to mirror the observed motor
act inside the brain of monkeys [9,10].
Further experiments have verified the existence of
mirror neurons in the parietal-frontal circuit, when an
animal was exposed to a task of observing a particular
action or intention mad by another animal [11,12]. Thus,
researchers suggested that mirror neurons are part of a
neural system where the observation of an action activates
the cortical area of the observer’s brain [10,13-15].
Therefore, the purpose of this review is to describe basic
concepts about the current literature on mirror neurons
and the major findings regarding the use of mirror therapy
and motor imagery as potential tools to promote cortical
reorganization and functional recovery in post-stroke
patients. The present review is divided in four sections: i)
Introduction to Mirror Neuron System: Evidences in
Humans; ii) Imitation: The role played by Mirror Neurons;
iii) Mirror Neuron System: The Hypothesis of Motor
Imagery, and iv) Contributions of the Mirror Neuron
System on Post-Stroke Rehabilitation.
Mirror neuron system: evidence in humans
The mirror neuron system is considered a major breakthrough
for neuroscience and it represents one important
* Correspondence: arias@email.ifc.unam.mx
11Sleep and Movement Disorders Clinic and Transcranial Magnetic
Stimulation Unit, Hospital General Dr Manuel Gea González, Secretaría
de
Salud, México, DF, México
12Sleep and Movement Disorders Clinic and Transcranial Magnetic
Stimulation Unit, Hospital General Ajusco Medio, Secretaría de
Salud, México,
DF, México
Full list of author information is available at the end of the
article
© 2013 Carvalho et al.; licensee BioMed Central Ltd. This is an
Open Access article distributed under the terms of the Creative
Commons Attribution License
(http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and
reproduction in any medium, provided the original work is properly
cited. The Creative Commons Public Domain Dedication
waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies
to the data made available in this article, unless otherwise
stated.
Carvalho et al. International
Archives of Medicine 2013, 6:41
http://www.intarchmed.com/content/6/1/41
feature during the evolution of the human brain [16,17].
In this context, several studies analyzed areas where this
system participates; in particular, the majority of the
experiments
in humans and monkeys found mirror neurons
in frontal and parietal lobes in tasks involving manual action
observation [5,6,18-20]. Moreover, other experiments
identified the activation of mirror neurons, specifically in
the inferior frontal gyrus and premotor cortex. These
findings were replicated in humans during task execution
and observation of motor acts with hands, feet and mouth
[21-23].
Several tools for cortical stimulation and brain mapping
have been employed to uncover the mechanisms
behind the activity of mirror neurons. Among them,
Transcranial Magnetic Stimulation (TMS) has provided
relevant information about the participation of the motor
cortex during simple action observation [20,24,25]. Hari
et al., 1998, investigated the
involvement of the mirror
neuron system during action observation using
magnetoencephalography.
With this technique, subjects were
instructed to observe stationary or moving stimuli. They
observed a suppression of the 15 to 25 Hz activity and
concluded that the human primary motor cortex is activated
during observation as well as execution of motor
tasks. Thus,
the mirror neuron system seems to play an
important role in human
mimicking behavior, and it is activated
when an individual observes
an action performed
by another person.
Furthermore, its activation does not
depend on memory; i.e., the
mirror neuron system is able
to identify action
complexity, and it unconsciously imitates
what we see, hear or
perceive [26].
Experiments using electroencephalography (EEG) also
demonstrate the existence of mirror neurons in humans
during movement observation [27,28]. Cooper et al. [28]
conducted an EEG study in order to analyze the occurrence
of alpha band oscillations over the sensorimotor
areas while the participants watched other people yawn.
To confirm this hypothesis, researchers showed videos
with individuals yawning to the subjects and found that
mirror neurons are involved in the recognition of yawning.
Additionally, Giromini et al. [27], analyzed the EEG
μ wave in central areas when
subjects watched other
people’s movements in different scenarios controlling
the amount of external stimuli provided. The results
showed that the sensation of motion is capable of
triggering activity of mirror neurons even when a small
amount of external stimuli is presented. In another
study, Oberman et
al. [29], examined the EEG μ rhythm
on the sensorimotor cortex in individuals with autism
when compared with controls of the same age [29]. They
found that, when children watched the videos with a
moving hand or with a bouncing ball or with any visual
stimulus, the mirror-neuron system responded dysfunctionally
in children with autism compared with controls,
as suggested in the “broken mirror” hypothesis. Taken
together, mirror neurons have functions that can explain
a wide range of human behaviors and neurological disorders
[30,31] (See Table 1).
Imitation and action learning: the role played by mirror
neurons
Mirror neurons have been associated with various forms
of human behaviors: imitation, mind theory, new skill
learning and intention reading [9,38-40]. Studies suggested
that humans have a mechanism for copying mental
notes of different behaviors, which partly explains
how we learn to smile, talk, walk, dance or play tennis.
