Mirror neurons and their relevance in neuro-rehabilitation

Mirror neurons are important for the rehabilitation of brain pathologies.

Is it possible to contribute, through the stimulation of mirror neurons, to functional recovery in patients who present hemiparesis as a consequence of a stroke?

Mirror neurons and their usefulness in neurological rehabilitation

About a month ago it was published in Psychology and Mind an article related to mirror neurons in which we talked mainly about their discovery and their importance in culture and social phenomena. This article aims to show, in broad strokes, the importance of these mirror neurons in the process of functional rehabilitation of the upper extremities in patients affected by Ictus.

In what processes are mirror neurons involved?

In 1996, Giacomo Rizzolati discovered, by serendipity, that these mirror neurons were activated by performing an action and seeing another person perform the same action. action and seeing another person performing the same action.Therefore, it can be concluded that they are essential for learning. learning and imitationand imitation, while playing an important role in social skills. social skillssuch as empathy empathyThey also play an important role in social skills, such as empathy, since thanks to them we can intuit what the other person thinks, is going to do or feels (Rizzolatti and Craighero, 2004).

Can their stimulation contribute to the rehabilitation of patients affected by CVA?

As mentioned, these are neurons that are involved in mechanisms that are involved in mechanisms that combine execution-observation. Therefore, based on these findings, it has been proven that their stimulation influences the rehabilitation process, and thus, several neuro-rehabilitation programs have been carried out. various functional neuro-rehabilitation programs have been carried outFor example, in cases where the patient has motor deficits in the upper extremities as a result of a cerebrovascular accident (CVA) or stroke.

An example of this is provided by the Rehabilitation Gamming System (RGS) (http://rgs-project.eu), an innovative project of Virtual Reality (VR) project carried out by the research team of the SPECS laboratory, the Pompeu Fabra University (UPF), the Hospital del Mar, the Valle Hebron Hospital and three other entities in collaboration with the Fundació TicSalut.

This project is based on the principle of brain plasticity and how functional reorganization can be achieved in areas affected by stroke through stimulation of secondary motor areas (Cameirao, Bermúdez, Duarte and Verschure, 2011). Such areas integrate the mirror neuron system (MNS), involved in motor execution and planning processes through the observation of such action.

RGS is an application that, by using VR through dynamic games, promotes the functional recovery of the patient. Thus, it allows the patient to advance in the process of rehabilitation of the upper extremities through the stimulation of the visual-motor pathway provided by the MNS. The material resources needed to carry out this therapy through RGS are mainly a computer with a Kinect sensor and RGS software, in addition to different interface devices (gloves, exoskeletons, etc.). Through the image provided by the screen, a representation of virtual arms can be observed, shown in first-person perspective, which simulates the movement of real arms in real time and in a simulated environment. In this way, the patient activates the injured motor neuronal circuits, which usually remain inactive due to the lack of movement of the paretic arm, thus inducing neuroplasticity in the affected area. As for the various games included in the program, they are mainly based on capturing objects, hitting them, dodging them, etc.

Also, each game is adapted in terms of complexity, each game is adapted in terms of complexity and speed of the stimuli to the performance in each of the arms and characteristics of the patient.. What is really interesting about this adaptation system is that it is dynamically modulated through two different strategies. On the one hand it adjusts the difficulty of the exercise, and on the other hand it amplifies the movement of the patient's affected arm in VR, showing faster, wider and more precise reaching movements. In this way, the patient is motivated to use his or her affected arm more frequently.

Another interesting aspect of the RGS system is that allows descriptive parameters of the user's progress to be capturedThese can be analyzed and presented automatically, allowing clinicians to monitor the patient's recovery process.

RGS has already been evaluated in several clinical studies that have demonstrated its efficacy in rehabilitation processes.. These studies were conducted to test the efficacy of therapy using RGS combined with Occupational Therapy (OT) compared to a control group receiving only OT. The results showed that the group of patients with whom RGS combined with TO was performed obtained better results than the control group (Cameirao et al., 2011).

Finally, it can be concluded that RGS is a VR therapy based on neuronal plasticity through the stimulation of the MNS in which, in a playful and enjoyable way, it is possible to contribute to the improvement of the MNS.In this way, it is possible to contribute to the improvement of upper limb mobility recovery in patients affected by stroke.

Bibliographic references:

• Cameirao, M.S, Bermudez, S., Duarte, O., and Verschure, P. (2011). Virtual reality based rehabilitation speeds up functional recovery of the upper extremities after stroke: a randomized controlled pilot study in the acute phase of stroke using the rehabilitation gaming system. Restorative neurology and neuroscience, 29(5), 287-298.
• Rizzolatti, G., and Craighero, L. (2004). The mirror-neuron system. Annual Review of Neuroscience, 27, 169-192.
• Página web The Rehabilitation Gaming System (www.eodyne.com).