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Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain

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Abstract
Background. Mirror visual feedback (MVF), a phenomenon where movement of one limb is perceived as movement of the other limb, has the capacity to alleviate phantom limb pain or promote motor recovery of the upper limbs after stroke. The tool has received great interest from health professionals; however, a clear understanding of the mechanisms underlying the neural recovery owing to MVF is lacking. Objective. We performed a systematic review to assess the effect of MVF on brain activation during a motor task. Methods. We searched PubMed, CINAHL, and EMBASE databases for neuroimaging studies investigating the effect of MVF on the brain. Key details for each study regarding participants, imaging methods, and results were extracted. Results. The database search yielded 347 article, of which we identified 33 suitable for inclusion. Compared with a control condition, MVF increases neural activity in areas involved with allocation of attention and cognitive control (dorsolateral prefrontal cortex, posterior cingulate cortex, S1 and S2, precuneus). Apart from activation in the superior temporal gyrus and premotor cortex, there is little evidence that MVF activates the mirror neuron system. MVF increases the excitability of the ipsilateral primary motor cortex (M1) that projects to the “untrained” hand/arm. There is also evidence for ipsilateral projections from the contralateral M1 to the untrained/affected hand as a consequence of training with MVF. Conclusion. MVF can exert a strong influence on the motor network, mainly through increased cognitive penetration in action control, though the variance in methodology and the lack of studies that shed light on the functional connectivity between areas still limit insight into the actual underlying mechanisms.
Keywords
sensorimotor control, systematic review, visual feedback, mirror, hemiparesis, stroke, cerebral palsy, RANDOMIZED CONTROLLED-TRIAL, REGIONAL PAIN SYNDROME, PHANTOM LIMB PAIN, NEAR-INFRARED SPECTROSCOPY, INDUCED MOVEMENT THERAPY, MOTOR CORTEX ACTIVATION, CORTICAL REORGANIZATION, STROKE PATIENTS, CORTICOSPINAL EXCITABILITY, BIMANUAL COORDINATION

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Citation

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MLA
Deconinck, Frederik, Ana RP Smorenburg, Alex Benham, et al. “Reflections on Mirror Therapy: a Systematic Review of the Effect of Mirror Visual Feedback on the Brain.” NEUROREHABILITATION AND NEURAL REPAIR 29.4 (2015): 349–361. Print.
APA
Deconinck, F., Smorenburg, A. R., Benham, A., Ledebt, A., Feltham, M. G., & Savelsbergh, G. J. (2015). Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain. NEUROREHABILITATION AND NEURAL REPAIR, 29(4), 349–361.
Chicago author-date
Deconinck, Frederik, Ana RP Smorenburg, Alex Benham, Annick Ledebt, Max G Feltham, and Geert JP Savelsbergh. 2015. “Reflections on Mirror Therapy: a Systematic Review of the Effect of Mirror Visual Feedback on the Brain.” Neurorehabilitation and Neural Repair 29 (4): 349–361.
Chicago author-date (all authors)
Deconinck, Frederik, Ana RP Smorenburg, Alex Benham, Annick Ledebt, Max G Feltham, and Geert JP Savelsbergh. 2015. “Reflections on Mirror Therapy: a Systematic Review of the Effect of Mirror Visual Feedback on the Brain.” Neurorehabilitation and Neural Repair 29 (4): 349–361.
Vancouver
1.
Deconinck F, Smorenburg AR, Benham A, Ledebt A, Feltham MG, Savelsbergh GJ. Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain. NEUROREHABILITATION AND NEURAL REPAIR. 2015;29(4):349–61.
IEEE
[1]
F. Deconinck, A. R. Smorenburg, A. Benham, A. Ledebt, M. G. Feltham, and G. J. Savelsbergh, “Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain,” NEUROREHABILITATION AND NEURAL REPAIR, vol. 29, no. 4, pp. 349–361, 2015.
@article{5685674,
  abstract     = {Background. Mirror visual feedback (MVF), a phenomenon where movement of one limb is perceived as movement of the other limb, has the capacity to alleviate phantom limb pain or promote motor recovery of the upper limbs after stroke. The tool has received great interest from health professionals; however, a clear understanding of the mechanisms underlying the neural recovery owing to MVF is lacking.
Objective. We performed a systematic review to assess the effect of MVF on brain activation during a motor task.
Methods. We searched PubMed, CINAHL, and EMBASE databases for neuroimaging studies investigating the effect of MVF on the brain. Key details for each study regarding participants, imaging methods, and results were extracted.
 Results. The database search yielded 347 article, of which we identified 33 suitable for inclusion. Compared with a control condition, MVF increases neural activity in areas involved with allocation of attention and cognitive control (dorsolateral prefrontal cortex, posterior cingulate cortex, S1 and S2, precuneus). Apart from activation in the superior temporal gyrus and premotor cortex, there is little evidence that MVF activates the mirror neuron system. MVF increases the excitability of the ipsilateral primary motor cortex (M1) that projects to the “untrained” hand/arm. There is also evidence for ipsilateral projections from the contralateral M1 to the untrained/affected hand as a consequence of training with MVF.
Conclusion. MVF can exert a strong influence on the motor network, mainly through increased cognitive penetration in action control, though the variance in methodology and the lack of studies that shed light on the functional connectivity between areas still limit insight into the actual underlying mechanisms.},
  author       = {Deconinck, Frederik and Smorenburg, Ana RP and Benham, Alex and Ledebt, Annick and Feltham, Max G and Savelsbergh, Geert JP},
  issn         = {1545-9683},
  journal      = {NEUROREHABILITATION AND NEURAL REPAIR},
  keywords     = {sensorimotor control,systematic review,visual feedback,mirror,hemiparesis,stroke,cerebral palsy,RANDOMIZED CONTROLLED-TRIAL,REGIONAL PAIN SYNDROME,PHANTOM LIMB PAIN,NEAR-INFRARED SPECTROSCOPY,INDUCED MOVEMENT THERAPY,MOTOR CORTEX ACTIVATION,CORTICAL REORGANIZATION,STROKE PATIENTS,CORTICOSPINAL EXCITABILITY,BIMANUAL COORDINATION},
  language     = {eng},
  number       = {4},
  pages        = {349--361},
  title        = {Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain},
  url          = {http://dx.doi.org/10.1177/1545968314546134},
  volume       = {29},
  year         = {2015},
}

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