This means that we mentally rehearse or imitate every
action observed, whether a somersault or [40,41] a
subtle smile, indicating that these cells are used to learn
everything from the first basic steps to more graceful
accurate movements. Therefore, imitation is involved in
learning through the transformation of visual inputs
encoded into action by the observer [18].
Studies hypothesize that mirror neurons provide a
fundamental neural basis for building imitative skills. To
clearly define imitative learning, it is necessary to establish
three strict criteria, i.e. the emulated behavior must:
i) be new to the imitator, ii) reproduce the behavioral
strategies of the model, and iii) share the same ultimate
goal. Therefore, behaviors that do not meet these criteria
should not be regarded as true and imitative and can be
explained by other mechanisms such as stimulus
enhancement of emulation or “response to facilitation”
[42]. Thus, to highlight the imitative process in humans,
functional magnetic resonance imaging (fMRI) studies
were conducted, instructing the volunteers to observe
and imitate a finger movement (imitation task), and to
later repeat the same movement in response to space
stimuli (task observation/execution). In other experiments
the same participants were asked to observe
identical stimuli, though without responding to them
(the observation tasks). The results showed that cortical
activation in imitation tasks is significantly higher than
in non-imitative ones [43,44]. Moreover, other fMRI
studies have shown that during a simple imitation task,
the activation of neuron cells occurs in Brodmann’s area
44, as well as in the parietal cortex. This result supported
other experiments showing that the mirror
neuron system is involved in human imitation [45,46].
The mirror neurons are present particularly in different
cortical areas: inferior frontal, inferior parietal, premotor
and occipital cortex [20]. For better visualization
(see Figure 1).
In this context, evidences
showed that the mirror
neuron system is involved
in imitation as a response to
the observed motor act [35]. Further studies applying
TMS found that the mirror neuron system plays a key
Carvalho et al. International
Archives of Medicine 2013, 6:41 Page 2 of 7
http://www.intarchmed.com/content/6/1/41
Figure 1 Neural circuitry for imitation
represented in the right hemisphere. vPMC = ventral premotor cortex; IFG = inferior frontal gyrus;
IPL = inferior parietal lobe; STG = superior temporal gyrus.
According to the evidence cited in this review, these regions are important to
understand the relationship between the mirror neuron areas and
the possible therapies in post-stroke patients.
Table 1 Clinical studies involving the mirror system
Study N Tool Procedure Results p value
Grèzes et al. [32] 12 fMRI Video recordings of objects, grasping
pantomimes.
Significant activation in the left intraparietal
area during object observation vs baseline.
p = 0.001
Montgomery et al. [33] 14 fMRI Videos of communicative hand gestures,
object-directed hand movements and
word stimuli.
Activations in the inferior parietal lobe and
frontal operculum. p < 0.001
Hamilton and Grafton. [34] 20 fMRI Handed participants watched
twelve sets
of videos presented in a pseudorandom
order and pressed a key if the film was
froze in the middle of the action.
A stronger response was found in regions
throughout the fronto-parietal circuits,
right inferior parietal lobule and right
inferior frontal gyrus extending to the
inferior frontal sulcus.
p < 0.001
Gazzola et al. [11] 16 fMRI Subjects watched either a human or a
robot performing various actions. All visual
stimuli were video clips lasting between
2.5 and 4 s.
During motor execution active areas
were: motor primary in the frontal lobe;
sensitive primary and secondary the
parietal lobe and the middle temporal
gyrus in the temporal lobe.
p < 0.001
Michielsen et al. [2,23] 22 fMRI Movement of the hands with
observation
of the mirror reflex.
The active regions were the precuneus
and the posterior cingulate cortex.
p < 0.005
Tanaka and Inui. [35] 12 fMRI Subjects were instructed to imitate
presented postures using their right
hand or fingers.
Significant activation was observed in
Broca’s area. p < 0.001
Heiser et al. [36] 14 TMS Patients watched different videos
showing a hand pressing a sequence of 2
(out of 4 possible keys) on a key-press box.
There was a selective deficit of the imitation
task for rTMS over the left and right pars
opercularis of the inferior frontal gyrus,
compared to rTMS over the occipital cortex.
p < 0.005
Stefan et al. [16] 20 TMS Task that encoded an elementary
motor memory.
Observation of movements led to the
formation of a lasting specific memory
trace in movement representations that
resembled that elicited by physical training.
p < 0.005
Oberman et al. [37] 11 EEG Subjects opened and closed their right
hand while watching a video of a
moving hand.
Consistent pattern of suppression in the
frequency band of interest. p = 0.001
Abbreviations: TMS, Transcranial magnetic stimulation, EEG, electroencephalography; μ, mu rhythm, fMRI, Functional magnetic resonance
imaging, FMS, Fugl-Meyer
scale, MP, Mental practice.
