Mirror Paradigm Research Articles

When proprioceptive feedback enhances visual perception of self-body movement: rehabilitation perspectives.

Rehabilitation approaches take advantage of vision's important role in kinesthesia, using the mirror paradigm as a means to reduce phantom limb pain or to promote recovery from hemiparesis. Notably, it is currently applied to provide a visual reafferentation of the missing limb to relieve amputees' pain. However, the efficiency of this method is still debated, possibly due to the absence of concomitant coherent proprioceptive feedback. We know that combining congruent visuo-proprioceptive signals at the hand level enhances movement perception in healthy people. However, much less is known about lower limbs, for which actions are far less visually controlled in everyday life than upper limbs. Therefore, the present study aimed to explore, with the mirror paradigm, the benefit of combined visuo-proprioceptive feedback from the lower limbs of healthy participants. We compared the movement illusions driven by visual or proprioceptive afferents and tested the extent to which adding proprioceptive input to the visual reflection of the leg improved the resulting movement illusion. To this end, 23 healthy adults were exposed to mirror or proprioceptive stimulation and concomitant visuo-proprioceptive stimulation. In the visual conditions, participants were asked to voluntarily move their left leg in extension and look at its reflection in the mirror. In the proprioceptive conditions, a mechanical vibration was applied to the hamstring muscle of the leg hidden behind the mirror to simulate an extension of the leg, either exclusively or concomitantly, to the visual reflection of the leg in the mirror. (i) Visual stimulation evoked leg movement illusions but with a lower velocity than the actual movement reflection on the mirror; (ii) proprioceptive stimulation alone provided more salient illusions than the mirror illusion; and (iii) adding a congruent proprioceptive stimulation improved the saliency, amplitude, and velocity of the illusion. The present findings confirm that visuo-proprioceptive integration occurs efficiently when the mirror paradigm is coupled with mechanical vibration at the lower limbs, thus providing promising new perspectives for rehabilitation.

Self/other distinction in adolescents with autism spectrum disorder (ASD) assessed with a double mirror paradigm.

Self/other distinction (SOD), which refers to the ability to distinguish one's own body, actions, and mental representations from those of others, is an essential skill for effective social interaction. A large body of clinical evidence suggests that disruptions in SOD may be key to social communication deficits in individuals with autism spectrum disorders (ASD). In particular, egocentric biases have been found in cognitive, affective, behavioural, and motor domains. However, research in this area is scarce and consists of recognition paradigms that have used only static images; these methods may be insufficient for assessing SOD, given the increasing role of embodiment in our understanding of the pathophysiology of ASD. A single-centre, prospective pilot study was carried out to investigate, for the first time, self-recognition and SOD in seven adolescents with ASD compared with matched, typically developing controls (TDCs) using the "Alter Ego"TM double mirror paradigm. The participants viewed a double mirror in which their own face was gradually morphed into the face of an unfamiliar other (self-to-other sequence) or vice versa (other-to-self sequence); participants were instructed to indicate at which point the morph looked more like their own face than the other's face. Two judgement criteria were used: 1) M1: the threshold at which subjects started to recognize their own face during the other-to-self morphing sequence; 2) M2: the threshold at which subjects started to recognize the other's face during the self-to-other morphing sequence. Consistent with the predictions, the results showed that the participants with ASD exhibited earlier self-recognition in the other-to-self sequence and delayed other-recognition in the self-to-other sequence, suggesting an egocentric bias. SOD impairments were also marginally correlated with ASD severity, indicating earlier face recognition in more severely affected individuals. Furthermore, in contrast with that of TDCs, the critical threshold for switching between self and other varied with the direction of morphing in ASD participants. Finally, these differences in face recognition and SOD using mirrors, unlike previous research using static images, support the central place of bodily self-consciousness in SOD impairments. Although additional research is needed to replicate the results of this preliminary study, it revealed the first behavioural evidence of altered SOD in ASD individuals on an embodied, semiecological face-recognition paradigm. Implications for understanding ASD are discussed from a developmental perspective, and new research and therapeutic perspectives are presented.

