The Mirror Neuron System in NeurorehabilitationPhinoj K. Abraham, MOTh(Neuroscience)Occupational TherapistHamad Medical Corporation, Qatar 1

5th January 2016

Overview The mirror neuron system – evidence

in humans Role of mirror neurons in imitation

and action understanding Mirror neuron system based

neurorehabilitation Clinical Implication & Potential

challenges2

THE MIRROR NEURON SYSTEM

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Mirror Neuron

• A mirror neuron is a neuron that fires both when an animal execute a task and when the animal observes the same action performed by another

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 - Rizzolatti, Giacomo; Craighero, Laila (2004)1

Functions of Mirror Neurons

1. Imitation Learning

2. Action Understanding/learning

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‘Location’ of mirror neurons

vPMC = ventral premotor cortex; IFG = inferior frontal gyrus; IPL = inferior parietal lobe; STG = superior temporal gyrus. 

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Int Arch Med. 2013; 6: 41. 3

ROLE OF MIRROR NEURONS IN IMITATION AND ACTION UNDERSTANDING

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Role of Mirror Neurons

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Observation

ImitationAction

Understanding

1) Imitation

…evidences showed that the mirror neuron system is involved in imitation as a response to the observed motor act

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( - Tanaka S, Inui T, 2002)2

Examples

• Neonatal (newborn) macaque imitating facial expressions

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2) Action Understanding

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Mirror Neurons in Congenitally blind

• https://www.drjanvandijk.org/webcasts/role-of-the-emotional-brain.html

• https://www.youtube.com/watch?v=NsEv5l1B-ys12

MIRROR NEURON SYSTEMBASEDNEURO-REHABILITATION

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Motor Imagery• ‘…internal reproduction of a given motor task,

which is repeated several times in order to promote learning or to improve motor skill’

TYPES1. Internal Images

• Mental simulation

2. External Images• Individual watches movement – by self or others

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(Carvalho et al)3

Motor Imagery - EvidencesSupportive

evidences

• Verma et al,4

• Improved gait parameters

• Spasticity attenuation

• Varies et al,5

• Improved visual imagination

Non-supportive evidence

• Letswart et al6• No significant

result among sub acute stroke

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consistent

Mirror Therapy - Evidences• Mirror Imagery Program • There is strong evidence that mirror therapy can

reduce pain associated with shoulder-hand syndrome.

• Mirror Therapy • There is conflicting evidence that mirror therapy

improves motor function following stroke and moderate evidence that it does not reduce spasticity

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Robert Teasell MD et al, EBRSR (16th Edition) – Executive Summary8

Action Observation• ‘…systematic observation of daily actions followed

by their imitation..’• A simple exposure to videos showing functional task

performances activated the mirror neuron system

EVIDENCES• There is moderate (Level 1b) evidence that action

observation improves performance on the Box & Block test. (EBRSR - 2013)7 17

Carvalho et al 3

Which mode of intervention is the best?

• Action observation, motor imagery, and imitation arerepresented in the same basic motor circuit as actionexecution—the mirror neuron system—and thus providean additional or alternative source of information to motor training that may be useful to promote recovery from stroke.

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CLINICAL IMPLICATIONS & POTENTIAL CHALLENGES

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Clinical Implications• Mirror neuron based interventions provide an

additional or alternative source of information to motor training that may be useful to promote recovery from stroke.• Intervention strategies are relatively simple like• Videos• Simulation of movement by self / others

• Occupation based activities can impose favorable outcomes . This is well in accordance with the philosophy of Occupational Therapy

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Potential Challenges• After a brain damage, many brain areas are

not activated in mirror therapy and this factor may compromise the therapy• Patient experience fatigue and attention

level decrease

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Why do people yawn at the same time?

References1. Rizzolatti, Giacomo; Craighero, Laila (2004). "The mirror-neuron

system" (PDF). Annual Review of Neuroscience 27 (1): 169–1922. Tanaka S, Inui T: Cortical involvement for action imitation of

hand/arm postures versus finger configurations: an fMRI study. Neuroreport 2002, 13(13):1599–1602.

3. Carvalho et al.: The mirror neuron system in post stroke rehabilitation. International Archives of Medicine 2013 6:41.

4. Verma R, Arya KN, Garg RK, Singh T: Task-oriented circuit class training program with motor imagery for gait rehabilitation in poststroke patients: a randomized controlled trial. Top Stroke Rehabil 2011, 18 (Suppl 1):620–632.

5. de Vries S, Tepper M, Otten B, Mulder T: Recovery of motor imagery ability in stroke patients. Rehabil ResPract 2011, 2011:283840

6. Ietswaart M, Johnston M, Dijkerman HC, Joice S, Scott CL, MacWalter RS, Hamilton SJ: Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy. Brain 2011, 134(Pt 5 1373–1386.

7. EBRSR, 10. Upper Extremity Interventions, http://www.ebrsr.com/sites/default/files/module-10-upper-extremity_final_16ed.pdf

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Thank You!