At least an explanation is given for how I might recover my left hand. But somewhat useful with something of a protocol.
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.
But you don't tell us if the treated group is actually able to use the affected hand. That is what you measure, not this connectivity stuff.
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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