A narrative review on clinical and research applications of The Mirror Paradigm: body image, psychopathology, and attachment

The Mirror Paradigm (MP) is an innovative technique that explores the influences of body representation, affect regulation, and nonverbal mirror behavior in children, adolescents and adults. The critical element of the MP is the use of a full-length mirror in front of which the interviewee is asked to answer questions about how they think and feel about their body, including perception, parental and sociocultural influences and the mind-body connection. Though research on MP is limited and focused mainly on adults, its many advantages are recognized. This narrative review aims to summarize its broad applicability, strengths and weakness and potential uses in both research and clinical settings. The review of the literature was performed through a research on PsycArticles, PsycInfo, Psychology & Behavioral Sciences Collection, PubMed and Web of Science Scopus databases, plus Google Scholar and ResearchGate, including pertinent and providing quantitative or qualitative data documents. Of 505 documents, 7 articles were eligible for this review (1.4% of initial records). Results revealed three main application of the MP: 1) Body image, where MP scores have been significantly correlated to body dissatisfaction assessed through questionnaires; 2) Psychopathology, where MP scores were useful in discriminating individuals with personality disorders and internalizing, externalizing, dissociative, and disordered eating symptoms; 3) Attachment, with nonverbal expressions and narratives about relationships to important others distinguishable between secure, preoccupied, and dismissive speakers as classified in the Adult Attachment Interview. Limitations and future directions are discussed, suggesting the MP as an innovative technique and measure promising for further integration in research and clinical practice.

Water as a Mirror Paradigm in Blanca Andréu’s "Elphistone" and her Poems in "L’anno di poesia 1990/1991"

Water as a Mirror Paradigm in Blanca Andréu’s "Elphistone" and her Poems in "L’anno di poesia 1990/1991"

Illusory perception of one's own movements in virtual reality

Introduction Perception of one's own movements (i.e., kinaesthesia) is achieved by integrating multiple sensory inputs such as proprioceptive and visual signals. Firstly, we investigated whether visual cues coming from an embodied first-person avatar can be used for the purpose of kinaesthesia. Secondly, as humans can identify living organisms and understand their actions solely based on a small animated set of well-positioned points of lights (i.e., by recognizing biological motion), we hypothesize that such visual motion cues can also participate in kinaesthesia. Materials and methods We used the “virtual mirror paradigm” in which the participant's left forearm was passively moved, and these movements controlled the displacements of both forearms of a first-person avatar. In a first experiment, right (ipsilateral) visual information was combined with left (contralateral) proprioceptive information to induce kinaesthetic illusions in the participant's static right forearm. The second experiment used the same paradigm, but the virtual forearms were either realistic or represented by three points of light. Thirty-four female participants and 30 others took part in the first and second experiment, respectively. Results Combination of visual information from the avatar with proprioceptive information from the participant's moving forearm elicited kinaesthetic “mirror like illusions”. Such illusions were evoked both with realistic virtual forearms and with point-light forearms. Discussion Visual information coming from an embodied first-person avatar can efficiently participate in kinaesthesia. In addition, kinaesthesia does not require visual access to an elaborate representation of the body segment, access to its biological movement may be sufficient.

From Embodiment of a Point-Light Display in Virtual Reality to Perception of One's Own Movements

Humans can recognize living organisms and understand their actions solely on the basis of a small animated set of well-positioned points of light, i.e. by recognizing biological motion. Our aim was to determine whether this type of recognition and integration also occurs during the perception of one's own movements. The participants (60 females) were immersed with a virtual reality headset in a virtual environment, either dark or illuminated, in which they could see a humanoid avatar from a first-person perspective. The avatar's forearms were either realistic or represented by three points of light. Embodiment was successfully achieved through a 1-min period during which either the realistic or point-light avatar's forearms faithfully reproduced voluntary flexion–extension movements. Then, the “virtual mirror paradigm” was used to evoke kinesthetic illusions. In this paradigm, a passive flexion–extension of the participant's left arm was coupled with the movements of the avatar's forearms. This combined visuo-proprioceptive stimulation, was compared with unimodal stimulation (either visual or proprioceptive stimulation only). We found that combined visuo-proprioceptive stimulation with realistic avatars evoked more vivid kinesthetic illusions of a moving right forearm than unimodal stimulations, regardless of whether the virtual environment was dark or illuminated. Kinesthetic illusions also occurred with point-light avatars, albeit less frequently and a little less intense, and only when the visual environment was optimal for slow motion detection of the point-light display (lit environment). We conclude that kinesthesia does not require visual access to an elaborate representation of a body segment. Access to biological movement can be sufficient.

