Patti Wood Body Language Expert Blog

Does watching people move or exercise help people? Does watching video of exercise reduce pain or improve ability?

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 Kim^{2, *} 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

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

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

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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.

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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

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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

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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

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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.

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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.

Body Language Read of Emma and Andrew - Chilly in the City!

Funny Wedding Toast - The Power of a Pause in Your Presentations

I coached a client who was giving the wedding toast for his daughter’s wedding. We worked on his content and delivery so the wedding toast would be both touching and amusing. Afterwards I asked him, “What was the best part?”

He replied, “The funniest part of the toast was never expected. My toast was after dinner before the cutting of the cake. The toast was going great between laughter and a few tears. I got to the part, “My wish to both of you is to have a love story like my Mother and Father in law. Amanda’s Grandparents tonight are celebrating their 56th wedding anniversary! How exciting to share the same wedding date!"

My father in-law stood up slowly on one side of the room and then my mother in-law stood up on the opposite side of the room and the crowd just laughed. The expression on my mother in-law was priceless.

I just thought of the power of the pause for humor and gave a long pause. Everyone kept laughing.

Can You Send a Text to Communicate a Death?

With the addition of technology, we now have many ways to communicate a message. We need to be smart about the choices we make. Because there are more ways to put your message across, it is easier to make the wrong choice. For example, if you are delivering a message that may elicit a strong emotional response in the receiver you should not use a text or email to transmit it. It is not just unprofessional; it can be unfeeling and cowardly. I was appalled to find out that in the Malaysia Airlines disaster, the airline officials sent a text message to the passenger’s families to tell them flight MH370 ended up in the Indian Ocean. They couldn't make a phone call?!

You may think that at work you have given out a lot of information and data to be credible. The amount is less important than what you say and how you say it. When you speak in person it is an opportunity to see and hear what emotion or emotions the person or people you are communicating with have, as well as an opportunity for you to acknowledge their emotions and if you need to shift the way they think, feel and act.

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.

Body Language Read of Rob Pattinson and FKA Twigs

Body Language Read of Bethenny Frankel and Mac

In the bathing suit shot above, I love that they are facing towards each other with all the lower body windows open to each other. I also like how the very strong Bethenny has her hands resting on his shoulders in a way that shows she is beginning to trust and rely on him. Wish they were looking in each other eyes. I give this couple a 4 on Life & Style's True Love Rating Scale.

The above photo of them walking ( love the red boots) I like that they are on the same walking plane, neither one ahead of the other. (Bethenny is typically a walk in front person in a couple). I also like how his arm is reaching out to touch her. I like that her purse is on the outside. But they are not close together so I give them a 3 on Life & Style's True Love Rating Scale.

Body Language Read of Andrew Garfield and Emma Stone

I did a body language read of Andrew Garfield and Emma Stone for Life & Style today which will appear in an upcoming Life & Style. Below are my reads of this couple.

In the top photo even though they are walking far apart they have a wonderful interlaced hand hold. Their heads are down facing toward the camera rather than down as reflective of their relationship.
I give them a 3

The second photo is interesting his forward position and intensity seem to be for the camera. He is pushing her back. Her fist could be meant for him or for the photographer but she is not as accepting of the kiss as I would like.
I give them a 4.

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.

Body Language Read of Ben and Jen

The photo of them in the blue shirts. I oddly actually like it. They have really nice melding hand hold though they are far apart and she is a step back, he is looking back and adjusting his gait to hers a bit in that moment. Yes he has a upside down masking smile suppression anger, but you can tell it is about the photographer as his body position is protective of her and she is actually relaxed and not responding to his facial expression as being meant for her. She is tilting her head to look at him not away from him!

The other photo is adorable I give it a 5 He is wrapped behind her in what I call Papa Bear position. It's actually a couples sleep position. He is protective and a bit playful. His feet are far apart that is Pappa protective stance, ready for guarding action. He has his elbow out, expanding his silhouette and making himself bigger and he has a playful smile on his face, and his eyes towards the photographers making sure she is safe. She is backing in to him and her rear and though her arms are close to her body and her hands are cupped around her stuff, her smile and close positions she is happily surmising to his protection and strength.

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.

Body Language Read of Lady Gaga and Taylor Kinney

What do you do if you are asked for a price quote via email?

Does your sales force talk about this as a new challenge of trying to respond to email RFQs Request for quotes?

An email comes in…

It’s a potential client who would like a quote on your services. Do you send them a quote or even a ball park number or do you at least attempt to bring this discussion to “real time” as in live via that cave man device called a “phone”?

Buyers are emailing because they want to avoid a sales pitch and just flat out save time. Sales people respond via email because they feel this is the way the prospect wants to proceed.

Personally, I don’t like anything that puts me in a price discussion without establishing a relationship. I want to hear their voice and find out important components such as their needs and be able to communicate the value of my services. Call me a crazy nonverbal communication expert, but I think it’s helpful to hear the true tone of one’s words. Oddly I am often told that I was the only person who suggested we talk.

What do you do when a potential client asks for pricing via email?

