Mirror Therapy: The Influence on Motor Control

Reid, H.M
University of Victoria

INTRODUCTION
Viewing the reflection of an unaffected limb using
a sagittally placed mirror creates the perception the
affected limb is being viewed1,2
Originally used for treating phantom limb pain,2
pain disorders, CRPS, somatoparaphrenia, and
post-stroke hemiparesis 1,2,3
Extensive brain activity while viewing the mirror
suggests reception and integration of multiple
modalities of sensory input2,3
NEUROANATOMY
APPLICATIONS
Significant bilateral activation in the supplementary motor area, primary motor cortex, occipital Effects are somatotopically specific, suggesting
lobe, cerebellum and corpus callosum1,6 specific motor impairments can be targeted using
motor sequences which recruit the focal muscular
Cingulate cortex and inferior frontal regions show activation, with a suggested role in resolving group2
conflict during cognitive tasks3 and DLPFC activation during feedback conflict4
Unrequested movement of non-functional limbs
suggests unconscious motor patterns may be
Ipsilateral sensorimotor cortex, cerebellum, and visual cortex show decreased activation when
moving the limb while viewing without mirror visual feedback6 automatically activated by the MNS2
Training an intact limb significantly improved
motor performance of the affected limb4

CONCLUSION
Activation of many areas, both ipsilateral and
contralateral to observed limb

Improvements in motor functioning is evident

Figure 2. fMRI activity during the use of mirror
glasses while performing a movement task.
Figure 1. a) Mirror glasses b) typical sagittal mirror
placement c) superimposition of unaffected limb
SENSORY CONFLICT
The absence of sensory input promotes the release
of silent synapses at the cortical level2 due to
disintegration of vision, touch, and proprioception3
Maximization of sensory experience by combining
sensory input and motor output with visual input3
Figure 3. Effects of training an unaffected limb on the motor
control of an affected limb.
NEUROPLASTICITY
Hypotheses include a mirror neuron system2, topographical reorganization3, supraspinal excitability
mechanisms,4 sensitization of spinal transmission neurons, and disinhibition of M15
The mirror neuron system (MNS) is a frontoparietal motor network of visuomotor mirror neurons
activated while performing or observing a visual action4
The primary motor cortex shows MNS-like properties, suggesting it may act to mirror the action of the
unaffected limb4
Short term plasticity of tactile receptive fields suggest tactile illusions alter the early processing of
sensory input3 and may lead to long-term changes with continued exposure
Neuroplasticity of the sensory and motor
cortices play a role in the reorganization of
neural circuitry
Alters the perception of motor control of an
affected limb
REFERENCES
1. Milde, C., Rance, M., Kirsch, P., Trojan, J., Fuchs, X., Foell, J., & Diers, M. (2015).
Do Mirror Glasses Have the Same Effect on Brain Activity as a Mirror Box? Evidence
from a Functional Magnetic Resonance Imaging Study with Healthy Subjects. Plos
ONE, 10(5), 1-15. doi:10.1371/journal.pone.0127694
2. Romano, D., Bottini, G., & Maravita, A. (2013). Perceptual effects of the mirror box
training in normal subjects. Restorative Neurology & Neuroscience, 31(4), 373-386.
doi:10.3233/RNN-120273
3. Egsgaard, L., Petrini, L., Christoffersen, G., & Arendt-Nielsen, L. (2011). Cortical
responses to the mirror box illusion: a high-resolution EEG study. Experimental Brain
Research, 215(3/4), 345-357. doi:10.1007/s00221-011-2902-x
4. Nojima, I., Mima, T., Koganemaru, S., Thabit, M. N., Fukuyama, H., & Kawamata,
T. (2012). Human Motor Plasticity Induced by Mirror Visual Feedback. Journal of
Neuroscience, 32(4), 1293-1300. doi:10.1523/JNEUROSCI.5364-11.2012
5. Kollewe, K., Jin, L., Krampfl, K., Dengler, R., & Mohammadi, B. (2009). Treatment
of Phantom Limb Pain with Botulinum Toxin Type A. Pain Medicine, 10(2), 300-303.
doi:10.1111/j.1526-4637.2008.00554.x
6. Arya, K. N. (2016). Underlying neural mechanisms of mirror therapy: Implications

Visual-kinesthetic feedback may reduce
proprioceptive interference from the affected limb
by favoring the perception of motor control3,5
These signals may facilitate reconstruction of a
functional brain representation 2,3
No evidence of spinal cord sensitivity, suggesting that the mechanism of plasticity is supraspinal, and for motor rehabilitation in stroke. Neurology India, 64(1), 38-44. doi:10.4103/0028-
3886.173622
the behavioural improvement is likely induced by changes to the excitatory connections in primary 7. Lppchen, C. H., Ringer, T., Blessin, J., Seidel, G., Grieshammer, S., Lange, R., &
Hamzei, F. (2012). Optical illusion alters M1 excitability after mirror therapy: a TMS
motor cortex study. Journal Of Neurophysiology, 108(10), 2857-2861.
CONTACT
The feedback may affect the primary motor cortex via DLPFC activation, shown to be activated during
intermodal sensory conflict4 Holly Reid
BSc. Kin Student
hmreid@uvic.ca