Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Room Ee-1622, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
J Neurol Neurosurg Psychiatry. 2011 Apr;82(4):393-8. doi: 10.1136/jnnp.2009.194134. Epub 2010 Sep 22.
To investigate the neuronal basis for the effects of mirror therapy in patients with stroke.
22 patients with stroke participated in this study. The authors used functional MRI to investigate neuronal activation patterns in two experiments. In the unimanual experiment, patients moved their unaffected hand, either while observing it directly (no-mirror condition) or while observing its mirror reflection (mirror condition). In the bimanual experiment, patients moved both hands, either while observing the affected hand directly (no-mirror condition) or while observing the mirror reflection of the unaffected hand in place of the affected hand (mirror condition). A two-factorial analysis with movement (activity vs rest) and mirror (mirror vs no mirror) as main factors was performed to assess neuronal activity resultant of the mirror illusion.
Data on 18 participants were suitable for analysis. Results showed a significant interaction effect of movement×mirror during the bimanual experiment. Activated regions were the precuneus and the posterior cingulate cortex (p<0.05 false discovery rate).
In this first study on the neuronal correlates of the mirror illusion in patients with stroke, the authors showed that during bimanual movement, the mirror illusion increases activity in the precuneus and the posterior cingulate cortex, areas associated with awareness of the self and spatial attention. By increasing awareness of the affected limb, the mirror illusion might reduce learnt non-use. The fact that the authors did not observe mirror-related activity in areas of the motor or mirror neuron system questions popular theories that attribute the clinical effects of mirror therapy to these systems.
探究镜像治疗对脑卒中患者影响的神经学基础。
22 名脑卒中患者参与了本研究。作者使用功能磁共振成像（fMRI）在两项实验中研究了神经元激活模式。在单手实验中，患者移动未受影响的手，观察时可以直接观察（无镜条件）或观察其镜像反射（镜像条件）。在双手实验中，患者同时移动双手，观察时可以直接观察患手（无镜条件）或观察替代患手的未受影响手的镜像（镜像条件）。采用运动（活动与休息）和镜像（镜像与无镜）作为主要因素的双因素分析，评估镜像错觉引起的神经元活动。
18 名参与者的数据适合分析。结果显示，在双手实验中存在运动×镜像的显著交互效应。激活区域为楔前叶和后扣带回皮质（p<0.05 假发现率）。
在这项关于脑卒中患者镜像错觉神经相关性的首次研究中，作者表明在双手运动期间，镜像错觉增加了楔前叶和后扣带回皮质的活动，这些区域与自我意识和空间注意有关。通过增加对患侧肢体的意识，镜像错觉可能减少习得性不用。作者没有观察到运动或镜像神经元系统中与镜像相关的活动，这对将镜像治疗的临床效果归因于这些系统的流行理论提出了质疑。
