Mirror Training Research Articles

Somatosensory cortex and body representation: Updating the motor system during a visuo-proprioceptive cue conflict.

The brain's representation of hand position is critical for voluntary movement. Representation is multisensory, relying on both visual and proprioceptive cues. When these cues conflict, the brain recalibrates its unimodal estimates, shifting them closer together to compensate. Converging lines of evidence from research in perception, behavior, and neurophysiology suggest that such updates to body representation must be communicated to the motor system to keep hand movements accurate. We hypothesized that primary somatosensory cortex (S1) plays a crucial role in conveying the proprioceptive aspects of the updated body representation to the motor system. We tested this hypothesis in two experiments. We predicted that proprioceptive, but not visual, recalibration would be associated with change in short latency afferent inhibition (SAI), a measure of sensorimotor integration (influence of sensory input on motor output) (Expt. 1). We further predicted that modulating S1 activity with repetitive transcranial magnetic stimulation (TMS) should affect variance and recalibration associated with the proprioceptive estimate of hand position, but have no effect on the visual estimate (Expt. 2). Our results are consistent with these predictions, supporting the idea that (1) S1 is indeed a key region in facilitating motor system updates based on changes in body representation, and (2) this function is mediated by unisensory (proprioceptive) processing, upstream of multisensory visuo-proprioceptive computations. Other aspects of the body representation (visual and multisensory) may be conveyed to the motor system via separate pathways, e.g. from posterior parietal regions to motor cortex.

An Actively Vision-Assisted Low-Load Wearable Hand Function Mirror Rehabilitation System

The restoration of fine motor function in the hand is crucial for stroke survivors with hemiplegia to reintegrate into daily life and presents a significant challenge in post-stroke rehabilitation. Current mirror rehabilitation systems based on wearable devices require medical professionals or caregivers to assist patients in donning sensor gloves on the healthy side, thus hindering autonomous training, increasing labor costs, and imposing psychological burdens on patients. This study developed a low-load wearable hand function mirror rehabilitation robotic system based on visual gesture recognition. The system incorporates an active visual apparatus capable of adjusting its position and viewpoint autonomously, enabling the subtle monitoring of the healthy side’s gesture throughout the rehabilitation process. Consequently, patients only need to wear the device on their impaired hand to complete the mirror training, facilitating independent rehabilitation exercises. An algorithm based on hand key point gesture recognition was developed, which is capable of automatically identifying eight distinct gestures. Additionally, the system supports remote audio–video interaction during training sessions, addressing the lack of professional guidance in independent rehabilitation. A prototype of the system was constructed, a dataset for hand gesture recognition was collected, and the system’s performance as well as functionality were rigorously tested. The results indicate that the gesture recognition accuracy exceeds 90% under ten-fold cross-validation. The system enables operators to independently complete hand rehabilitation training, while the active visual system accommodates a patient’s rehabilitation needs across different postures. This study explores methods for autonomous hand function rehabilitation training, thereby offering valuable insights for future research on hand function recovery.

Validity and Impact of Methods for Collecting Training Data for Myoelectric Prosthetic Control Algorithms.

Intuitive regression control of prostheses relies on training algorithms to correlate biological recordings to motor intent. The quality of the training dataset is critical to run-time regression performance, but accurately labeling intended hand kinematics after hand amputation is challenging. In this study, we quantified the accuracy and precision of labeling hand kinematics using two common training paradigms: 1) mimic training, where participants mimic predetermined motions of a prosthesis, and 2) mirror training, where participants mirror their contralateral intact hand during synchronized bilateral movements. We first explored this question in healthy non-amputee individuals where the ground-truth kinematics could be readily determined using motion capture. Kinematic data showed that mimic training fails to account for biomechanical coupling and temporal changes in hand posture. Additionally, mirror training exhibited significantly higher accuracy and precision in labeling hand kinematics. These findings suggest that the mirror training approach generates a more faithful, albeit more complex, dataset. Accordingly, mirror training resulted in significantly better offline regression performance when using a large amount of training data and a non-linear neural network. Next, we explored these different training paradigms online, with a cohort of unilateral transradial amputees actively controlling a prosthesis in real-time to complete a functional task. Overall, we found that mirror training resulted in significantly faster task completion speeds and similar subjective workload. These results demonstrate that mirror training can potentially provide more dexterous control through the utilization of task-specific, user-selected training data. Consequently, these findings serve as a valuable guide for the next generation of myoelectric and neuroprostheses leveraging machine learning to provide more dexterous and intuitive control.

