This document discusses the mirror neuron system and its role in neurorehabilitation. It begins by providing an overview of mirror neurons, their role in imitation and action understanding. It then discusses how the mirror neuron system can be used in neurorehabilitation approaches like motor imagery, mirror therapy, and action observation. While these mirror neuron-based interventions provide additional methods for motor training and recovery from stroke, there are also potential challenges to their use including damaged brain areas limiting activation and issues with patient fatigue or attention.

1. The Mirror Neuron
System in
Neurorehabilitation
Phinoj K. Abraham, MOTh(Neuroscience)
Occupational Therapist
Hamad Medical Corporation, Qatar 1
5th January 2016

2. 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 challenges
2

3. THE MIRROR NEURON SYSTEM
3

4. 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
4
- Rizzolatti, Giacomo; Craighero, Laila (2004)1

5. Functions of Mirror Neurons
1. Imitation Learning
2. Action Understanding/learning
5

6. ‘Location’ of mirror neurons
vPMC = ventral premotor cortex; IFG = inferior frontal
gyrus; IPL = inferior parietal lobe; STG = superior temporal
gyrus.
6
Int Arch Med. 2013; 6: 41. 3

7. ROLE OF MIRROR NEURONS IN
IMITATION AND ACTION
UNDERSTANDING
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8. Role of Mirror Neurons
8
Action
Understanding

9. 1) Imitation
…evidences showed that the mirror neuron
system is involved in imitation as a response
to the observed motor act
9
( - Tanaka S, Inui T,
2002)2

10. Examples
• Neonatal (newborn)
macaque imitating facial
expressions
10

11. 2) Action Understanding
11

12. Mirror Neurons in Congenitally
blind
• https://www.drjanvandijk.org/webcasts/role-of-the-emotional-
brain.html
• https://www.youtube.com/watch?v=NsEv5l1B-ys
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13. MIRROR NEURON SYSTEM
BASED
NEURO-REHABILITATION
13

14. Motor Imagery
• ‘…internal reproduction of a given motor
task, which is repeated several times in
order to promote learning or to improve
motor skill’
TYPES
1. Internal Images
• Mental simulation
2. External Images
14
(Carvalho et al)3

15. Motor Imagery - Evidences
Supportive 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
15
Results are not consistent

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

17. 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

18. Which mode of intervention is
the best?
• Action observation, motor imagery, and imitation are
represented in the same basic motor circuit as action
execution—the mirror neuron system—and thus
provide
an additional or alternative source of information to
motor training that may be useful to promote recovery
18

19. CLINICAL IMPLICATIONS
&
POTENTIAL CHALLENGES
19

20. 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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21. 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
21

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Why do people yawn at the same time?

23. References
1. Rizzolatti, Giacomo; Craighero, Laila (2004). "The mirror-
neuron system" (PDF). Annual Review of Neuroscience 27 (1):
169–192
2. 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-
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