Exploring Self-Consciousness From Self- and Other-Image Recognition in the Mirror: Concepts and Evaluation.

A historical review of the concepts of self-consciousness is presented, highlighting the important role of the body (particularly, body perception but also body action), and the social other in the construction of self-consciousness. More precisely, body perception, especially intermodal sensory perception including kinesthetic perception, is involved in the construction of a sense of self allowing self-other differentiation. Furthermore, the social other, through very early social and emotional interactions, provides meaning to the infant’s perception and contributes to the development of his/her symbolization capacities. This is a necessary condition for body image representation and awareness of a permanent self in a time-space continuum (invariant over time and space). Self-image recognition impairments in the mirror are also discussed regarding a comprehensive developmental theory of self-consciousness. Then, a neuropsychological and neurophysiological approach to self-consciousness reviews the role of complex brain activation/integration pathways and the mirror neuron system in self-consciousness. Finally, this article offers new perspectives on self-consciousness evaluation using a double mirror paradigm to study self- and other- image and body recognition.

Enhancement of Anatomical Education Using Augmented Reality: An Empirical Study of Body Painting.

Students in undergraduate premedical anatomy courses may experience suboptimal and superficial learning experiences due to large class sizes, passive lecture styles, and difficult-to-master concepts. This study introduces an innovative, hands-on activity for human musculoskeletal system education with the aim of improving students' level of engagement and knowledge retention. In this study, a collaborative learning intervention using the REFLECT (augmented reality for learning clinical anatomy) system is presented. The system uses the augmented reality magic mirror paradigm to superimpose anatomical visualizations over the user's body in a large display, creating the impression that she sees the relevant anatomic illustrations inside her own body. The efficacy of this proposed system was evaluated in a large-scale controlled study, using a team-based muscle painting activity among undergraduate premedical students (n=288) at the Johns Hopkins University. The baseline knowledge and post-intervention knowledge of the students were measured before and after the painting activity according to their assigned groups in the study. The results from knowledge tests and additional collected data demonstrate that the proposed interactive system enhanced learning of the musculoskeletal system with improved knowledge retention (F(10,133) =3.14, P<0.001), increased time on task (F(1,275) =5.70, P<0.01), and a high level of engagement (F(9,273) =8.28, P<0.0001). The proposed REFLECT system will be of benefit as a complementary anatomy learning tool for students.

The respective contributions of visual and proprioceptive afferents to the mirror illusion in virtual reality.

The reflection of passive arm displacement in a mirror is a powerful means of inducing a kinaesthetic illusion in the static arm hidden behind the mirror. Our recent research findings suggest that this illusion is not solely visual in origin but results from the combination of visual and proprioceptive signals from the two arms. To determine the respective contributions of visual and proprioceptive signals to this illusion, we reproduced the mirror paradigm in virtual reality. As in the physical version of the mirror paradigm, one of the participant’s arms (the left arm, in our study) could be flexed or extended passively. This movement was combined with displacements of the avatar’s left and right forearms, as viewed in a first-person perspective through a virtual reality headset. In order to distinguish between visual and proprioceptive contributions, two unimodal conditions were applied separately: displacement of the avatar’s forearms in the absence of physical displacement of the left arm (the visual condition), and displacement of the left forearm while the avatar’s forearms were masked (the proprioceptive condition). Of the 34 female participants included in the study, 28 experienced a kinaesthetic mirror illusion in their static (right) arm. The strength of the illusion (expressed in terms of speed and duration) evoked by the bimodal condition was much higher than that observed in either of the two unimodal conditions. Our present results confirm that the involvement of visual signals in the mirror illusion—often considered as a prototypic visual illusion—has been overstated. The mirror illusion also involves non-visual signals (bilateral proprioceptive-somaesthetic signals, in fact) that interact with the visual signals and strengthen the kinaesthetic effect.