Carvalho et al. International
Archives of Medicine 2013, 6:41 Page 3 of 7
http://www.intarchmed.com/content/6/1/41
role in imitation. The use of TMS caused a temporary
depression in the caudal region of the left frontal gyrus
when the volunteers pressed the keyboard as a response
to a red light indicating which key should be pressed.
The findings suggested that during imitation, segmentation
of cortical action to be imitated occurred and
organization of these movements occurred as well [36].
Mirror neuron system: the hypothesis of motor imagery
Mental practice (MP), or motor imagery, is the internal
reproduction of a given motor act, which is repeated
several times in order to promote learning or just to
improve a given motor skill [8]. Thus, MP results from
the conscious access to the intention of moving, and it
establishes a relationship between motor events and cognitive
perceptions, specifically in post-stroke patients
[47,48]. MP can be used according to two different
principles: the first consists of internal images, where
the individual will perform a mental simulation, and the
second applies external image, i.e. the individual watches
the movement performed by another individual or by
segments of his own body, and this plays an important
role in the acquisition of new motor skills [49], improving
post-stroke patients rehabilitation. Verma et al. [50]
evaluated the effectiveness of circuit training with MP in
post-stroke individuals, and observed that the gait significantly
improved with this practice, i.e. the spasticity
was attenuated and ambulation was improved [50]. De
Vries et al. [47] surveyed 12 subjects who underwent
three imagery tasks, in order to examine whether MP
improves the recovery of individuals 3 to 6 weeks after
the stroke [47]. Results revealed improvements in the
ability of visual imagination and suggest that patients
with acute stroke, who cannot perform mental practice,
should use this modality during the period of rehabilitation.
On the other hand, Letswaart et al. [51] conducted
a cohort study in post-stroke patients (about three
months later) with residual weakness in the upper limb
[51]. Thirty nine patients underwent four weeks of mental
rehearsal of superior movements, 3 times per week,
using each arm for 45 minutes. When compared to 32
patients who received normal care, the MP group did
not show any significant result, suggesting that motor
recovery of post-stroke individuals does not increase
with MP. Despite the involvement of mirror neurons in
the motor act imitation [35], its activation via MP in the
early stages of post-stroke rehabilitation was not consistent
[51].
Contributions of the mirror neuron system on post-stroke
rehabilitation
The functional damages caused by stroke may be
irreversible and compromise the physical functions:
cognitive, perceptive, visual and emotional [52]. Thus,
physical therapists use many treatments on stroke
patients in order to attenuate their sequels. From this
point of view, the physical therapy intervention has been
implemented based on the neural system. Findings that
mirror neurons were activated in monkeys’ cerebral
cortex were the first step to research these neurons in
human brains [6]. This fact promoted the current treatments
of many diseases with the mirror therapy.
The imitation of the movement requires a complex
cognitive function that is gradually constructed in
several stages including motor observation [53,54]. Considering
this, therapies which activate mirror neurons
have been used in studies seeking a better post-stroke
rehabilitation. In particular, Burns (2008) has shown that
motor acts observation in
post-stroke patients rehabilitation
may accelerate the return
to functional activities
[55]. Within this context, researchers used fMRI to
examine brain activity in post-stroke patients watching a
video which contained sequences of mouth, hand and
foot movements and they noted that the patients’ cortical
areas were activated after observation. A simple exposure
to videos showing functional task performances
activated the mirror neuron system [7,48]. In particular,
the use of mirror therapy has been shown to improve
movement recovery, reinforcing motor circuits responsible
for the execution of observed actions [8]. This
treatment model uses a mirror in such a way that it
reflects the action of the healthy limb hiding the affected
one. This technique has shown that a neural network
responsible for controlling the movement of a particular
body region can also be used to control the movements
of the contralateral body region. Thus, the idea is to
retrain the brain via
a simple task, where the
individual
can perform a series of movements with the healthy
limb; this is reflected by the mirror and the brain is
“tricked” thinking that the movement is performed by
the affected limb [1].
The use of mirror therapy
in post-stroke patients
involves a re-assemblage of
the body image in the
sensorimotor cortex, which
can generate movement
limitations, classified as “learned
paralysis”. In fact, the
fibers that extend from the
brain to the spinal cord are
deprived of oxygen and
suffer an injury, causing a real
paralysis. In addition to
this, in the early stages of
cerebral damage, the
penumbra area presents a cellular
swelling, temporarily
leaving neurons with little or no
conduction property.
Moreover, during its inactive
period, the brain receives
only negative visual feedback;
this will possibly promote
a form of learned paralysis,
due to residual mirror
neuron functioning. In this case,
mirror therapy can
potentially reactivate the cortical
motor neurons [56].