Reversed Mirror Therapy (REMIT) after Stroke—A Proof-of-Concept Study

In mirror training (MIT), stroke patients strive to move their hands while looking at the reflected image of the unaffected one. The recruitment of the mirror neurons and visual-proprioceptive conflict are expected to facilitate the paretic voluntary movement. Here, a reversed MIT (REMIT) is presented, which requires moving hands while looking at the reflected image of the paretic one, giving the illusion of being unable to move the unimpaired hand. This study compares MIT and REMIT on post-stroke upper-limb recovery to gain clues on the mechanism of action of mirror therapies. Eight chronic stroke patients underwent two weeks of MIT and REMIT (five sessions each) in a crossover design. Upper-limb Fugl-Meyer, Box and Block and handgrip strength tests were administered at baseline and treatments end. The strength of the mirror illusion was evaluated after each session. MIT induced a larger illusory effect. The Fugl-Meyer score improved to the same extent after both treatments. No changes occurred in the Box and Block and the handgrip tests. REMIT and MIT were equally effective on upper-limb dexterity, challenging the exclusive role of mirror neurons. Contrasting learned nonuse through an intersensory conflict might provide the rationale for both forms of mirror-based rehabilitation after stroke.

Mirror training device improves dental students’ performance on virtual simulation dental training system

IntroductionClinical practice of dentistry entails the use of indirect vision using a dental mirror. The Mirrosistant is a device that helps dental students become proficient with use of indirect vision mirror operation. This study aimed to explore the role of the Mirrosistant on students’ performance with the virtual simulation dental training system.Materials and methodsA total of 72 dental students were equally assigned to the Control group and the Experimental group. Subsequently, Mirrosistant was used to conduct a series of mirror training exercises in the Experimental group. The training consisted of tracing the edge and filling in the blank of the prescribed shape, as well as preparing the specified figure on raw eggs using indirect vision via Mirrosistant. Next, both groups were examined using the SIMODONT system, a virtual reality dental trainer, for mirror operation. In addition, a five-point Likert scale questionnaire was used to assess student feedback by using Mirrosistant.ResultsThe mirror operation examination conducted by the SIMODONT system revealed that mirror training using Mirrosistant had statistically improved students’ performances (score: 80.42 ± 6.43 vs. 69.89 ± 15.98, P = 0.0005) and shorten their performance time of mirror operation (time of seconds: 243.28 ± 132.83 vs. 328.53 ± 111.89, P = 0.0013). Furthermore, the questionnaire survey indicated that the participants had positive attitudes toward the mirror training using Mirrosistant. Most students believed that the mirror training device could improve their perceptions of direction and distance, as well as their sensations of dental operation and dental fulcrum.ConclusionMirror training using Mirrosistant can enhance dental students’ mirror perceptual and operational skills on virtual simulation dental training system.

Immediate Effects of Fine-Motor Training on Coordination and Dexterity of the Non-Dominant Hand in Healthy Adults: A Randomized Controlled Trial.

Several studies have demonstrated the beneficial effects of mirror training; however, only a few studies in Eastern countries have investigated fine-motor exercises using chopsticks, which have numerous advantages. We aimed to compare changes in coordination and dexterity of the non-dominant hand in healthy adults after conducting fine-motor training with the dominant hand using a mirror. We divided 100 healthy adults (age: 20−40 years) into experimental and control groups (each n = 50). The experimental group placed the non-dominant hand in a mirror box and indirectly imitated the fine-motor exercises conducted with the dominant hand using chopsticks. The control group performed the task with the non-dominant hand using chopsticks. We conducted the Chopsticks Manipulation Test and the Purdue Pegboard Test to assess the pre- and post-intervention coordination and dexterity of the non-dominant hand. Both groups showed a significant post-intervention improvement in coordination and dexterity (p < 0.01). There was no significant between-group difference in the functional improvement of coordination and dexterity (p > 0.05). Fine-motor training using mirrors and chopsticks significantly improved coordination and dexterity of the non-dominant hand. This training could be used to improve activity in brain regions associated with the non-dominant hand in healthy adults.

