Posts Tagged mirror neuron system

[Abstract] EXOPINCH – A Robotic Mirror Therapy System for Hand Rehabilitation


Introduction ExoPinch is a robotic mirror therapy system for hand rehabilitation, focusing to increase the corticospinal excitability for the patients with hemiparesis. We propose that specific type of visual stimuli may be implemented in the action observation treatment to have a positive additional impact by activating the mirror neuron system (MNS) in premotor cortex. Recently, mirror therapy (MT) has been used as an alternative treatment for stroke of upper and lower limbs. In MT, the patient places the intact limb on the reflective side of a mirror and the non-intact limb on the non-reflective side of the mirror. Observation of the healthy limb’s reflection gives the illusion that the affected limb is functioning as instructed [1]. The underlying mechanism of the MT of stroke patients has mainly been related to the activation of the neurons with mirror-like properties. They were first discovered in the macaque monkey ventral premotor area F5 [2]. These mirror neurons discharge both when a particular action is done by an individual and when that same action done by another individual is observed. MT together with robotic assistive devices in the field of rehabilitation has led researchers to the robotics neuro-rehabilitation [3] and robots are particularly suitable for the application of motor learning principles to neurorehabilitation [4]. In the robotic mirror therapy systems, the motion of the functional hand is tracked by the intact hand using the robotic system. Based on the properties of the MNS and its role in motor learning, this system has been activated as a novel approach for training in the rehabilitation of patients with motor impairment of the upper limb following stroke. In this study, unlike the conventional mirror therapy where the functional hand motion is observed through a mirror, selected motions which provide higher activation for the mirror neuron system are observed through the prepared video streams aiming to improve the efficacy of the therapy. ExoPinch assists the patient’s index and thumb fingers to track the observed and imagined pinching actions. The selected motions are determined by the experiments on healthy subjects. In general, MNS is supposed to decode the kinematics of the observed motion. During the experiments, it is seen that the observed actions that include kinetic features (imposing force or torque) also increase the MNS activity. Therefore, the selected motions for the robotic mirror therapy system include features enforcing the kinetics, as well. This approach is supported by the motor learning principles where the kinematic and kinetic aspects are both concerned [6]. Methods ExoPinch is an exoskeletal type of rehabilitation robot. The index and thumb fingers are the parts of fully-actuated mechanisms with 2 degrees of actuation and 1 degree of actuation respectively. The exoskeleton mechanism of ExoPinch is synthesized using genetic algorithm over a multiobjective objective function. The mechanism design is based on the kinematic synthesis and the optimization of the transmission angles during the pinching motion. Dynamical models are built in MATLAB and Simechanics. Passive joint torques of the index and thumb fingers with spasticity are modeled as well to introduce the resistances to the motion. 10 healthy volunteers participated in this study. In the experiments, the suppression (desynchronization) in mu band (8-12 Hz) power as an index of the human mirror neuron system (MNS) [7] was studied while subjects observed object-directed hand actions with varying kinetics and kinematics contexts: squeezing a hard and a soft spring; grasping a long and a short stick, Fig.1. Our main purpose was to explore whether observation of any of these actions may have a relatively strong effect on MNS activity. The activation of mirror neurons in premotor cortex during action observation plays a crucial role in observational learning [5],[8] and rehabilitation is a motor relearning process [6]. Therefore, the recruitment of MNS in this respect with action observation might provide an effective neurorehabilitative program for patients with strok that may lead to a personal optimal therapy in the future. Figure 1. Video library elements imposing kinetic and kinematic features Electroencephalography (EEG) method was used to investigate the activity of the MNS. EEG data were recorded continuously (bandpass, 0.1-100 Hz; sampling rate, 250 Hz) with the 16 channel 32-bit A/D converter using OpenBCI. UltraCortex Mark 2 dry electrode headset was used conforming international 10-20 electrode placement. EEG data were processed offline using EEGLAB. The mean mu (8-12 Hz) band power values (in dB) were extracted at a number of frontal (F7, F8), central (C3, C4) and parietal (P3, P4) channels since these regions almost exclusively included regions that have been associated with the MNS in the literature. Event Related Spectral Perturbation (ERSP) method was used for analyzing the mirror neuron activity in time-frequency domain. A two-way repeated measures of ANOVA revealed the main effect of video stimuli of squeezing soft/hard springs, at the frontal channels close to ventral premotor cortex area of the brain. These results showed that the observed actions imposing kinetic features can increase the MNS activity. Therefore, the selected motions to be observed by the patients will include the features that impose the kinetics, as well, aiming to improve the efficacy of the therapy.