Therefore, mirror therapy has been
used in many clinical
instances, because it accelerates
the functional recovery of
a wide range of sensorimotor
Carvalho et al.
International Archives of Medicine 2013, 6:41 Page 4 of
7
http://www.intarchmed.com/content/6/1/41
disorders, such as post-stroke hemiparesis [57]. Hamzei
et al. [58] studied the neural
plasticity in the primary
sensory motor cortex using mirror therapy conducting
an experiment in which subjects performed hand movement
tasks for 20 minutes every day during 4 days [58].
The authors found that compared to the control group,
the performance of the untrained hand improved significantly
in the group that used the mirror therapy.
Moreover, in the pre-training and post-training analysis,
right dorsal and left ventral pre-motor cortex, primary
sensorimotor
cortex and supplementary motor area were activated.
Thus, mirror therapy influences the neural circuitry,
which reprograms the motor act by observing the hand
trained by the illusory movement of the untrained hand.
In order to examine the clinical effects of mirror
therapy and cortical reorganization in 40 post-stroke
patients, Michielsen et al. [2] divided the subjects into
two groups: control and mirror therapy groups; they
performed a task using the upper limb one hour per day,
five days per week, during six weeks. For such analysis,
fMRI and Fugl-Meyer scale (FMS), which evaluates
motor function, were used. The FMS results showed that
the group with mirror therapy significantly improved its
scores, but these changes were not sustained in the
follow-up trials. On the other hand, a more balanced
activity was observed in the primary motor cortex after
fMRI. In another study, Michielsen et al. [23] used the
mirror therapy in 22 post-stroke patients who performed
unimanual and bimanual tasks under two conditions:
hand observation (no mirror condition), and observation
of the hand reflex in the mirror (mirror condition). They
found a significant increase in the posterior cingulate
activity and a reduction of ‘learned non-use’ (loss of
movement ability) patterns during of the movement with
the mirror in the bimanual task. They did not find activation
during the unimanual condition suggesting that it
is not the illusion of a virtual moving hand that causes
this activation, but the mismatch between the movement
one performs and the movement that is observed [2,23].
Franceschini et
al. [59] valuated the efficacy of
the mirror
therapy for upper limb motor impairment in poststroke
patients. In
this study, 28 patients with chronic
upper limb motor impairment
underwent a treatment
consisting of watching
videos of hand movements for
5 days a week during 4
weeks, and the subjects performed
imitation of the movement
[59]. Due to the significant
findings, they concluded
that the observed action can be
used as an effective
strategy in post-stroke rehabilitations.
Thus, mirror neurons can be
activated not only using
mirror therapy, but also
through motor imagery [8].
MNS and music therapy
Some of the mirror neurons could respond to sounds
that are specific for actions, which were named as
“audio-visual” mirror neurons [18]. This suggests that
combined therapies including both visual and auditory
that activate mirror neuron system might be more
effective in promoting rehabilitation, which could be,
possibly, achieved by online virtual pets [60] or designed
multi-media techniques. On the other hand, this
suggested that auditory function impairment might be
restored with specifically designed MNS training procedures.
This idea is yet to be clinically tested.
As a unique and multi-modal stimulus, music transfers
visual, auditory, somatosensory and proprioceptive information
simultaneously. Interestingly, it has been suggested
that music related brain activity involving imitation and
synchronization overlapped with MNS brain regions
[61,62]. Additionally, the inferior frontal gyrus and the
ventral premotor cortex (including Broca’s area)
that belong
to MNS participated in music execution and listening
[63]. For instance, Broca’s area was activated during
music
perception tasks, active music tasks such as singing, and
imagination of playing an instrument [64]. These evidences
strongly argued for the potential function of MNS
during music-relevant behaviors. It should be noted that
in autism patients, individuals with normal (singing) and
even superior abilities with specific aspects of music processing
(pitch memory and absolute pitch, etc.) could be
found as well. This dissociation between singing and
speaking is similar to what was observed in Broca’s
aphasia
patients.
The music based activation of MNS therefore provided
alternative option of brain activity manipulation beyond
visual training therapy, as well as the possibility of
mutli-sensory stimulation. For instance, Melodic intonation
therapy (MIT) is one of music-based therapeutic
interventions using hand tapping to promote engagement
of the sensorimotor network in patients with
aphasia [65,66]. These available approaches are ready to
be modified from a MNS based perspective for further
studies. Music therapy has already been employed to
treat some disorders discussed above, such as aphasia
[67], stroke [68,69]. It is acknowledged that the psychosomatic
effects of music also contributed to the beneficial
aspects of music therapy [70,71]; whether MNS
activation also mediates such effects are to be examined.