Effect of Mirror Image Therapy Combined with Whole Body Vibration Training on Unilateral Spatial Neglect after Stroke

<sec><title>Objective</title> To explore the effect of mirror image therapy combined with whole body vibration training on the rehabilitation of patients with unilateral spatial neglect after stroke. </sec><sec><title>Methods</title> According to the inclusion criteria, patients with unilateral spatial neglect after stroke who attended the rehabilitation center of the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from October 2019 to December 2020 were selected. After the hospital ethics committee approvaled, 90 eligible patients were included. According to the random grouping method, participants were divided into mirror image therapy group, whole body vibration training group and combination group, with 30 cases in each group. There was no statistically significant difference in the general data of the three groups. The mirror image therapy group used a mirror box dedicated to mirror therapy for upper limb and hand mirror training. According to the differences in the patients functional status, different movement tasks were selected, such as grooming, eating, buttoning, turning books, and holding objects. The whole body vibration training group adopted whole body vibration training, using the Wellengang vibration therapy instrument developed by SVG company in Germany, the vibration frequency with 30 Hz, the vibration amplitude with 3 mm, the total treatment time was 30 minutes, 1 time/d, 6 days a week for 8 weeks. The combined group used both mirror image therapy (20 min) + whole body vibration training (10 min) for 6 days once a week for 8 weeks. All three groups were treated with the Catherine Bogor scale (CBS) before treatment and at the time of treatment for 8 weeks, respectively, to assess the severity of the spatial neglect of the patients. The mini-mental status examination (MMSE) was used to evaluate the cognitive dysfunction of patients. The simplified Fugl-Meyer Assessment scale (FMA) was used to evaluate the patients upper limb motor function. The Barthel index (BI) was used to measure the self-care ability of patients. </sec><sec><title>Results</title> Before treatment, there was no significant difference in CBS, MMSE, FMA and BI scores among the three groups (<italic>P</italic>>0.05). After 8 weeks of treatment, the CBS scores of the three groups were significantly lower than those before treatment, however MMSE, FMA and BI scores were significantly higher than those before the treatment, but the combined group was better than the mirror image group and the whole body vibration training group, and the difference was statistically significant respectively (<italic>P</italic><0.05). </sec><sec><title>Conclusion</title> Mirror image therapy combined with whole body vibration training can effectively improve the degree of spatial neglect and cognitive dysfunction in patients with unilateral spatial neglect after stroke, and enhance upper limb motor function and self-care ability. </sec>

Kinematics analysis and gait planning for a hemiplegic exoskeleton robot

Background: As the world's aging population increases, the number of hemiplegic patients is increasing year by year. At present, in many countries with low medical level, there are not enough rehabilitation specialists. Due to the different condition of patients, the current rehabilitation training system cannot be applied to all patients. so that patients with hemiplegia cannot get effective rehabilitation training. Methods: Through a motion capture experiment, the mechanical design of the hip joint, knee joint and ankle joint was rationally optimized based on the movement data. Through the kinematic analysis of each joint of the hemiplegic exoskeleton robot, the kinematic relationship of each joint mechanism was obtained, and the kinematics analysis of the exoskeleton robot was performed using the Denavit-Hartenberg (D-H) method. The kinematics simulation of the robot was carried out in automatic dynamic analysis of mechanical systems (ADAMS), and the theoretical calculation results were compared with the simulation results to verify the correctness of the kinematics relationship. According to the exoskeleton kinematics model, a mirror teaching method of gait planning was proposed, allowing the affected leg to imitate the movement of the healthy leg with the help of an exoskeleton robot. Conclusions: A new hemiplegic exoskeleton robot designed by Shenzhen Institute of Advanced Technology (SIAT-H) is proposed, which is lightweight, modular and anthropomorphic. The kinematics of the robot have been analyzed, and a mirror training gait is proposed to enable the patient to form a natural walking posture. Finally, the wearable walking experiment further proves the feasibility of the structure and gait planning of the hemiplegic exoskeleton robot.

