When this research came out 9 years ago did your doctor do ONE DAMN THING with it? Or is your doctor incompetently WAITING FOR SOMEONE ELSE TO SOLVE THE PROBLEM?
Well shit, the problem has been solved, all your doctor had to do was implement it, buy a few mirrors and do a little training for the therapists. But your doctor did absolutely nothing? Right?
Functional Plasticity Induced by Mirror Training: The Mirror as the Element Connecting Both Hands to One Hemisphere
Abstract
Background.
Mirror therapy (MT) is a promising therapeutic approach in stroke patients with severe hand paresis.
Objective.
The ipsilateral (contralesional) primary sensorimotor cortex (SMC) and the mirror neuron system have been suggested to play decisive roles in the MT network. The present study investigated its underlying neural plasticity. Methods. Two groups of healthy participants (n = 13 in each group) performed standardized fine motor tasks moving pegs and marbles (20 min/d for 4 days) with their right hand with either a mirror (mirror training group, MG) or a nonreflective board (control training group, CG) positioned orthogonally in front of them. The number of items moved by each hand was tested after each training session. Functional MRI (fMRI) was acquired before and after the training procedure to investigate the mirror training (MTr)-specific network by the analysis of the factors Time and Group.
Results.
The hand performance test of the trained right hand did not differ between the 2 groups. The untrained left hand improved significantly more in the MG compared with the CG. fMRI analysis of action observation and imitation of grasping tasks demonstrated MTr-specific activation changes within the right dorsal and left ventral premotor cortex as well as in the left SMC (SMCleft). Analysis of functional and effective connectivity showed a MTr-specific increase of functional coupling between each premotor region and the left supplementary motor area, which in turn showed an increased functional interaction with the ipsilateral SMCleft.
Conclusions.
MTr remodels the motor system by functionally connecting hand movement to the ipsilateral SMC. On a system level, it leads to interference of the neural circuit related to motor programming and observation of the trained hand with the illusionary movement of the untrained hand.
Introduction
Effective stroke management is important as the treatment of stroke consumes a significant amount of resources.1 Functional recovery can occur even in the chronic stage of stroke with plastic changes induced in the affected primary motor cortex (M1) by intense motor training of the paretic hand.2,3 Additional commitment of noninvasive stimulation over the affected M1 by repetitive transcranial magnetic stimulation (TMS)4 or by transcranial direct current stimulation5 promotes functional recovery in association with plastic changes within the affected M1. However, the effectiveness of such strategies is limited to patients with mild to moderate hand paresis. Thus, an effective therapy regime for patients with severe hand paresis or loss of hand function is still lacking.
Mirror therapy (MT) is a promising therapeutic approach in stroke patients, even in those with complete loss of hand function. By using a mirror that is positioned orthogonally in front of the patient, the reflection of the right arm in the mirror provides an illusion that the left arm is being moved. MT was first described by Ramachandran and colleagues6 in patients with phantom pain after limb amputation and has been suggested to improve hand functional deficit in stroke patients.7 Ramachandran and Altschuler8 suggested that the ipsilateral (contralesional) corticospinal tracts from the M1 play a role while training with a mirror,8 but a recent functional MRI (fMRI) study reported an activation shift toward the ipsilesional sensorimotor cortex (SMC) after MT in chronic stroke patients in contrast with a control group.9 It has also been suggested that the mirror neuron system (MNS) plays an important role while observing one’s hand in the mirror and training via action observation (AO) and imitation (IMI).8,10
The underlying neural plasticity of MT is currently unknown. Therefore, in the present study, fMRI was used to address this issue. We focused on training-induced plasticity by training with a mirror rather than the direct effect of observing one’s hand in the mirror, as was investigated with the use of functional imaging11,12 or TMS.13-15
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