Ann Rehabil Med.  2011 Dec;35(6):747-758. 10.5535/arm.2011.35.6.747.

Facilitation of Corticospinal Excitability According to Motor Imagery and Mirror Therapy in Healthy Subjects and Stroke Patients

Affiliations
  • 1Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul 139-711, Korea. md52516@hanmail.net
  • 2Department of Biomedical Engineering, Keimyung University, Daegu 704-701, Korea.

Abstract


OBJECTIVE
To delineate the changes in corticospinal excitability when individuals are asked to exercise their hand using observation, motor imagery, voluntary exercise, and exercise with a mirror. METHOD: The participants consisted of 30 healthy subjects and 30 stroke patients. In healthy subjects, the amplitudes and latencies of motor evoked potential (MEP) were obtained using seven conditions: (A) rest; (B) imagery; (C) observation and imagery of the hand activity of other individuals; (D) observation and imagery of own ipsilateral hand activity; (E) observation and imagery of the hand activity of another individual with a mirror; (F) observation and imagery of own symmetric ipsilateral hand activity (thumb abduction) with a mirror; and (G) observation and imagery of own asymmetric ipsilateral hand activity (little finger abduction) with a mirror. In stroke patients, MEPs were obtained in the A, C, D, E, F conditions.
RESULTS
In both groups, increment of the percentage MEP amplitude (at rest) and latency decrement of MEPs were significantly higher during the observation of the activity of the hand of another individual with a mirror and during symmetric ipsilateral hand activity on their own hand with a mirror than they were without a mirror. In healthy subjects, the increment of percentage MEP amplitude and latency decrement were significantly higher during the observation of the symmetric ipsilateral hand activity with a mirror compared to the observation of the activity of the asymmetric ipsilateral hand with a mirror of their own hand.
CONCLUSION
In both groups, corticospinal excitability was facilitated by viewing the mirror image of the activity of the ipsilateral hand. These findings provide neurophysiological evidence supporting the application of various mirror imagery programs during stroke rehabilitation.

Keyword

Stroke; Corticospinal excitability; Transcranial magnetic stimulation; Motor imagery; Mirror therapy

MeSH Terms

Evoked Potentials, Motor
Fingers
Hand
Humans
Stroke
Transcranial Magnetic Stimulation

Figure

  • Fig. 1 (A, B) Relaxation and kinesthetic motor imagery state. (C) Observation and imagery of the activity of the hand of another individual without a mirror. (D) Observation and imagery of own hand activity without a mirror. (E) Observation and imagery of the activity of the hand of another individual with a mirror. (F) Observation and imagery of own symmetric hand activity with a mirror. (G) Observation and imagery of own asymmetric hand activity with a mirror.

  • Fig. 2 Increment of percentage MEP values in healthy subjects. Mean (±SEM) values of the MEP amplitude measured during the experiment, expressed as percentage of the MEP at rest in 30 healthy subjects. Based on repeated measures ANOVA, the percentage MEP amplitude of observation and imagery of the activity of the hand of another individual with a mirror (E) was significantly increased compared with observation and imagery of the activity of the hand of another individual without a mirror (C) (†p<0.01). In addition, the percentage MEP amplitude of observation and imagery of self hand activity with a mirror (F) was significantly increased compared with observation and imagery of own hand activity without a mirror (D) (*p<0.05). (A) rest; (B) imagery; (C) observation and imagery of the activity of the hand of another individual without a mirror; (D) observation and imagery of self hand activity without a mirror; (E) observation and imagery of the activity of the hand of another individual with a mirror; (F) observation and imagery of own symmetric hand activity with a mirror; and (G) observation and imagery of own asymmetric hand activity with a mirror.

  • Fig. 3 Decrement of MEP latency values in healthy subjects. Mean (±SEM) values of the MEP latency during the experiment in 30 healthy subjects. Based on repeated measures ANOVA, the MEP latency of observation and imagery of the activity of the hand of another individual with a mirror (E) was significantly decreased compared with observation and imagery of the activity of the hand of another individual without a mirror (C) (‡p<0.001). In addition, the MEP latency of observation and imagery of own hand activity with a mirror (F) was significantly decreased compared with observation and imagery of own hand activity without a mirror (D) (†p<0.01). (A) rest; (B) imagery; (C) observation and imagery of the activity of the hand of another individual without a mirror; (D) observation and imagery of own hand activity without a mirror; (E) observation and imagery of the activity of the hand of another individual with a mirror; (F) observation and imagery of own symmetric hand activity with a mirror; and (G) observation and imagery of own asymmetric hand activity with a mirror.