The Modulatory Effects of Intermittent Theta Burst Stimulation in Combination With Mirror Hand Motor Training on Functional Connectivity: A Proof-of-Concept Study.

Mirror training (MT) is an observation-based motor learning strategy. Intermittent theta burst stimulation (iTBS) is an accelerated form of excitatory repetitive transcranial magnetic stimulation (rTMS) that has been used to enhance the cortical excitability of the motor cortices. This study aims to investigate the combined effects of iTBS with MT on the resting state functional connectivity at alpha frequency band in healthy adults. Eighteen healthy adults were randomized into one of three groups—Group 1: iTBS plus MT, Group 2: iTBS plus sham MT, and Group 3: sham iTBS plus MT. Participants in Groups 1 and 3 observed the mirror illusion of the moving (right) hand in a plain mirror for four consecutive sessions, one session/day, while participants in Group 2 received the same training with a covered mirror. Real or sham iTBS was applied daily over right motor cortex prior to the training. Resting state electroencephalography (EEG) at baseline and post-training was recorded when participants closed their eyes. The mixed-effects model demonstrated a significant interaction effect in the coherence between FC4 and C4 channels, favoring participants in Group 1 over Group 3 (Δβ = −0.84, p = 0.048). A similar effect was also found in the coherence between FC3 and FC4 channels favoring Group 1 over Group 3 (Δβ = −0.43, p = 0.049). In contrast to sham iTBS combined with MT, iTBS combined with MT may strengthen the functional connectivity between bilateral premotor cortices and ipsilaterally within the motor cortex of the stimulated hemisphere. In contrast to sham MT, real MT, when combined with iTBS, might diminish the connectivity among the contralateral parietal–frontal areas.

Mirror-type rehabilitation training with dynamic adjustment and assistance for shoulder joint

The real physical image of the affected limb, which is difficult to move in the traditional mirror training, can be realized easily by the rehabilitation robots. During this training, the affected limb is often in a passive state. However, with the gradual recovery of the movement ability, active mirror training becomes a better choice. Consequently, this paper took the self-developed shoulder joint rehabilitation robot with an adjustable structure as an experimental platform, and proposed a mirror training system completed by next four parts. First, the motion trajectory of the healthy limb was obtained by the Inertial Measurement Units (IMU). Then the variable universe fuzzy adaptive proportion differentiation (PD) control was adopted for inner loop, meanwhile, the muscle strength of the affected limb was estimated by the surface electromyography (sEMG). The compensation force for an assisted limb of outer loop was calculated. According to the experimental results, the control system can provide real-time assistance compensation according to the recovery of the affected limb, fully exert the training initiative of the affected limb, and make the affected limb achieve better rehabilitation training effect.

Model of Methods and Approaches for the Formation of School Readiness and Qualities of the XXI Century in 6-7 Year Old Children

The authors share experience in the educational process with 6-7 year olds on a tested model with elements - semiotic approach, competence approach, team approach, methods "mirror training", "mind map" and "design thinking" in 6-7 year olds. children in their educational and practical activities for acquiring creative thinking; solving problems; finding solutions in order to obtain a constructive result. The tested methods and approaches help to: tolerate the expression of the personal position; concentration and promotion of children's independence; team interaction; equality of the organization and self-organization in the training; to respect the experiences of children in pedagogical interaction; and others with which 6-7 year old children to acquire the necessary competencies for the new social role "student". Through the applied model the children mastered three main types of intelligence necessary for the transition kindergarten-school: abstract (or conceptual) intelligence, characterized by the ability to use verbal and symbolic material, practical intelligence with which children feel comfortable in the specific environment when they have to deal with objects, social intelligence, which implies communication with others and the ability to dialogue with them. The stability of the model is expressed in its universality - it can be applied by children, parents, teachers, in all regime moments and in the next age period - school age.