via (PDF) EXOPINCH-A Robotic Mirror Therapy System for Hand Rehabilitation


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[Abstract+References] Action, observation or imitation of virtual hand movement affect differently regions of the mirror neuron system and the default mode network


Virtual reality (VR)-based paradigms use visual stimuli that can modulate visuo-motor networks leading to the stimulation of brain circuits. The aims of this study were to compare the changes in blood-oxygenation level dependent (BOLD) signal when watching and imitating moving real (RH) and virtual hands (VH) in 11 healthy participants (HP). No differences were found between the observation of RH or VH making this VR-based experiment a promising tool for rehabilitation protocols. VH-imitation involved more the ventral premotor cortex (vPMC) as part of the mirror neuron system (MNS) compared to execution and VH-observation conditions. The dorsal-anterior Precuneus (da-Pcu) as part of the Precuneus/posterior Cingulate Cortex (Pcu/pCC) complex, a key node of the Default Mode Network (DMN), was also less deactivated and therefore more involved. These results may reflect the dual visuo-motor roles for the vPMC and the implication of the da-Pcu in the reallocation of attentional and neural resources for bimodal task management. The ventral Pcu/pCC was deactivated regardless of the condition confirming its role in self-reference processes. Imitation of VH stimuli can then modulate the activation of specific areas including those belonging to the MNS and the DMN.



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[ARTICLE] The role of virtual reality in improving motor performance as revealed by EEG: a randomized clinical trial – Full Text



Many studies have demonstrated the usefulness of repetitive task practice by using robotic-assisted gait training (RAGT) devices, including Lokomat, for the treatment of lower limb paresis. Virtual reality (VR) has proved to be a valuable tool to improve neurorehabilitation training. The aim of our pilot randomized clinical trial was to understand the neurophysiological basis of motor function recovery induced by the association between RAGT (by using Lokomat device) and VR (an animated avatar in a 2D VR) by studying electroencephalographic (EEG) oscillations.


Twenty-four patients suffering from a first unilateral ischemic stroke in the chronic phase were randomized into two groups. One group performed 40 sessions of Lokomat with VR (RAGT + VR), whereas the other group underwent Lokomat without VR (RAGT-VR). The outcomes (clinical, kinematic, and EEG) were measured before and after the robotic intervention.


As compared to the RAGT-VR group, all the patients of the RAGT + VR group improved in the Rivermead Mobility Index and Tinetti Performance Oriented Mobility Assessment. Moreover, they showed stronger event-related spectral perturbations in the high-γ and β bands and larger fronto-central cortical activations in the affected hemisphere.


The robotic-based rehabilitation combined with VR in patients with chronic hemiparesis induced an improvement in gait and balance. EEG data suggest that the use of VR may entrain several brain areas (probably encompassing the mirror neuron system) involved in motor planning and learning, thus leading to an enhanced motor performance.


