The Mirror Neuron System
in Neuro Rehabilitation
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Overview
The mirror neuron system – evidence in
humans
Role of mirror neurons in imitation and action
understanding
Mirror neuron system based neurorehabilitation
Clinical Implication & Potential challenges
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THE MIRROR NEURON SYSTEM
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Mirror Neuron
• A mirror neuron is a neuron that fires both
when an animal execute a task and when the
animal observes the same action performed by
another
- Rizzolatti, Giacomo; Craighero, Laila (2004)1
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Functions of Mirror Neurons
1. Imitation Learning
2. Action Understanding/learning
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‘Location’ of mirror neurons
vPMC = ventral premotor cortex; IFG = inferior frontal gyrus; 6
IPL = inferior parietal lobe; STG = superior temporal gyrus.
Int Arch Med. 2013; 6: 41. 3
ROLE OF MIRROR NEURONS IN
IMITATION AND ACTION
UNDERSTANDING
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Role of Mirror Neurons
Imitation
Action
Understanding
Observation
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1) Imitation
…evidences showed that the mirror neuron system
is involved in imitation as a response to the
observed motor act
( - Tanaka S, Inui T,
2002)2
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Examples
• Neonatal (newborn) macaque
imitating facial expressions
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2) Action Understanding
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MIRROR NEURON SYSTEM
BASED
NEURO-REHABILITATION
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Motor Imagery
• ‘…internal reproduction of a given motor task,
which is repeated several times in order to
promote learning or to improve motor skill’
(Carvalho et al)3
TYPES
1. Internal Images
• Mental simulation
2. External Images
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• Individual watches movement – by self or others
Motor Imagery - Evidences
Supportive evidences Non-supportive evidence
• Verma et al,4 • Letswart et al6
• Improved gait • No significant result
parameters among sub acute
• Spasticity attenuation stroke
• Varies et al,5
• Improved visual
imagination
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Mirror Therapy - Evidences
• Mirror Imagery Program
• There is strong evidence that mirror therapy can reduce
pain associated with shoulder-hand syndrome.
• Mirror Therapy
• There is conflicting evidence that mirror therapy
improves motor function following stroke and
moderate evidence that it does not reduce spasticity
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Robert Teasell MD et al, EBRSR (16th Edition) – Executive Summary 8
Mirror therapy
• Mirror therapy is a type of motor imagery whereby the
patient moves his unaffected limb while watching the
movement in a mirror; this in turn sends a visual stimulus to
the brain to promote movement in the affected limb.
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Action Observation
• ‘…systematic observation of daily actions followed by their
imitation..’
• A simple exposure to videos showing functional task
performances activated the mirror neuron system
Carvalho et al 3
EVIDENCES
• There is moderate (Level 1b) evidence that action
observation improves performance on the Box & Block 18
test. (EBRSR - 2013)7
Which mode of intervention is
the best?
• Action observation, motor imagery, and imitation are
represented in the same basic motor circuit as action
execution—the mirror neuron system—and thus provide
an additional or alternative source of information to motor 19
training that may be useful to promote recovery from stroke.
CLINICAL IMPLICATIONS
&
POTENTIAL CHALLENGES
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Clinical Implications
• Mirror neuron based interventions provide an additional or
alternative source of information to motor training that
may be useful to promote recovery from stroke.
• Intervention strategies are relatively simple like
• Videos
• Simulation of movement by self / others
• Occupation based activities can impose favorable
outcomes . This is well in accordance with the philosophy 21
of Occupational Therapy
Potential Challenges
• After a brain damage, many brain areas are not
activated in mirror therapy and this factor may
compromise the therapy
• Patient experience fatigue and attention level decrease
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Why do people yawn at the same time?
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References
1. Rizzolatti, Giacomo; Craighero, Laila (2004). "The mirror-neuron
system" (PDF). Annual Review of Neuroscience 27 (1): 169–192
2. 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.
3. Carvalho et al.: The mirror neuron system in post stroke rehabilitation.
International Archives of Medicine 2013 6:41.
4. 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.
5. de Vries S, Tepper M, Otten B, Mulder T: Recovery of motor imagery
ability in stroke patients. Rehabil ResPract 2011, 2011:283840
6. Ietswaart M, Johnston M, Dijkerman HC, Joice S, Scott CL, MacWalter
RS, Hamilton SJ: Mental practice with motor imagery in stroke recovery:
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randomized controlled trial of efficacy. Brain 2011, 134(Pt 5 1373–1386.
7. EBRSR, 10. Upper Extremity Interventions,
http://www.ebrsr.com/sites/default/files/module-10-upper-extremity_final_
Thank You!
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