Abstract
To investigate the neuronal activation pattern underlying the effects of mirror illusion in children/adolescents with normal motor development and in children/adolescents with hemiparesis and preserved contralateral corticospinal organisation. The type of cortical reorganisation was classified according to results of transcranial magnetic stimulation. Only subjects with congenital lesions and physiological contralateral cortical reorganisation were included. Functional magnetic resonance imaging was performed to investigate neuronal activation patterns with and without a mirror box. Each test consisted of a unimanual and a bimanual motor task. Seven children/adolescents with congenital hemiparesis (10-20 years old, three boys and four girls) and seven healthy subjects (8-17 years old, four boys and three girls) participated in this study. In the bimanual experiment, children with hemiparesis showed a significant effect of the mirror illusion (p<0.001 at voxel level, family-wise error corrected at cluster level) in the dorsolateral prefrontal cortex and anterior cingulate cortex of the affected and unaffected hemispheres, respectively. No significant effects of the mirror illusion were observed in unimanual experiments and in healthy participants. Mirror illusion in children/adolescents with hemiparesis leads to activation of brain areas involved in visual conflict detection and cognitive control to resolve this conflict. This effect is observed only in bimanual training. We consider that for mirror therapy in children and adolescents with hemiparesis a bimanual approach is more suitable than a unimanual approach.
Highlights
IntroductionBrain tumours, traumatic brain injury and congenital brain lesions/malformations are the most common causes of spastic hemiparesis in children
Ischaemic or haemorrhagic stroke, brain tumours, traumatic brain injury and congenital brain lesions/malformations are the most common causes of spastic hemiparesis in children
Children with hemiparesis showed a significant effect of the mirror illusion (p
Summary
Brain tumours, traumatic brain injury and congenital brain lesions/malformations are the most common causes of spastic hemiparesis in children. The impaired upper limb function results in difficulties with reaching, grasping, releasing and manipulating objects. A mirror is placed in the patient’s mid-sagittal plane between both hands so that the mirror reflection of the unaffected limb is superimposed on the affected limb. This provides the visual illusion of a normally moving affected limb. A systematic review concluded that mirror therapy is effective for improving motor function and possibly beneficial for daily activities and pain in adult stroke patients [11]. The effect of the mirror illusion on the motor system in upper limb rehabilitation has repeatedly been studied in healthy adults and in adults diagnosed with stroke.
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