First you know that typically the RFQs are typically collected and used by someone lower in the chain. If you talk to them and try to find out their budget and needs they typically say, “I don’t know I have to check with….” They are gathering prices that they like rather than product of services that they like. I swear I think that there are sales and negation programs not that say that one way to get the lowest quote is to send a request via email then say you don’t know the budget or the only thing you know is that it is a very small budget! You want to get to the decision maker. So if you can ask lots of questions to discover needs and if the “I don’t know” emailer can’t answer them, you have the opportunity to ask to speak to the decision maker. Have your needs and questions ready. Be able to send them out via email or if you get a call with the “I don’t knower” be able to ask them very pithy questions that let them know you care about serving them and you have the experience of serving and customizing based on needs.

Geno Smiths Body Language Sports writer notices body language After Jets Fifth Straight Loss Smith Says He Remains Optimistic

Oct. 12, 2014 10:14 p.m. ET

The words could have been patronizing coming from anyone but Peyton Manning. He is arguably the greatest of all time, a future Hall of Famer on the brink of breaking the NFL record for passing touchdowns.

So the Jets’ Geno Smith listened as the two quarterbacks met for the traditional postgame handshake after Denver’s 31-17 win Sunday at MetLife Stadium.

“Keep your head up, keep at it,” Manning said, as Smith recalled.

His obscene outburst at a Jets fan notwithstanding, Smith is often difficult to read. He doesn’t sport the famously glum “Manning face” that Peyton and especially his brother, Giants quarterback Eli Manning, do when things aren’t going well. He said Sunday evening that he remains “optimistic.”

But Smith’s body language shows that he realizes he has become a league-wide punch line.

Even “Saturday Night Live” is in on the joke. About 12 hours before kickoff Sunday, Weekend Update anchor Colin Jost quipped that Smith celebrated his 24th birthday on Friday, but “sadly, when Smith blew out the candles, his birthday wish was intercepted and returned for a touchdown.”

It turned out to be a prescient joke, after Smith’s desperate, last-minute heave on Sunday ended up in the hands of Denver’s Aqib Talib, who trotted into the end zone to clinch the game.

Even after the cursing incident, which followed a two-turnover performance against Detroit on Sept. 28, Smith bristled at a reporter who asked whether backup Michael Vickcould provide a spark for the team for a quarter of a game. Smith said that “didn’t make sense” and then told the reporter, who had tried to ask a follow-up question, “That’s not a question. Next question.”

The fieriness cooled into icy sobriety just days later, after Smith was benched during halftime in the Jets’ 31-0 loss to San Diego. As head coach Rex Ryan spoke at a spirited postgame news conference in a windowless, air-condition-less room, I saw Smith sneak into a folding chair to Ryan’s right. His arms rested on his thighs and he stared straight ahead. I had spent the previous week interviewing him about his 22-year-old adopted brother, who is also his apartment-mate and confidant, so I tried to make eye contact with him. The quarterback either ignored me or didn’t see me, confined to his own melancholy mind.

If he was more engaged after Sunday’s loss to Denver, it was barely noticeable. Smith improved on his 4-for-12 performance from a week ago by finishing Sunday 23-of-43 with two touchdowns and that one last-minute interception. He has now thrown six touchdowns and seven interceptions this season.

After the game, he never complained about his offensive line, which for the second straight week gave him little time to throw, nor about his receivers, who dropped three important passes. Uncharacteristically, though, he did assign some blame to his running backs, who gained just 20 yards on 13 carries, before catching himself.

“Obviously, we’ve got to run the ball better,” he said. “But the passing game should be able to pick it up.”

I asked how he was feeling at that moment, with Jets 1-6 on the season and looking ahead to a Thursday night matchup in New England. He gave the obvious answer. “I’m frustrated,” he said. “Five losses in a row obviously has everyone frustrated. But I’m optimistic.”

He said Thursday’s game would give the team a quick chance to bounce back. Someone else asked Smith how he could stay optimistic as the ship continued to sink. The question seemed to surprise him.

“I wake up every day and I get another chance at life,” he said. “That’s good enough for me.”

Write to Stu Woo at Stu.Woo@wsj.com

Should Doctors Give Speeches and Media Interviews?

There are advantages and cautions for doctors trying to grow their practice by giving lectures and media interviews.

As a professional speaker, media coach and body language expert who is quoted in the National Media several times a week, I know many pros and cons of that kind of exposure. I have done media training with doctors including the American Academy of Emergency Physicians. My experience is that it can build a doctor’s credibility and their confidence level in general.

If you not only know your material for a speech, but have a captivating interactive delivery style rather than a boring, monotone, PowerPoint filled lecture, you gain great respect. You also need to really know how to handle difficult questions from audiences and the media.

It is amazing how being quoted in print media or being interviewed on TV or radio impresses people. The most important thing is to do it well so you do not harm your credibility.

Patti Wood Body Language Expert Blog

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Does watching people move or exercise help people? Does watching video of exercise reduce pain or improve ability?

Body Language Read of Emma and Andrew - Chilly in the City!

Funny Wedding Toast - The Power of a Pause in Your Presentations

Can You Send a Text to Communicate a Death?

Body Language Read of Rob Pattinson and FKA Twigs

Body Language Read of Bethenny Frankel and Mac

Body Language Read of Andrew Garfield and Emma Stone

Body Language Read of Ben and Jen

Body Language Read of Lady Gaga and Taylor Kinney

What do you do if you are asked for a price quote via email?

Geno Smiths Body Language Sports writer notices body language After Jets Fifth Straight Loss Smith Says He Remains Optimistic

Should Doctors Give Speeches and Media Interviews?

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