Contribution of Visual Motion Cues from a Held Tool to Kinesthesia

Incorporation of a tool into the body schema is well established. Here, we assessed whether visual signals originating from the tool provide relevant cues for the perception of arm movements, as would signals originating from the arm holding it. Kinesthetic illusions were investigated by passively moving one arm (via a robotized manipulandum) and therefore the tool (a rake), using the mirror paradigm, with the reflected part being limited to the tool, the arm, or both. Illusory movements concerned the other arm, remaining static and hidden behind the mirror. In Experiments 1 and 3, participants held the same tools in their hands. Results showed that seeing the displacement of the reflected tool in the mirror induced kinesthetic mirror illusions in the hidden arm, similarly to seeing the reflected arm itself, though slightly reduced in terms of strength and occurrence frequency. In Experiment 2, participants held either the same objects in their hands (the rakes) or different ones (a rake, the image of which was reflected in the mirror, and a ball in the other hand). Results showed that mirror vision of the moving tool was not sufficient for mirror illusions to occur, the same tool in the two hands being an essential condition. Finally, in Experiment 3, we showed that neither prior practice nor active tool use was necessary for the tool mirror illusion to occur. Altogether, these results demonstrate that the visual cues originating from the held-tool are integrated for sensing arm movement.

What’s left of the mirror illusion when the mirror can no longer be seen? Bilateral integration of proprioceptive afferents!

Recent data suggest that manipulating the muscle afferents of one arm affects both ipsilateral and contralateral perceptual estimates. Here, we used the mirror paradigm to study the bimanual integration of kinesthetic muscle afferents. The reflection of a moving hand in a mirror positioned in the sagittal plane creates an illusion of symmetrical bimanual movement. Although vision clearly has a role in kinesthesia, its role in the mirror illusion might have been overestimated. Conversely, the role of bimanual integration of muscle afferents might have been underestimated. We hypothesized that muscle-proprioceptive afferents of the passively displaced arm (the image of which was reflected in the mirror) are involved in this illusion. We evoked in 19 healthy adult participants the mirror illusion by displacing passively their left arm, the image of which was reflected in the mirror. Once participants experienced the illusion that their hidden right arm was moving, we then either occluded their view of the mirror (using occlusive glasses) and/or prevent the passive left arm displacement. Participants’ illusion characteristics (duration and kinematic) under these conditions were compared with classical mirror illusion (without visual occlusion). We found that as long as the arm was still moving, the kinesthetic illusion decayed slowly after visual occlusion. These findings suggest that the mirror illusion results from the combination of visuo-proprioceptive signals from the two arms and is not purely visual in origin. Our findings also support the more general concept whereby proprioceptive afferents are integrated bilaterally for the purpose of kinesthesia during bimanual tasks.

CHANGING PARADIGMS IN SOUTHEAST ASIAN ARCHAEOLOGY

Abstract: An argument is presented for Southeast Asian archaeologists to replace the Birds Eye View/Rear View Mirror paradigm prevalent during the mid-twentieth century with a forward-facing, “emergent” paradigm in alignment with current trends in archaeological theory. An earlier version of this text was prepared for a keynote address at the European Association of Southeast Asian Archaeologists (EurASEAA), 14th International Conference that took place at in Dublin, September 18-21 2012.

Identifying Oneself with the Face of Someone Else Impairs the Egocentered Visuo-spatial Mechanisms: A New Double Mirror Paradigm to Study Self-other Distinction and Interaction.