Mirror motion recognition method about upper limb rehabilitation robot based on sEMG

A novel method of mirror motion recognition by rehabilitation robot with multi-channels sEMG signals is proposed, aiming to help the stroked patients to complete rehabilitation training movement. Firstly the bilateral mirror training is used and the model of muscle synergy with basic sEMG signals is established. Secondly, the constrained L1/2-NMF is used to extracted the main sEMG signals information which can also reduce the limb movement characteristics. Finally the relationship between sEMG signal characteristics and upper limb movement is described by TSSVD-ELM and it is applied to improve the model stability. The validity and feasibility of the proposed strategy are verified by the experiments in this paper, and the rehabilitation robot can move with the mirror upper limb. By comparing the method proposed in this paper with PCA and full-action feature extraction, it is confirmed that convergence speed is faster; the feature extraction accuracy is higher which can be used in rehabilitation robot systems.

Enhancing mirror visual feedback with intermittent theta burst stimulation in healthy adults.

Excitatory brain stimulation, in the form of intermittent theta burst stimulation (iTBS), combined with mirror visual feedback (MVF), is hypothesized to promote neuroplasticity and motor performance. This study aimed to investigate the combined effects of iTBS with mirror training (MT) on the MVF-induced sensorimotor event-related desynchronization (ERD) and the non-dominant hand motor performance in healthy adults. Eighteen healthy right-handed subjects were randomly assigned to one of three groups (Group 1: iTBS plus MT, Group 2: iTBS plus sham MT, or Group 3: sham iTBS plus MT). For participants in Groups 1 and 3, motor training was performed for 15 minutes for the right hand over four consecutive days, with MVF superimposing on their inactive left hand behind a mirror. Participants in Group 2 received the same right-hand motor training, but the mirror was covered without MVF. iTBS or sham iTBS was applied daily over the right primary motor cortex prior to the training. Electroencephalography at pre/post-training was recorded while participants performed right-hand movement under mirror and direct view. Motor performance was assessed at baseline and post-training. Baseline comparisons demonstrated that a shift in sensorimotor ERD towards the right hemisphere was induced by MVF, in mu-1 (8-10 Hz) (p = 0.002), mu-2 (10-12 Hz) (p = 0.004) and beta-1 (12-16 Hz) (p = 0.049) bands. After the training, participants in Group 1 showed a stronger MVF-induced sensorimotor ERD in mu-1 (p = 0.017) and mu-2 (p = 0.009) bands than those in Group 3. No significant between-group difference in motor outcomes was observed. iTBS appears to prime subjects' brain to be more receptive to MVF.

Sensorimotor training modulates automatic imitation of visual speech.

The observation-execution links underlying automatic-imitation processes are suggested to result from associative sensorimotor experience of performing and watching the same actions. Past research supporting the associative sequence learning (ASL) model has demonstrated that sensorimotor training modulates automatic imitation of perceptually transparent manual actions, but ASL has been criticized for not being able to account for opaque actions, such as orofacial movements that include visual speech. To investigate whether the observation-execution links underlying opaque actions are as flexible as has been demonstrated for transparent actions, we tested whether sensorimotor training modulated the automatic imitation of visual speech. Automatic imitation was defined as a facilitation in response times for syllable articulation (ba or da) whenin the presence of a compatible visual speech distractor, relative to whenin the presence of an incompatible distractor. Participants received either mirror (say /ba/ when the speaker silently says /ba/, and likewise for /da/) or countermirror (say /da/ when the speaker silently says /ba/, and vice versa) training, and automatic imitation was measured before and after training. The automatic-imitation effect was enhanced following mirror training and reduced following countermirror training, suggesting that sensorimotor learning plays a critical role in linking speech perception and production, and that the links between these two systems remain flexible in adulthood. Additionally, as compared to manual movements, automatic imitation of speech was susceptible to mirror training but was relatively resilient to countermirror training. We propose that social factors and the multimodal nature of speech might account for the resilience to countermirror training of sensorimotor associations of speech actions.

