http://nnr.sagepub.com/content/early/2016/11/29/1545968316680483.abstract
- Sebastian Grunt, MD, PhD1⇑
- Christopher J. Newman, MD2
- Stefanie Saxer, MSc1,3
- Maja Steinlin, MD1
- Christian Weisstanner, MD4
- Alain Kaelin-Lang, MD, PhD5,6
- 1Division of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital Bern, Inselspital, Bern University Hospital, University of Bern, Switzerland
- 2Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
- 3Institute of Human Movement Sciences and Sport, ETH Zürich, Switzerland
- 4University Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Bern, Switzerland
- 5University Clinic of Neurology, University Hospital, Bern, Switzerland
- 6Neurocenter of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
- Sebastian Grunt, Department of Neuropaediatrics, Development and Rehabilitation, University Children’s Hospital, Inselspital, Bern, Switzerland. Email: sebastian.grunt@insel.ch
Abstract
Background. Mirror therapy
provides a visual illusion of a normal moving limb by using the mirror
reflection of the unaffected arm instead
of viewing the paretic limb and is used in
rehabilitation to improve hand function. Little is known about the
mechanism underlying
its effect in children with hemiparesis.
Objective. To investigate the effect of the mirror illusion (MI) on the excitability of the primary motor cortex (M1) in children and
adolescents.
Methods. Twelve patients with
hemiparesis (10-20 years) and 8 typically developing subjects (8-17
years) participated. Corticospinal
reorganization was classified as contralateral
(projection from contralateral hemisphere to affected hand) or
ipsilateral
(projection from ipsilateral hemisphere to affected
hand). M1 excitability of the hemisphere projecting to the affected
(nondominant
in typically developing subjects) hand was obtained
during 2 different conditions using single-pulse transcranial magnetic
stimulation (TMS). Each condition (without/with
mirror) consisted of a unimanual and a bimanual task. Motor-evoked
potentials
(MEPs) were recorded from the abductor pollicis
brevis and flexor digitorum superficialis muscles.
Results. MEP amplitudes were significantly increased during the mirror condition (P
= .005) in typically developing subjects and in patients with
contralateral reorganization. No significant effect of MI was
found in subjects with ipsilateral reorganization.
MI increased M1 excitability during active movements only. This increase
was not correlated to hand function.
Conclusion.
MI increases the excitability of M1 in hemiparetic patients with
contralateral corticospinal organization and in typically
developing subjects. This finding provides
neurophysiological evidence supporting the application of mirror therapy
in selected
children and adolescents with hemiparesis.
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