  • Fig. 4 Observation-execution matching. The percentage MEP amplitude increment and latency decrement of observation and imagery of own symmetric hand activity with a mirror (F) was significantly increased compared with observation and imagery of own asymmetric hand activity with a mirror (G) (‡p<0.001) in 30 healthy subjects (observation-execution matching).

  • Fig. 5 Increment of percentage MEP amplitude and decrement of MEP latency in stroke patients. The percentage MEP amplitude increment and latency decrement of MEPs were significantly greater in the activity of the hand of another individual with a mirror (E) than in observation and imagery of the activity of the hand of another individual without a mirror (C) (‡p<0.001). In addition, the percentage MEP amplitude increment and latency decrement of MEPs were significantly greater in own hand activity with a mirror (F) than in observation and imagery of own hand activity without a mirror (D) (†p<0.01, ‡p<0.001). (A) rest; (C) observation and imagery of the activity of the hand of another individual without a mirror; (D) observation and imagery of self hand activity without a mirror; (E) observation and imagery of the activity of the hand of another individual with a mirror; (F) observation and imagery of the own hand activity with a mirror.


Cited by  1 articles

Virtual Reality-Guided Motor Imagery Increases Corticomotor Excitability in Healthy Volunteers and Stroke Patients
Hyungjun Im, Jeunghun Ku, Hyun Jung Kim, Youn Joo Kang
Ann Rehabil Med. 2016;40(3):420-431.    doi: 10.5535/arm.2016.40.3.420.