Conclusion
The mirror neuron system can explain many human
behaviors and disorders. Mirror neurons are involved in
imitative learning through interactions with neural
motor areas in humans. The application of mirror therapy
techniques, based on the functions of the mirror
neuron system, in post-stroke patients has demonstrated
good results, mainly when combined with other therapies.
Moreover, the studies showed that the mirror
neuron system interacts with vision, proprioception and
Carvalho et al. International
Archives of Medicine 2013, 6:41 Page 5 of 7
http://www.intarchmed.com/content/6/1/41
motor commands, promoting the recruitment of mirror
neurons and the cortical reorganization and functional
recovery of post-stroke patients. However, many brain
areas are not activated in
mirror therapy and this factor
may compromise the therapy.
Also, patients experience
fatigue and attention level
decrease, which may cause a
deficiency in concentration
when executing mirror
therapy tasks.
Competing interests
The authors declared that there are no competing interests.
Authors’ contributions
DC, ST, PR and OAC participated in the definition of the study
design and
the protocol. Authors DC, ST, PR and OAC managed the literature
searches.
Authors DC, ST, AEN, PR and OAC wrote the first draft of the
manuscript.
All authors contributed to and have approved the final manuscript.
Acknowledgements
OAC is supported by Hospital General Dr. Manuel Gea Gonzalez and
Hospital
General Ajusco Medio.
Author details
1Physiotherapy Laboratory, Veiga de Almeida University (UVA), Rio
de Janeiro,
Brazil. 2Brain Mapping and Sensory Motor Integration, Institute of
Psychiatry
of Federal, University of Rio de Janeiro (IPUB/UFRJ), Rio de
Janeiro, Brazil.
3NCI, Shanghai, China. 4Institute of Applied Neuroscience (INA),
Rio de
Janeiro, Brazil. 5Laboratory of Panic and Respiration, Institute
of Psychiatry,
Federal University of Rio de Janeiro (IPUB/UFRJ) - National
Institute of
Translational Medicine (INCT-TM), Rio de Janeiro, Brazil. 6Faculty
of Medical
Sciences, Quiropraxia Program, Central University, Santiago,
Chile. 7Physical
Activity Neuroscience, Physical Activity Postgraduate Program,
Salgado de
Oliveira University (UNIVERSO), Niterói, Brazil. 8Neurology Unit,
Hospital
Álvarez-Buylla, Mieres, Spain. 9Division of Epidemiology and
Biostatistic,
Institute of Health Community, Federal Fluminense University
(UFF), Rio de
Janeiro, Brazil. 10Bioscience Department (EEFD/UFRJ), School of
Physical
Education, Rio de Janeiro, Brazil. 11Sleep and Movement Disorders
Clinic and
Transcranial Magnetic Stimulation Unit, Hospital General Dr Manuel
Gea
González, Secretaría de Salud, México, DF, México. 12Sleep and
Movement
Disorders Clinic and Transcranial Magnetic Stimulation Unit,
Hospital General
Ajusco Medio, Secretaría de Salud, México, DF, México. 13Institute
of
Phylosophy, Federal University of Uberlândia, Uberlândia, Brazil.
Received: 3 September 2013 Accepted: 12 October 2013
Published: 17 October 2013
References
1. Altschuler EL, Wisdom SB, Stone L, Foster C, Galasko D,
Llewellyn DM,
Ramachandran VS: Rehabilitation
of hemiparesis after stroke with a
mirror. Lancet 1999, 353(9169):2035–2036.
2. Michielsen ME, Selles RW, van der Geest JN, Eckhardt M, Yavuzer
G, Stam HJ,
Smits M, Ribbers GM, Bussmann JB: Motor recovery and cortical
reorganization after mirror therapy in chronic stroke patients: a
phase II
randomized controlled trial. Neurorehabil Neural Repair 2011, 25(3):223–233.
3. Broderick J, Brott T, Kothari R, Miller R, Khoury J, Pancioli
A, Gebel J, Mills D,
Minneci L, Shukla R: The greater cincinnati/northern kentucky stroke
study: preliminary first-ever and total incidence rates of stroke
among
blacks. Stroke 1998, 29(2):415–421.
4. Kalra L, Ratan R: Recent advances in stroke rehabilitation 2006.
Stroke 2007, 38(2):235–237.
5. Umilta MA, Escola L, Intskirveli I, Grammont F, Rochat M,
Caruana F, Jezzini
A, Gallese V, Rizzolatti G: When pliers become fingers in the monkey
motor system. Proc Natl Acad Sci USA 2008, 105(6):2209–2213.
6. Van Der Werf YD, Van Der Helm E, Schoonheim MM, Ridderikhoff A,
Van
Someren EJ: Learning by observation
requires an early sleep window.
Proc Natl Acad Sci USA 2009, 106(45):18926–18930.