Methods for multiple-telescope beam imaging and guiding in the near-infrared

Atmospheric turbulence and precise measurement of the astrometric baseline vector between any two telescopes are two major challenges in implementing phase referenced interferometric astrometry and imaging. They limit the performance of a fibre-fed interferometer by degrading the instrument sensitivity and astrometric measurements precision and by introducing image reconstruction errors due to inaccurate phases. A multiple beam acquisition and guiding camera was built to meet these challenges for a recently commissioned four beam combiner instrument, GRAVITY, at the ESO Very Large Telescope Interferometer. For each telescope beam it measures: a) field tip-tilts by imaging stars in the sky; b) telescope pupil shifts by imaging pupil reference laser beacons installed on each telescope using a $2 \times 2$ lenslet; c) higher order aberrations using a $9 \times 9$ Shack-Hartmann. The telescope pupils are imaged for a visual monitoring while observing. These measurements enable active field and pupil guiding by actuating a train of tip-tilt mirrors placed in the pupil and field planes, respectively. The Shack-Hartmann measured quasi-static aberrations are used to focus the Auxiliary Telescopes and allow the possibility of correcting the non-common path errors between the Unit Telescopes adaptive optics systems and GRAVITY. The guiding stabilizes light injection into single-mode fibres, increasing sensitivity and reducing the astrometric and image reconstruction errors. The beam guiding enables to achieve astrometric error less than $50\,\mu$as. Here, we report on the data reduction methods and laboratory tests of the multiple beam acquisition and guiding camera and its performance on-sky.

The TMS Motor Map Does Not Change Following a Single Session of Mirror Training Either with Or without Motor Imagery.

Both motor imagery and mirror training have been used in motor rehabilitation settings to promote skill learning and plasticity. As motor imagery and mirror training are suggested to be closely linked, it was hypothesized that mirror training augmented by motor imagery would increase corticospinal excitability (CSE) significantly compared to mirror training alone. Forty-four participants were split over two experimental groups. Each participant visited the laboratory once to receive either mirror training alone or mirror training augmented with layered stimulus response training (LSRT), a type of motor imagery training. Participants performed 16 min of mirror training, making repetitive grasping movements paced by a metronome. Transcranial magnetic stimulation (TMS) mapping was performed before and after the mirror training to test for changes in CSE of the untrained hand. Self-reports suggested that the imagery training was effective in helping the participant to perform the mirror training task as instructed. Nonetheless, neither training type resulted in a significant change of TMS map area, nor was there an interaction between the groups. The results from the study revealed no effect of a single session of 16 min of either mirror training or mirror training enhanced by imagery on TMS map area. Despite the negative result of the present experiment, this does not suggest that either motor imagery or mirror training might be ineffective as a rehabilitation therapy. Further study is required to allow disentangling the role of imagery and action observation in mirror training so that mirror training can be further tailored to the individual according to their abilities.

Representations of Face Images and Collaborative Representation Classification for Face Recognition

Collaborative representation classification (CRC) was firstly proposed by Zhang et al. [L. Zhang, M. Yang, X. Feng, Y. Ma and D. Zhang, Collaborative Representation based Classification for Face Recognition, Computer Science, 2014]. It was an excellent algorithm for solving face recognition problems. The method suggests that the combination of all original training samples can approach the test samples accurately. But in fact, this does not mean it can well solve complex face recognition problems in some special situation, such as face recognition with varying illuminations and facial expressions. In the paper, we proposed an improvement to previous CRC method. By using a dedicated algorithm to combine the linear combinations of the original and their mirror training samples to represent the test samples, we can get more accurate recognition of test samples. The experimental results show that the proposed method does obtain notable accuracy improvement in comparison with the previous method.