Looking at our face in a mirror is one of the strongest phenomenological experiences of the Self in which we need to identify the face as reflected in the mirror as belonging to us. Recent behavioral and neuroimaging studies reported that self-face identification not only relies upon visual-mnemonic representation of one’s own face but also upon continuous updating and integration of visuo-tactile signals. Therefore, bodily self-consciousness plays a major role in self-face identification, with respect to interplay between unisensory and multisensory processing. However, if previous studies demonstrated that the integration of multisensory body-related signals contributes to the visual processing of one’s own face, there is so far no data regarding how self-face identification, inversely, contributes to bodily self-consciousness. In the present study, we tested whether self–other face identification impacts either the egocentered or heterocentered visuo-spatial mechanisms that are core processes of bodily self-consciousness and sustain self–other distinction. For that, we developed a new paradigm, named “Double Mirror.” This paradigm, consisting of a semi-transparent double mirror and computer-controlled Light Emitting Diodes, elicits self–other face merging illusory effect in ecologically more valid conditions, i.e., when participants are physically facing each other and interacting. Self-face identification was manipulated by exposing pairs of participants to an Interpersonal Visual Stimulation in which the reflection of their faces merged in the mirror. Participants simultaneously performed visuo-spatial and mental own-body transformation tasks centered on their own face (egocentered) or the face of their partner (heterocentered) in the pre- and post-stimulation phase. We show that self–other face identification altered the egocentered visuo-spatial mechanisms. Heterocentered coding was preserved. Our data suggest that changes in self-face identification induced a bottom-up conflict between the current visual representation and the stored mnemonic representation of one’s own face which, in turn, top-down impacted bodily self-consciousness.

The mirror paradigm: Assessing the embodied self in the context of abuse.

The mirror paradigm: Assessing the embodied self in the context of abuse.

The kinaesthetic mirror illusion: How much does the mirror matter?

The reflection of a moving hand in a mirror positioned in the sagittal plane can create an illusion of symmetrical, bimanual movement. This illusion is implicitly presumed to be of visual origin. However, muscle proprioceptive afferents of the arm reflected in the mirror might also affect the perceived position and movement of the other arm. We characterized the relative contributions of visual and proprioceptive cues by performing two experiments. In Experiment 1, we sought to establish whether kinaesthetic illusions induced using the mirror paradigm would survive marked visual impoverishment (obtained by covering between 0 and 100% of the mirror in 16% steps). We found that the mirror illusion was only significantly influenced when the visual degradation was 84% or more. In Experiment 2, we masked the muscle proprioceptive afferents of the arm reflected in the mirror by co-vibrating antagonistic muscles. We found that masking the proprioceptive afferents reduced the velocity of the illusory displacement of the other arm. These results confirm that the mirror illusion is not a purely visual illusion but emerges from a combination of congruent signals from the two arms, i.e. visual afferents from the virtually moving arm and proprioceptive afferents from the contralateral, moving arm.

Supplemental Material for The Mirror Paradigm: Assessing the Embodied Self in the Context of Abuse

Supplemental Material for The Mirror Paradigm: Assessing the Embodied Self in the Context of Abuse

Anchoring the “floating arm”: Use of proprioceptive and mirror visual feedback from one arm to control involuntary displacement of the other arm

Arm movement control takes advantage of multiple inputs, including those originating from the contralateral arm. In the mirror paradigm, it has been suggested that control of the unseen arm, hidden by the mirror, is facilitated by the reflection of the other, moving arm. Although proprioceptive feedback originating from the moving arm, (the image of which is reflected in the mirror), is always coupled with visual feedback in the mirror paradigm, the former has received little attention. We recently showed that the involuntary arm movement following a sustained, isometric contraction, known as the “floating arm” or “Kohnstamm phenomenon”, was adjusted to the passive-motorized displacement of the other arm. However, provision of mirror feedback, that is, the reflection in the mirror of the passively moved arm, did not add to this coupling effect. Therefore, the interlimb coupling in the mirror paradigm may to a large extent have a proprioceptive origin rather than a visual origin. The objective of the present study was to decouple mirror feedback and proprioceptive feedback from the reflected, moving arm and evaluate their respective contributions to interlimb coupling in the mirror paradigm. First (in Experiment 1, under eyes-closed conditions), we found that masking the proprioceptive afferents of the passively moved arm (by co-vibrating the antagonistic biceps and triceps muscles) suppressed the interlimb coupling between involuntary displacement of one arm and passive displacement of the other. Next (in Experiment 2), we masked proprioceptive afferents of the passively moved arm and specifically evaluated mirror feedback. We found that interlimb coupling through mirror feedback (though significant) was weaker than interlimb coupling through proprioceptive feedback. Overall, the present results show that in the mirror paradigm, proprioceptive feedback is stronger and more consistent than visual-mirror feedback in terms of the impact on interlimb coupling.