7. Cacchio A, De Blasis E, De Blasis V, Santilli V, Spacca G: Mirror therapy in
complex regional pain syndrome type 1 of the upper limb in stroke
patients. Neurorehabil Neural Repair
2009, 23(8):792–799.
8. Garrison KA, Winstein CJ, Aziz-Zadeh L: The mirror neuron system: a neural
substrate for methods in stroke rehabilitation. Neurorehabil Neural Repair
2010, 24(5):404–412.
9. Rizzolatti G, Craighero L: The mirror-neuron system. Annu Rev Neurosci
2004, 27:169–192.
10. Fadiga L, Craighero L, Olivier E: Human motor cortex excitability during
the perception of others’ action. Curr Opin Neurobiol 2005, 15(2):213–218.
11. Gazzola V, Rizzolatti G, Wicker B, Keysers C: The anthropomorphic brain:
the mirror neuron system responds to human and robotic actions.
Neuroimage 2007, 35(4):1674–1684.
12. Cattaneo L, Rizzolatti G: The mirror neuron system. Arch Neurol 2009,
66(5):557–560.
13. Buccino G, Binkofski F, Riggio L: The mirror neuron system and action
recognition. Brain Lang 2004, 89(2):370–376.
14. Rizzolatti G: The
mirror neuron system and its function in humans.
Anat Embryol 2005,
210(5–6):419–421.
15. Williams JH, Waiter GD, Gilchrist A, Perrett DI, Murray AD,
Whiten A: Neural
mechanisms of imitation and ‘mirror neuron’ functioning in autistic
spectrum disorder. Neuropsychologia 2006,
44(4):610–621.
16. Stefan K, Cohen LG, Duque J, Mazzocchio R, Celnik P, Sawaki L,
Ungerleider
L, Classen J: Formation
of a motor memory by action observation.
J Neurosci 2005, 25(41):9339–9346.
17. Pfeifer JH, Iacoboni M, Mazziotta JC, Dapretto M: Mirroring others’
emotions relates to empathy and interpersonal competence in
children.
Neuroimage 2008, 39(4):2076–2085.
18. Kohler E, Keysers C, Umilta MA, Fogassi L, Gallese V,
Rizzolatti G: Hearing
sounds, understanding actions: action representation in mirror
neurons.
Science 2002, 297(5582):846–848.
19. Dapretto M, Davies MS, Pfeifer JH, Scott AA, Sigman M,
Bookheimer SY,
Iacoboni M: Understanding emotions in
others: mirror neuron
dysfunction in children with autism spectrum disorders. Nat Neurosci
2006, 9(1):28–30.
20. Iacoboni M, Dapretto M: The mirror neuron system and the
consequences of its dysfunction. Nat Rev Neurosci 2006,
7(12):942–951.
21. Gazzola V, Aziz-Zadeh L, Keysers C: Empathy and the somatotopic
auditory mirror system in humans. Curr Biol 2006, 16(18):1824–1829.
22. Le Bel RM, Pineda JA, Sharma A: Motor-auditory-visual integration: the
role of the human mirror neuron system in communication and
communication disorders. J Commun Disord 2009,
42(4):299–304.
23. Michielsen ME, Smits M, Ribbers GM, Stam HJ, van der Geest JN,
Bussmann
JB, Selles RW: The
neuronal correlates of mirror therapy: an fMRI study on
mirror induced visual illusions in patients with stroke. J Neurol Neurosurg
Psychiatry 2011, 82(4):393–398.
24. Caggiano V, Fogassi L, Rizzolatti G, Pomper JK, Thier P, Giese
MA, Casile A:
View-based encoding of actions in mirror neurons of area f5 in
macaque
premotor cortex. Curr Biol 2011, 21(2):144–148.
25. Cattaneo Z, Mattavelli G, Papagno C, Herbert A, Silvanto J: The role of the
human extrastriate visual cortex in mirror symmetry
discrimination: a
TMS-adaptation study. Brain Cogn 2011, 77(1):120–127.
26. Maeda F, Kleiner-Fisman G, Pascual-Leone A: Motor facilitation while
observing hand actions: specificity of the effect and role of
observer’s
orientation. J Neurophysiol 2002,
87(3):1329–1335.
27. Giromini L, Porcelli P, Viglione DJ, Parolin L, Pineda JA: The feeling of
movement: EEG evidence for mirroring activity during the
observations
of static, ambiguous stimuli in the Rorschach cards. Biol Psychol 2010,
85(2):233–241.
28. Cooper NR, Puzzo I, Pawley AD, Bowes-Mulligan RA, Kirkpatrick
EV,
Antoniou PA, Kennett S: Bridging a yawning chasm: EEG
investigations into the debate concerning the role of the human
mirror neuron system in contagious yawning. Cogn Affect Behav
Neurosci 2012, 12(2):393–405.
