Rehabilitation of Severe Impairment in Motor Function after Stroke: Suggestions for Harnessing the Potentials of Mirror Neurons and the Mentalizing Systems to Stimulate Recovery

Abstract

Rehabilitation of severe impairment in motor function following stroke is very challenging. This is because one of the driving forces for recovery of motor function is tasks practice, something this category of patients cannot voluntarily perform. However, it has now been shown that tasks practice can equally be carried out cognitively and through observation of another person’s practice, using techniques known as mental practice and tasks observation, respectively. Mental practice and tasks observation are believed to activate networks of neurons in the brain known as mirror neurons and mentalizing systems to induce recovery. The effectiveness of these techniques has, however, limited evidence at the moment. One possible explanation for this could be the nature of the protocols of these techniques, especially as regards to the intensity of practice. This article proposes ways the potentials of the mirror neurons and mentalizing systems can be harnessed to optimize recovery of severe impairment in motor function using mental practice and tasks observation. The article suggests, among other ways, protocols where tasks observation or mirror therapy are carried out first, and are then followed by mental practice, increasing the number of times the tasks are observed or mentalized, observation of significant others performing the tasks and mental practice of very familiar tasks.

Effects and safety of vagus nerve stimulation on upper limb function in patients with stroke: a systematic review and meta-analysis

“…This is because, the types of interventions used for the upper limb trainings in the included studies are known to also improve upper limb function 50 , 51 . Thus, VNS may be used as an adjunct therapy to other rehabilitation techniques, which re-echoes previous claim that neuromodulation techniques should be used in combination with other rehabilitation techniques 13 . Similarly, hybrid therapy, where two or more techniques are combined has been advocated during stroke rehabilitation for optimal gain 52 .…”

“…In addition, although, growing evidence supports the importance of rehabilitation intervention after stroke, strategies to reduce the risk of long-term post-stroke disability beyond a year remain unclear 12 . This may be partly because of the severity of their impairment, as there are not many rehabilitation techniques that are used for severe impairment in motor function following stroke 13 . Therefore, strategies that will help enhance cortical reorganization by directly targeting the neuromodulatory systems such as the vagus nerve stimulation (VNS) are needed 14 .…”

Efficacy and safety of whole-body vibration therapy for post-stroke spasticity: A systematic review and meta-analysis

“…Spasticity can be treated in various ways, such as by administering botulinum toxin injections ( 5 ), which is considered the most widely used local treatment of spasticity. Rehabilitation interventions such as stretching of the muscles ( 5 ), aquatic exercise ( 6 , 7 ), mirror therapy ( 8 , 9 ), ultrasound therapy ( 10 ), electrical stimulation ( 11 ), and extracorporeal shock wave therapy ( 12 ) have also been shown to be useful. Recently, whole-body vibration (WBV) was suggested as a potential therapeutic approach to address spasticity in stroke survivors ( 13 , 14 ).…”

WITHDRAWN: Task-oriented mirrored upper-limb robotic training in subacute patients after stroke: a case control study

“…In addition, it has also been shown that, mirror therapy may affect the excitability of the transcallosal pathway, thereby facilitating communication between the cerebral hemispheres and inducing homeostasis between the motor cortex(Avanzino et al, 2014). The mirror neuron system is also thought to be responsible for the mirror effect, where mirror neurons are activated by motor performance and observation of similar motor activity in mirror images(Carvalho et al, 2013;Abdullahi et al, 2022;Tofani et al, 2022). Activation of these neurons may induce positive cortical reorganization and associated motor control.Assistive technology helps patients regain good function, work ability or participate in meaningful activities of daily living(Holloway and Dawes, 2016).…”