Mirror neurons and their relevance in neuro-rehabilitation
Can one contribute, through the stimulation of mirror neurons, to functional recovery in patients who present hemiparesis as a consequence of a stroke?
About a month ago it was published in Psychology and Mind an article related to mirror neurons in which they spoke, mainly, about their discovery and its importance in culture and social phenomena. This article aims to show, in broad strokes, the importance of said mirror neurons in the process of functional rehabilitation of the upper extremities in patients affected by Ictus .
In what processes are mirror neurons involved?
In 1996, Giacomo Rizzolati discovered, by serendipity, that these mirror neurons were activated by perform an action and when seeing another person performing that same action n, therefore, it can be concluded that they are essential for the learning and the imitation , while playing an important role in the social skills , such as empathy , because thanks to them we can intuit what the other person thinks, will do or feels (Rizzolatti and Craighero, 2004).
Can stimulation contribute to the rehabilitation of patients affected by stroke?
As mentioned, they are neurons that are involved in mechanisms that combine execution-observation . Therefore, based on these findings, it has been proven that their stimulation influences the rehabilitation process, therefore, they have been carried out various functional neuro-rehabilitation programs , as for example, in cases in which the patient presents motor deficits in the upper extremities as a consequence of a cerebrovascular accident (CVA) or stroke.
An example of this is given to us through Rehabilitation Gamming System (RGS) (//rgs-project.eu), an innovative project of Virtual reality (RV) carried out by the research team of the SPECS laboratory, the Pompeu Fabra University (UPF), the Hospital del Mar, the Valle Hebrón Hospital and three other entities in collaboration with the Fundació TicSalut.
This project is based on the principle of brain plasticity and how functional reorganization can be achieved in the areas affected by stroke through the stimulation of secondary motor areas (Cameirao, Bermúdez, Duarte and Verschure, 2011). Such areas integrate the mirror neuron system (MNS), involved in motor planning and execution processes by observing said action.
RGS is an application that, through the use of VR through dynamic games, promotes the functional recovery of the patient. Thus, it allows the patient to advance in the process of rehabilitation of the upper extremities by stimulating the visual-motor path provided by the MNS. The material resources necessary to carry out this therapy through RGS are, mainly, a computer with Kinect sensor and RGS software, as well as adding different interface devices (gloves, exoskeletons, etc.). Through the image provided by the screen you can see a representation of virtual arms, shown in first person perspective, that simulate the movement of the real arms in real time and in a simulated environment, in this way, the active patient the injured motor neuronal circuits, which usually remain inactive due to the lack of movement of the paretic arm, thus inducing the 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 the performance stimuli in each of the arms and characteristics of the patient . What is really interesting about this adaptation 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 affected arm of the patient in RV, showing faster, wider and more precise range movements. In this way, the patient is motivated to use his affected arm more frequently.
Another interesting aspect of the RGS system is that allows to capture descriptive parameters of the user's progress , to be analyzed and presented automatically, allowing the clinical staff to supervise the patient's recovery process.
RGS has already been evaluated in Several clinical studies have shown their effectiveness in the rehabilitation processes . These studies were carried out to verify the efficacy of the therapy by using RGS combined with Occupational Therapy (OT) in comparison with a control group that only received TO.The results showed that the group of patients with whom RGS was combined with TO had better results than the control group (Cameirao et al., 2011).
Finally, it can be concluded that RGS supposes an RV therapy based on neuronal plasticity through the stimulation of the MNS in which, in a fun and entertaining way , it can contribute to the improvement of upper extremity mobility recovery in patients affected by stroke.
- Cameirao, M.S, Bermúdez, S., Duarte, O., and Verschure, P. (2011). Virtual reality based rehabilitation speeds up of the upper extremity after stroke: a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system. Restorative neurology and neuroscience, 29(5), 287-298.
- Rizzolatti, G., and Craighero, L. (2004). The mirror-neuron system. Annual Review of Neuroscience, 27, 169-192.
- Website The Rehabilitation Gaming System (www.eodyne.com).