29. Oberman LM, Hubbard EM, McCleery JP, Altschuler EL,
Ramachandran VS,
Pineda JA: EEG evidence for mirror neuron
dysfunction in autism
spectrum disorders. Brain Res Cogn Brain Res 2005, 24(2):190–198.
30. Gallese V, Keysers C, Rizzolatti G: A unifying view of the basis of social
cognition. Trends Cogn Sci 2004, 8(9):396–403.
31. Pomeroy VM, Clark CA, Miller JS, Baron JC, Markus HS, Tallis
RC: The
potential for utilizing the “mirror neurone system” to enhance recovery
of the severely affected upper limb early after stroke: a review
and
hypothesis. Neurorehabil Neural Repair
2005, 19(1):4–13.
Carvalho et al. International
Archives of Medicine 2013, 6:41 Page 6 of 7
http://www.intarchmed.com/content/6/1/41
32. Grèzes J, Tucker M, Armony J, Ellis R, Passingham RE: Objects automatically
potentiate action: an fMRI study of implicit processing. Eur J Neurosci
2003, 17(12):2735–2740.
33. Montgomery KJ, Isenberg N, Haxby JV: Communicative hand gestures and
object-directed hand movements activated the mirror neuron system.
Soc Cogn Affect Neurosci 2007, 2(2):114–122.
34. Hamilton AF, Grafton ST: Action outcomes are represented in human
inferior frontoparietal cortex. Cereb Cortex 2008,
18(5):1160–1168.
35. Tanaka S, Inui T: Cortical involvement for action imitation of hand/arm
postures versus finger configurations: an fMRI study. Neuroreport 2002,
13(13):1599–1602.
36. Heiser M, Iacoboni M, Maeda F, Marcus J, Mazziotta JC: The essential role
of Broca’s area in imitation. Eur J Neurosci 2003,
17(5):1123–1128.
37. Oberman LM, Pineda JA, Ramachandran VS: The human mirror neuron
system: a link between action observation and social skills. Soc Cogn
Affect Neurosci 2007,
2(1):62–66.
38. Rizzolatti G, Fogassi L, Gallese V: Neurophysiological mechanisms
underlying the understanding and imitation of action. Nat Rev Neurosci
2001, 2(9):661–670.
39. Hickok G: Eight
problems for the mirror neuron theory of action
understanding in monkeys and humans. J Cogn Neurosci 2009,
21(7):1229–1243.
40. Martineau J, Andersson F, Barthelemy C, Cottier JP, Destrieux
C: A typical
activation of the mirror neuron system during perception of hand
motion in autism. Brain Res 2010, 1320:168–175.
41. Koski L, Iacoboni M, Dubeau MC, Woods RP, Mazziotta JC: Modulation of
cortical activity during different imitative behaviors. J Neurophysiol 2003,
89(1):460–471.
42. Gallese V, Goldman A: Mirror neurons and the simulation theory of
mind-reading. Trends Cogn Sci 1998,
2(12):493–501.
43. Iacoboni M, Woods RP, Brass M, Bekkering H, Mazziotta JC,
Rizzolatti G: Cortical
mechanisms of human imitation. Science 1999,
286(5449):2526–2528.
44. Nishitani N, Hari R: Temporal dynamics of cortical representation for
action. Proc Natl Acad Sci USA 2000, 97(2):913–918.
45. Williams JH, Whiten A, Suddendorf T, Perrett DI: Imitation, mirror neurons
and autism. Neurosci Biobehav Rev 2001, 25(4):287–295.
46. Hamilton AF, Brindley RM, Frith U: Imitation and action understanding in
autistic spectrum disorders: how valid is the hypothesis of a
deficit in
the mirror neuron system? Neuropsychologia 2007,
45(8):1859–1868.
47. de Vries S, Tepper M, Otten B, Mulder T: Recovery of motor imagery ability
in stroke patients. Rehabil ResPract 2011,
2011:283840.
48. de Vries S, Mulder T: Motor imagery and stroke rehabilitation: a critical
discussion. J Rehabil Med 2007, 39(1):5–13.
49. Anwar MN, Tomi N, Ito K: Motor imagery facilitates force field learning.
Brain Res 2011, 1395:21–29.
50. Verma R, Arya KN, Garg RK, Singh T: Task-oriented circuit class training
program with motor imagery for gait rehabilitation in poststroke
patients: a randomized controlled trial. Top Stroke Rehabil 2011,
18(Suppl 1):620–632.
51. Ietswaart M, Johnston M, Dijkerman HC, Joice S, Scott CL,
MacWalter RS,
Hamilton SJ: Mental
practice with motor imagery in stroke recovery:
randomized controlled trial of efficacy. Brain 2011, 134(Pt 5):1373–1386.