Virtual reality (VR) is the simulation of a real environment generated by a computer software and experienced by the user through a human–machine interface [1]. This interface enables the patient to perceive the environment as real and 3D (i.e., the sense of presence), thus increasing patient’s engagement (i.e., embodiment) [2]. Hence, VR can be used to provide the patient with repetitive, task-specific training (as opposed to simply using a limb by chance) that are effective for motor learning functions [3, 4, 5, 6]. In fact, VR provides the patient with multisensory feedbacks that can potentiate the use-dependent plasticity processes within the sensory-motor cortex, thus promoting/enhancing functional motor recovery [7, 8, 9, 10, 11, 12, 13, 14]. Furthermore, VR can increase patients’ motivation during rehabilitation by decreasing the perception of exertion [8], thus allowing patients to exercise more effortlessly and regularly [9].

It is possible to magnify the sense of presence by manipulating the characteristics of the VR, including screen size, duration of exposure, the realism of the presentation, and the use of animated avatar, i.e., a third-person view of the user that appears as a player in the VR [15]. About that, the use of an avatar may strengthen the use-dependent plastic changes within higher sensory-motor areas belonging to the mirror neuron system (MNS) [16, 17, 18]. In fact, the observation of an action, even simulated (on a screen, as in the case of VR), allows the recruitment of stored motor programs that would promote, in turn, movement execution recovery [19, 20]. These processes are expressed by wide changes in α and β oscillation magnitude at the electroencephalography (EEG) (including an α activity decrease and a β activity increase) across the brain areas putatively belonging to the MNS (including the inferior frontal gyrus, the lower part of the precentral gyrus, the rostral part of the inferior parietal lobule, and the temporal, occipital and parietal visual areas) [8, 9, 21, 22].

In the last years, motor function recovery has benefited from the use of robotic devices. In particular, robot-assisted gait training (RAGT) provides the patient with highly repeated movement execution, whose feedback, in turn, permits to boost the abovementioned use-dependent plasticity processes [23]. RAGT has been combined with VR to further improve gait in patients suffering from different neurologic diseases [24]. Nonetheless, the knowledge of the neurophysiologic substrate underpinning neurorobotic and VR interaction is still poor [25, 26]. Indeed, a better understanding of this interaction would allow physician to design more personalized rehabilitative approaches concerning the individual brain plasticity potential to be harnessed to gain functional recovery [27].

The relative suppression of the μ rhythm is considered as the main index of MNS activity [28]. Nonetheless, conjugating VR and neurorobotic could make brain dynamics more complex, because of many factors related to motor control and psychological aspects come into play, including intrinsic motivation, selective attention, goal setting, working memory, decision making, positive self-concept, and self-control. Altogether, these aspects may modify and extend the range of brain rhythms deriving from different cortical areas related to MNS activation by locomotion, including theta and gamma oscillations [29, 30, 31]. Specifically, theta activity has been related to the retrieval of stored motor memory traces, whereas the gamma may be linked to the conscious access to visual target representations [30, 31]. Such broadband involvement may be due to the recruitment of multiple brain pathways expressing both bottom-up (automatic recruitment of movement simulation) and top-down (task-driven) neural processes within the MNS implicated in locomotion recognition [32]. A recent work has shown that observed, executed, and imagined action representations are decoded from putative mirror neuron areas, including Broca’s area and ventral premotor cortex, which have a complex interplay with the traditional MNS areas generating the μ rhythm [33].

Therefore, we hypothesized that the combined use of VR and RAGT may induce a stronger and wider modification of the brain oscillations deriving from the putative MNS areas, thus augmenting locomotor function gain [34, 35]. The aim of our pilot randomized clinical trial was to understand the neurophysiological basis underpinning gait recovery induced by the observation of an animated avatar in a 2D VR while performing RAGT by studying the temporal patterns of broadband cortical activations.[…]

Continue —> The role of virtual reality in improving motor performance as revealed by EEG: a randomized clinical trial | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 5 Average changes at TPOST as compared to TPRE in scalp ERP projections relatively to the full gait cycle. The left and right hemispheres plots correspond to the affected and unaffected ones, respectively. ERS and ERD are masked in red and blue tones, respectively, whereas non-significant differences are in green (see Table 5)

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[WEB DITE] Music And Epilepsy, Part 2 – Music As Therapy

Approximately one-third of patients with epilepsy have a drug-resistant form of the disease. But even in cases where the pharmacological treatment is effective, it is common for side-effects of anti-epileptic drugs to arise, including skin rashes, dizziness, liver damage, psychiatric symptoms, cognitive impairment, and pregnancy-associated complications.

Surgery has a good rate of success in achieving long-term remission of epilepsy symptoms, but the number of patients undergoing surgery still represents a small percentage of patients with drug-resistant epilepsy.

Therefore, alternative, non-pharmacological treatment options are sought after. Music therapy is one of them.

The “Mozart effect”

The therapeutic potential of music has been widely investigated in cognitive neuroscience. But in the specific case of epilepsy, this use of music as therapy is particularly fascinating due its dual effect.

As seen in Part 1 of the music and epilepsy diptych, on the one hand, music can induce seizures, in what is known as musicogenic epilepsy, but on the other hand, it may have a beneficial outcome, at least in some patients and with some specific melodies.

This ability of music in reducing neuronal discharges and in reducing seizures has been known for decades. The first studies used mainly pure tones or loud music stimulation to shorten the duration of seizures. But in 1998, Hughes and colleagues reported for the first time a therapeutic effect of Mozart’s music on patients with epilepsy; they demonstrated that Mozart’s Sonata for Two Pianos in D Major (K.448) exerted an acute effect on the amount of epileptic activity, both during and between seizures. They called it the “Mozart effect”.

Subsequently, various trials or case reports started using Mozart’s K.448 to reduce seizures, initially only in chronic epilepsy conditions, but recently also for acute epilepsy.

Beneficial effects of Mozart’s music have been reported even for patients who had already tried more than two types of antiepileptic drugs with no success; while drugs had failed to control their seizures, Mozart was able to significantly reduce or even completely abolish epileptic discharges.

The anti-epileptic effect of Mozart’s music has also been supported by animal studies, where it has been shown to reduce the frequency of spontaneous seizures in rats.

These studies were reviewed in a meta-analysis by Dastgheib and colleagues published in 2014 summarizing the effects of Mozart’s music on epilepsy. The authors found that 84% of the examined patients exhibited significantly reduced epileptic discharges following Mozart music therapy. Still, there have been some accounts of the opposite effect; in some cases, despite being a clear minority, Mozart’s music actually led to an increase in seizures.

But the positive effect of Mozart does not appear to be exclusive to that particular sonata. For example, recent studies have found that, in addition to Mozart’s K.448, also Mozart’s K.545 could reduce epileptic discharges.

The mechanisms of music’s effects

The mechanisms by which Mozart may act as an anticonvulsant are unknown. This effect has been attributed to fundamental elements of music such as its rhythmic structure and its lower harmonics. These characteristics may somehow activate neuronal networks by evoking neuronal patterns with anticonvulsant properties.

Continue —> Music And Epilepsy, Part 2 – Music As Therapy | Brain Blogger

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Effects of motor tasks through photos and videos in patients after stroke – Full Text HTML


The aim of the present study was to examine the effects of motor tasks through photos and videos in post-stroke patients. Participants were 12 patients and 10 control people. Five functional tasks were presented in four different sequences and participants had to indicate the ones which reached the goal correctly. By ANOVA it was found that the response time of the patients was greater than of the control group (photos = patients: 4833 ± 310 ms, control: 1112 ± 76 ms, p = .0001 and videos = patients: 3655 ± 242 ms, control: 2451 ± 270 ms, p = .0001). Patients performed better with videos (p = .001). These results may influence therapeutic strategies and enable a discussion about a possible impairment of the mirror neuron system.

Full Text HTML –>  Psicologia: Reflexão e Crítica – Effects of motor tasks through photos and videos in patients after stroke.

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