The Effects of Either a Mirror, Internal or External Focus Instructions on Single and Multi-Joint Tasks

Training in front of mirrors is common, yet little is known about how the use of mirrors effects muscle force production. Accordingly, we investigated how performing in front of a mirror influences performance in single and multi-joint tasks, and compared the mirror condition to the established performance effects of internal focus (IF) and external focus (EF) instructions in a two part experiment. In the single-joint experiment 28 resistance-trained participants (14 males and 14 females) completed two elbow flexion maximal voluntary isometric contractions under four conditions: mirror, IF, EF and neutral instructions. During these trials, surface EMG activity of the biceps and triceps were recorded. In the multi-joint experiment the same participants performed counter-movement jumps on a force plate under the same four conditions. Single-joint experiment: EF led to greater normalized force production compared to all conditions (P≤0.02, effect-size range [ES] = 0.46–1.31). No differences were observed between neutral and mirror conditions (P = 0.15, ES = 0.15), but both were greater than IF (P<0.01, ES = 0.79–1.84). Surface EMG activity was comparable across conditions (P≥0.1, ES = 0.10–0.21). Multi-joint experiment: Despite no statistical difference (P = 0.10), a moderate effect size was observed for jump height whereby EF was greater than IF (ES = 0.51). No differences were observed between neutral and mirror conditions (ES = 0.01), but both were greater than IF (ES = 0.20–22). The mirror condition led to superior performance compared to IF, inferior performance compared to EF, and was equal to a neutral condition in both tasks. These results provide novel and practical evidence concerning mirror training during resistance type training.

Network interactions underlying mirror feedback in stroke: A dynamic causal modeling study.

Mirror visual feedback (MVF) is potentially a powerful tool to facilitate recovery of disordered movement and stimulate activation of under-active brain areas due to stroke. The neural mechanisms underlying MVF have therefore been a focus of recent inquiry. Although it is known that sensorimotor areas can be activated via mirror feedback, the network interactions driving this effect remain unknown. The aim of the current study was to fill this gap by using dynamic causal modeling to test the interactions between regions in the frontal and parietal lobes that may be important for modulating the activation of the ipsilesional motor cortex during mirror visual feedback of unaffected hand movement in stroke patients. Our intent was to distinguish between two theoretical neural mechanisms that might mediate ipsilateral activation in response to mirror-feedback: transfer of information between bilateral motor cortices versus recruitment of regions comprising an action observation network which in turn modulate the motor cortex. In an event-related fMRI design, fourteen chronic stroke subjects performed goal-directed finger flexion movements with their unaffected hand while observing real-time visual feedback of the corresponding (veridical) or opposite (mirror) hand in virtual reality. Among 30 plausible network models that were tested, the winning model revealed significant mirror feedback-based modulation of the ipsilesional motor cortex arising from the contralesional parietal cortex, in a region along the rostral extent of the intraparietal sulcus. No winning model was identified for the veridical feedback condition. We discuss our findings in the context of supporting the latter hypothesis, that mirror feedback-based activation of motor cortex may be attributed to engagement of a contralateral (contralesional) action observation network. These findings may have important implications for identifying putative cortical areas, which may be targeted with non-invasive brain stimulation as a means of potentiating the effects of mirror training.

Chronic pain : Perception, reward and neural processing

Many chronic pain syndromes are characterized by enhanced perception of painful stimuli as well as alterations in cortical processing in sensory and motor regions. In this review article the alterations in muscle pain and neuropathic pain are described. Alterations in patients with fibromyalgia and chronic back pain are described as examples for musculoskeletal pain and also in patients with phantom limb pain after amputation and complex regional pain syndrome as examples for neuropathic pain. In addition to altered pain perception, cumulative evidence on alterations in the processing of reward and the underlying mechanisms in chronic pain has been described. A description is given of what is known on how pain and reward interact and affect each other. The relevance of such interactions for chronic pain is discussed. The implications of these findings for therapeutic approaches are delineated with respect to sensorimotor training and behavioral therapy, focusing on the effectiveness of these approaches, mechanisms and future developments. In particular, we discuss operant behavioral therapy in patients with chronic back pain and fibromyalgia as well as prosthesis training in patients with phantom limb pain and discrimination, mirror and imaginary training in patients with phantom limb pain and complex regional pain syndrome. With respect to the processing of reward, the focus of the discussion is on the role of reward and associated learning in pain therapy.