52. Wojner-Alexander AW, Garami Z, Chernyshev OY, Alexandrov AV: Heads
down: flat positioning improves blood flow velocity in acute
ischemic
stroke. Neurology 2005, 64(8):1354–1357.
53. Small SL, Buccino G, Solodkin A: The mirror neuron system and treatment
of stroke. Dev Psychobiol 2012, 54(3):293–310.
54. Garrison KA, Aziz-Zadeh L, Wong SW, Liew SL, Winstein CJ: Modulating
the motor system by action observation after stroke. Stroke 2013,
44(8):2247–2253.
55. Burns MS: Application
of neuroscience to technology in stroke
rehabilitation. Top Stroke Rehabil 2008, 15(6):570–579.
56. Ramachandran VS, Rogers-Ramachandran D, Stewart M: Perceptual
correlates of massive cortical reorganization. Science 1992,
258(5085):1159–1160.
57. Sutbeyaz S, Yavuzer G, Sezer N, Koseoglu BF: Mirror therapy enhances
lower-extremity motor recovery and motor functioning after stroke:
a randomized controlled trial. Arch Phys Med Rehabil 2007,
88(5):555–559.
58. Hamzei F, Lappchen CH, Glauche V, Mader I, Rijntjes M, Weiller
C:
Functional plasticity induced by mirror training: the mirror as
the
element connecting both hands to one hemisphere. Neurorehabil Neural
Repair 2012, 26(5):484–496.
59. Franceschini M, Agosti M, Cantagallo A, Sale P, Mancuso M,
Buccino G:
Mirror neurons: action observation treatment as a tool in stroke
rehabilitation. Eur J Phys Rehabil Med 2010, 46(4):517–523.
60. Altschuler EL: Play with online virtual pets as a method to improve mirror
neuron and real world functioning in autistic children. Med Hypotheses
2008, 70(4):748–749.
61. D’Ausilio A: Mirror-like mechanisms and music. ScientificWorldJournal 2009,
9:1415–1422.
62. Molnar-Szakacs I, Overy K: Music and mirror neurons: from motion to
‘e’motion. Soc Cogn Affect Neurosci 2006, 1(3):235–241.
63. Fadiga L, Craighero L, D’Ausilio A: Broca’s area in language, action, and
music. Ann N Y Acad Sci 2009, 1169:448–458.
64. Tillmann B, Janata P, Bharucha JJ: Activation of the inferior frontal cortex
in musical priming. Brain Res Cogn Brain Res 2003, 16(2):145–161.
65. Sparks R, Helm N, Albert M: Aphasia rehabilitation resulting from melodic
intonation therapy. Cortex 1974, 10(4):303–316.
66. Norton A, Zipse L, Marchina S, Schlaug G: Melodic intonation therapy:
shared insights on how it is done and why it might help. Ann N Y Acad
Sci 2009, 1169:431–436.
67. Tomaino CM: Effective
music therapy techniques in the treatment of
nonfluent aphasia. Ann N Y Acad Sci 2012,
1252(1):312–317.
68. van Wijck F, Knox D, Dodds C, Cassidy G, Alexander G,
Macdonald R:
Making music after stroke: using musical activities to enhance arm
function. Ann N Y Acad Sci 2012, 1252(1):305–311.
69. Forsblom A, Laitinen S, Sarkamo T, Tervaniemi M: Therapeutic role of music
listening in stroke rehabilitation. Ann N Y Acad Sci 2009,
1169:426–430.
70. Sarkamo T, Tervaniemi M, Laitinen S, Forsblom A, Soinila S,
Mikkonen M,
Autti T, Silvennoinen HM, Erkkila J, Laine M, et al: Music listening enhances
cognitive recovery and mood after middle cerebral artery stroke.
Brain 2008, 131(Pt
3):866–876.
71. Hari R, Forss N, Avikainen S, Kirveskarj E, Salenius S,
Rizzolatti G: Activation
of human primary motor cortex during action observation: a
neuromagnetic study. Proc Natl Acad Sci USA 1998, 95:15061–15065.
doi:10.1186/1755-7682-6-41
Cite this article as: Carvalho et al.: The
mirror neuron system in poststroke
rehabilitation. International Archives of Medicine 2013 6:41.
Submit your next manuscript to BioMed Central
and take full advantage of:
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at
www.biomedcentral.com/submit
Patti Wood, MA, Certified Speaking Professional - The Body Language Expert. For more body language insights go to her website at www.PattiWood.net. Check out Patti's website for her new book "SNAP, Making the Most of First Impressions, Body Language and Charisma" at www.snapfirstimpressions.com. Also check out Patti's YouTube channel at http://youtube.com/user/bodylanguageexpert.
.jpg)
.jpg)
.jpg)
.jpg)