Reference

1. Han CE, Arbib MA, Schweighofer N. Stroke rehabilitation reaches a threshold. PLoS Comput Biol. 2008; 4:e1000133. PMID: 18769588.
Article
2. Page SJ, Sisto SA, Levine P. Modified constraint-induced therapy in chronic stroke. Am J Phys Med Rehabil. 2002; 81:870–875. PMID: 12394999.
Article
3. Nudo RJ. Adaptive plasticity in motor cortex: implications for rehabilitation after brain injury. J Rehabil Med. 2003; 41(Suppl):7–10. PMID: 12817650.
Article
4. Krakauer JW. Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol. 2006; 19:84–90. PMID: 16415682.
Article
5. Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY. Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med. 2009; 52:269–229. PMID: 19398398.
Article
6. Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. J Neural Transm. 2007; 114:1265–1278. PMID: 17579805.
Article
7. Sharma N, Baron JC, Rowe JB. Motor imagery after stroke: relating outcome to motor network connectivity. Ann Neurol. 2009; 66:604–616. PMID: 19938103.
Article
8. Kuhtz-Buschbeck JP, Mahnkopf C, Holzknecht C, Siebner H, Ulmer S, Jansen O. Effector-independent representations of simple and complex imagined finger movements: a combined fMRI and TMS study. Eur J Neurosci. 2003; 18:3375–3387. PMID: 14686911.
Article
9. Ruby P, Decety J. What you believe versus what you think they believe: a neuroimaging study of conceptual perspective-taking. Eur J Neurosci. 2003; 17:2475–2480. PMID: 12814380.
Article
10. Stinear CM, Byblow WD, Steyvers M, Levin O, Swinnen SP. Kinesthetic, but not visual, motor imagery modulates corticomotor excitability. Exp Brain Res. 2006; 168:157–164. PMID: 16078024.
Article
11. Page SJ, Levine P, Leonard A. Mental practice in chronic stroke: results of a randomized, placebo-controlled trial. Stroke. 2007; 38:1293–1297. PMID: 17332444.
12. Verbunt JA, Seelen HA, Ramos FP, Michielsen BH, Wetzelaer WL, Moennekens M. Mental practice-based rehabilitation training to improve arm function and daily activity performance in stroke patients: a randomized clinical trial. BMC Neurol. 2008; 8:7. PMID: 18405377.
Article
13. Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci. 1996; 263:377–386. PMID: 8637922.
14. Dohle C, Pullen J, Nakaten A, Kust J, Rietz C, Karbe H. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair. 2009; 23:209–217. PMID: 19074686.
Article
15. Yavuzer G, Selles R, Sezer N, Sütbeyaz S, Bussmann JB, Köseoğlu F, Atay MB, Stam HJ. Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2008; 89:393–398. PMID: 18295613.
Article
16. Liepert J, Hamzei F, Weiller C. Motor cortex disinhibition of the unaffected hemisphere after acute stroke. Muscle Nerve. 2000; 23:1761–1763. PMID: 11054757.
Article
17. Shimizu T, Hosaki A, Hino T, Sato M, Komori T, Hirai S, Rossini PM. Motor cortical disinhibition in the unaffected hemisphere after unilateral cortical stroke. Brain. 2002; 125:1896–1907. PMID: 12135979.
Article
18. Calautti C, Naccarato M, Jones PS, Sharma N, Day DD, Carpenter AT, Bullmore ET, Warburton EA, Baron JC. The relationship between motor deficit and hemisphere activation balance after stroke: a 3T fMRI study. Neuroimage. 2007; 34:322–331. PMID: 17045490.
Article
19. Stinear CM, Barber PA, Coxon JP, Fleming MK, Byblow WD. Priming the motor system enhances the effects of upper limb therapy in chronic stroke. Brain. 2008; 131:1381–1390. PMID: 18356189.
Article
20. Garry MI, Loftus A, Summers JJ. Mirror, mirror on the wall: viewing a mirror reflection of unilateral hand movements facilitates ipsilateral M1 excitability. Exp Brain Res. 2005; 163:118–122. PMID: 15754176.
Article
21. Funase K, Tabira T, Higashi T, Liang N, Kasai T. Increased corticospinal excitability during direct observation of self movement and indirect observation with a mirror box. Neurosci Lett. 2007; 419:108–112. PMID: 17481817.
22. Hallett M. Transcranial magnetic stimulation and the human brain. Nature. 2000; 406:147–150. PMID: 10910346.
Article
23. Rossini PM, Barker AT, Berardelli A, Caramia MD, Caruso G, Cracco RQ, Dimitrijevic MR, Hallett M, Katayama Y, Lucking CH, et al. Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol. 1994; 91:79–92. PMID: 7519144.
Article
24. Talelli P, Greenwood RJ, Rothwell JC. Arm function after stroke: neurophysiological correlates and recovery mechanisms assessed by transcranial magnetic stimulation. Clin Neurophysiol. 2006; 117:1641–1659. PMID: 16595189.
Article
25. Wassermann EM. Variation in the response to transcranial magnetic brain stimulation in the general population. Clin Neurophysiol. 2002; 113:1165–1171. PMID: 12088713.
Article
26. Leonard G, Tremblay F. Corticomotor facilitation associated with observation, imagery and imitation of hand actions: a comparative study in young and old adults. Exp Brain Res. 2007; 177:167–175. PMID: 16947064.
Article
27. Clark S, Tremblay F, Ste-Marie D. Differential modulation of corticospinal excitability during observation, mental imagery and imitation of hand actions. Neuropsychologia. 2004; 42:105–112. PMID: 14615080.
Article
28. Buccino G, Solodkin A, Small SL. Functions of the mirror neuron system: implications for neurorehabilitation. Cogn Behav Neurol. 2006; 19:55–63. PMID: 16633020.
Article
29. Merians AS, Tunik E, Fluet GG, Qiu Q, Adamovich SV. Innovative approaches to the rehabilitation of upper extremity hemiparesis using virtual environments. Eur J Phys Rehabil Med. 2009; 45:123–133. PMID: 19158659.
30. Shinoura N, Suzuki Y, Watanabe Y, Yamada R, Tabei Y, Saito K, Yagi K. Mirror therapy activates outside of cerebellum and ipsilateral M1. NeuroRehabilitation. 2008; 23:245–252. PMID: 18560141.
Article
31. Sundara M, Namasivayam AK, Chen R. Observation-execution matching system for speech: a magnetic stimulation study. Neuroreport. 2001; 12:1341–1344. PMID: 11388407.
Article
32. Sakamoto M, Muraoka T, Mizuguchi N, Kanosue K. Execution-dependent modulation of corticospinal excitability during action observation. Exp Brain Res. 2009; 199:17–25. PMID: 19669129.
Article
Full Text Links
  • ARM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr