Objective To evaluate the concurrent and training effects of action observation (AO) and action execution with mirror visual feedback (MVF) on the activation of the mirror neuron system (MNS) and its relationship with the activation of the motor cortex in stroke individuals. Methods A literature search using CINAHL, PubMed, PsycINFO, Medline, Web of Science, and SCOPUS to find relevant studies was performed. Results A total of 19 articles were included. Two functional magnetic resonance imaging (fMRI) studies reported that MVF could activate the ipsilesional primary motor cortex as well as the MNS in stroke individuals, whereas two other fMRI studies found that the MNS was not activated by MVF in stroke individuals. Two clinical trials reported that long-term action execution with MVF induced a shift of activation toward the ipsilesional hemisphere. Five fMRI studies showed that AO activated the MNS, of which, three found the activation of movement-related areas. Five electroencephalography (EEG) studies demonstrated that AO or MVF enhanced mu suppression over the sensorimotor cortex. Conclusions MVF may contribute to stroke recovery by revising the interhemispheric imbalance caused by stroke due to the activation of the MNS. AO may also promote motor relearning in stroke individuals by activating the MNS and motor cortex.
Background and Purpose-Our previous studies demonstrated that mental imagery intervention enhanced poststroke patients relearning daily task performance. This study aimed to test the efficacy of mental imagery for promoting generalization of the task skills learned in a training environment to trained and untrained tasks carried out in a novel environment. Methods-Thirty-five acute poststroke patients were randomly assigned to the mental imagery (MI; nϭ18) or conventional functional rehabilitation (FR; nϭ17) group. The MI intervention was 3-week standardized practices and daily tasks using the chunking-regulation-rehearsal strategies. Outcome measurements were the performances on trained and untrained tasks in the training and novel environments. Results-The MI patients showed significantly better performances on 4 of 5 trained tasks (Pϭ0.001 to 0.026) versus only 1 task in the FR patients (Pϭ0.021). The MI patients also outperformed their FR counterpart on the 3 (of 5) (Pϭ0.025 to 0.049) trained and 2 (of 3) untrained tasks (Pϭ0.042 to 0.045) carried out in the novel environment. Conclusions-The mental imagery intervention was useful for improving patients' ability on performing the tasks which they did not previously trained on and in places different from the training environments. These involved generalization of the skills learned at the task performance level. Our findings are limited to poststoke patients who share similar characteristics with those in this study.
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