Kinaesthetic mirror illusion and spatial congruence.

Position sense and kinaesthesia are mainly derived from the integration of somaesthetic and visual afferents to form a single, coherent percept. However, visual information related to the body can play a dominant role in these perceptual processes in some circumstances, and notably in the mirror paradigm. The objective of the present study was to determine whether or not the kinaesthetic illusions experienced in the mirror paradigm obey one of the key rules of multisensory integration: spatial congruence. In the experiment, the participant's left arm (the image of which was reflected in a mirror) was either passively flexed/extended with a motorized manipulandum (to induce a kinaesthetic illusion in the right arm) or remained static. The right (unseen) arm remained static but was positioned parallel to the left arm's starting position or placed in extension (from 15° to 90°, in steps of 15°), relative to the left arm's flexed starting position. The results revealed that the frequency of the illusion decreased only slightly as the incongruence prior to movement onset between the reflected left arm and the hidden right arm grew and remained quite high even in the most incongruent settings. However, the greater the incongruence between the visually and somaesthetically specified positions of the right forearm (from 15° to 90°), the later the onset and the lower the perceived speed of the kinaesthetic illusion. Although vision dominates perception in a context of visuoproprioceptive conflict (as in the mirror paradigm), our results show that the relative weightings allocated to proprioceptive and visual signals vary according to the degree of spatial incongruence prior to movement onset.

The mirror paradigm and mirror therapy: does the "virtual hand" have a beneficial impact on motor behavior?

The paradigm can be used to investigate the role of visual afferents in motor control as well as in position perception and kinesthesia. The paradigm has also been evaluated as tool (i.e. therapy) for restoring brain functions in general and promoting recovery from hemiparesis in particular. However, recent reviews have cast doubt on the paradigm's beneficial impact on motor behavior. In this Research Highlight, we briefly review recently published results (including our own work) on the impact of the paradigm and therapy on motor functions in stroke patients and in healthy participants with or without simulated motor dysfunctions. Overall, our assessment failed to evidence clear or systematic facilitation of motor behavior (i.e. bimanual coupling) in either voluntary or involuntary upper limb activity in healthy participants. Our findings thus mirror those of recent reviews questioning the benefit of therapy over mental imagery or bimanual coupling in recovery from motor dysfunction following stroke.

Passive or simulated displacement of one arm (but not its mirror reflection) modulates the involuntary motor behavior of the other arm

Recent studies of both healthy and patient populations have cast doubt on the mirror paradigm’s beneficial effect on motor behavior. Indeed, the voluntary arm displacement that accompanies reflection in the mirror may be the determining factor in terms of the motor behavior of the contralateral arm. The objective of the present study was to assess the respective effects of mirror reflection and arm displacement (whether real or simulated) on involuntary motor behavior of the contralateral arm following sustained, isometric contraction (Kohnstamm phenomenon). Our results revealed that (i) passive displacement of one arm (displacement of the left arm via a motorized manipulandum moving at 4°/s) influenced the velocity of the Kohnstamm phenomenon (forearm flexion occurring shortly after the cessation of muscle contraction) in the contralateral arm and (ii) mirror vision had no effect. Indeed, the velocity of the Kohnstamm phenomenon tended to be adjusted to match the velocity of the passive displacement of the other arm. In a second experiment, arm displacement was simulated by vibrating the triceps at 25, 50 or 75Hz. Results showed that the velocity of the Kohnstamm phenomenon in one arm increased with the vibration frequency applied to the other arm. Our results revealed the occurrence of bimanual coupling because involuntary displacement of one arm was regulated by muscle-related information generated by the actual or simulated displacement of the other arm. In line with the literature data on voluntary motor behavior, our study failed to evidence an additional impact of mirror vision on involuntary motor behavior.