Mirror neurons and their relevance in neuro-rehabilitation

Can it contribute, by stimulating mirror neurons, to functional recovery in patients with hemiparesis following stroke?

Mirror neurons and their usefulness in neurological rehabilitation

About a month ago it was published in Psychology and the mind an article on mirror neurons in which he mainly spoke about his discovery and its importance in culture and social phenomena. This article aims to show, in general, the importance of these mirror neurons in the process of functional rehabilitation of the upper limbs in patients with Trace.

What processes are mirror neurons involved in?

In 1996, Giacomo Rizzolati discovered, by chance, that these mirror neurons were activated in the to perform an action and see another person perform the same actionn, therefore, it can be concluded that they are essential for the learning and the imitation, While playing an important role in social skills, As the empathy, Because thanks to them we can get an idea of ​​what the other is thinking, going to do or feel (Rizzolatti and Craighero, 2004).

Can its stimulation contribute to the rehabilitation of stroke patients?

As mentioned, these are neurons that they are involved in mechanisms that combine execution-observation. Therefore, based on these results, it was found that their stimulation influences the rehabilitation process, so they were carried out various functional neuro-rehabilitation programs, As in cases where the patient has motor deficits of the upper limbs as a result of a stroke or stroke.

An example of this is given to us through Rehabilitation play system (RGS) (http://rgs-project.eu), an innovative project of Virtual reality (RV) carried out by the SPECS laboratory research team, Pompeu Fabra University (UPF), La Mar hospital, Vall d’Hebron hospital and three other entities in collaboration with the TicSalut Foundation.

This project is based on the principle of brain plasticity and how functional reorganization can be achieved in areas affected by stroke through stimulation of secondary motor areas (Cameirao, Bermúdez, Duarte & Verschure, 2011). These areas integrate the mirror neural system (MNS), involved in motor execution and planning processes by observing this action.

RGS is an application which, thanks to the use of VR through dynamic games, promotes the functional recovery of the patient. Thus, it allows the patient to move forward in the process of upper limb rehabilitation by stimulating the visual-motor pathway provided by the MNS. The hardware resources needed to perform this therapy using RGS are mainly a computer with Kinect sensor and RGS software, as different interface devices (gloves, exoskeletons, etc.) can be added. Through the image provided by the screen you can see a representation of virtual arms, shown in first person perspective, which simulate the movement of real arms in real time and in a simulated environment, in this way the patient activates injured motor neural circuits, which usually remain inactive due to lack of movement of the apherical arm, thereby inducing neuroplasticity of the affected area. As for the various games included in the program, they are mainly based on capturing objects, hitting them, dodging them, etc.

Likewise, each game adapts in terms of complexity and speed of performance stimuli in each arm and patient characteristics. What is really interesting about this coping system is that it is dynamically modulated through two different strategies. On the one hand, it adjusts the difficulty of the exercise and, on the other hand, it amplifies the movement of the patient’s affected arm in VR, showing faster, wider and more precise range movements. In this way, it is possible to motivate the patient to use his affected arm more frequently.

Another interesting aspect of the RGS system is that allows you to capture descriptive parameters of user progress, Can be analyzed and presented automatically, allowing clinical staff to follow the patient’s recovery process.

RGS has already been evaluated in several clinical studies that have demonstrated its effectiveness in rehabilitation processes. These studies were performed to test the efficacy of therapy using RGS combined with occupational therapy (OT) compared to a control group receiving only OT. The results showed that the group of patients with whom RGS was associated with TO performed better than the control group (Cameirao et al., 2011).

Finally, we can conclude that RGS is a VR therapy based on neuronal plasticity by stimulating MNS in which, in a fun and enjoyable way, May help improve recovery of upper limb mobility in stroke patients.

Bibliographical references:

  • Cameirao, MS, Bermúdez, S., Duarte, O., and Verschure, P. (2011). Virtual Reality-Based Rehabilitation Accelerates Functional Recovery of Upper Limbs After Stroke: A Randomized Controlled Pilot Study in Acute Stroke Using the Rehabilitation Play System. Neurology and Restorative Neurosciences, 29 (5), 287-298.
  • Rizzolatti, G., and Craighero, L. (2004). The mirror neural system. Annual Journal of Neuroscience, 27, 169-192.
  • The Rehabilitation Gaming System website (www.eodyne.com).

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