Paola Reissig

Visual feedback-related changes in ipsilateral cortical excitability during unimanual movement: Implications for mirror therapy.

Provision of a mirror image of a hand undertaking a motor task (i.e., mirror therapy) elicits behavioural improvements in the inactive hand. A greater understanding of the neural mechanisms underpinning this phenomenon is required to maximise its potential for rehabilitation across the lifespan, e.g., following hemiparesis or unilateral weakness. Young and older participants performed unilateral finger abductions with no visual feedback, with feedback of the active or passive hands, or with a mirror image of the active hand. Transcranial magnetic stimulation was used to assess feedback-related changes in two neurophysiological measures thought to be involved in inter-manual transfer of skill, namely corticospinal excitability (CSE) and intracortical inhibition (SICI) in the passive hemisphere. Task performance led to CSE increases, accompanied by decreases of SICI, in all visual feedback conditions relative to rest. However, the changes due to mirror feedback were not significantly different to those observed in the other (more standard) visual conditions. Accordingly, the unimanual motor action itself, rather than modifications in visual feedback, appears more instrumental in driving changes in CSE and SICI. Therefore, changes in CSE and SICI are unlikely to underpin the behavioural benefits of mirror therapy. We discuss implications for rehabilitation and directions of future research.

The Influence of Mirror-Visual Feedback on Training-Induced Motor Performance Gains in the Untrained Hand

The well-documented observation of bilateral performance gains following unilateral motor training, a phenomenon known as cross-limb transfer, has important implications for rehabilitation. It has recently been shown that provision of a mirror image of the active hand during unilateral motor training has the capacity to enhance the efficacy of this phenomenon when compared to training without augmented visual feedback (i.e., watching the passive hand), possibly via action observation effects [1]. The current experiment was designed to confirm whether mirror-visual feedback (MVF) during motor training can indeed elicit greater performance gains in the untrained hand compared to more standard visual feedback (i.e., watching the active hand). Furthermore, discussing the mechanisms underlying any such MVF-induced behavioural effects, we suggest that action observation and the cross-activation hypothesis may both play important roles in eliciting cross-limb transfer. Eighty participants practiced a fast-as-possible two-ball rotation task with their dominant hand. During training, three different groups were provided with concurrent visual feedback of the active hand, inactive hand or a mirror image of the active hand with a fourth control group receiving no training. Pre- and post-training performance was measured in both hands. MVF did not increase the extent of training-induced performance changes in the untrained hand following unilateral training above and beyond those observed for other types of feedback. The data are consistent with the notion that cross-limb transfer, when combined with MVF, is mediated by cross-activation with action observation playing a less unique role than previously suggested. Further research is needed to replicate the current and previous studies to determine the clinical relevance and potential benefits of MVF for cases that, due to the severity of impairment, rely on unilateral training programmes of the unaffected limb to drive changes in the contralateral affected limb.

Age-Specific Effects of Mirror-Muscle Activity on Cross-Limb Adaptations Under Mirror and Non-Mirror Visual Feedback Conditions

Cross-limb transfer (CLT) describes the observation of bilateral performance gains due to unilateral motor practice. Previous research has suggested that CLT may be reduced, or absent, in older adults, possibly due to age-related structural and functional brain changes. Based on research showing increases in CLT due to the provision of mirror visual feedback (MVF) during task execution in young adults, our study aimed to investigate whether MVF can facilitate CLT in older adults, who are known to be more reliant on visual feedback for accurate motor performance. Participants (N = 53) engaged in a short-term training regime (300 movements) involving a ballistic finger task using their dominant hand, while being provided with either visual feedback of their active limb, or a mirror reflection of their active limb (superimposed over the quiescent limb). Performance in both limbs was examined before, during and following the unilateral training. Furthermore, we measured corticospinal excitability (using TMS) at these time points, and assessed muscle activity bilaterally during the task via EMG; these parameters were used to investigate the mechanisms mediating and predicting CLT. Training resulted in significant bilateral performance gains that did not differ as a result of age or visual feedback (both p > 0.1). Training also elicited bilateral increases in corticospinal excitability (p < 0.05). For younger adults, CLT was significantly predicted by performance gains in the trained hand (β = 0.47), whereas for older adults it was significantly predicted by mirror activity in the untrained hand during training (β = 0.60). The present study suggests that older adults are capable of exhibiting CLT to a similar degree to younger adults. The prominent role of mirror activity in the untrained hand for CLT in older adults indicates that bilateral cortical activity during unilateral motor tasks is a compensatory mechanism. In this particular task, MVF did not facilitate the extent of CLT.

Noninvasive brain stimulation can elucidate and interact with the mechanisms underlying motor learning and retention: implications for rehabilitation.

Seminal work in animals indicates that learning a motor task results in long-term potentiation (LTP) in primary motor cortex (M1) and a subsequent occlusion of LTP induction (Rioult-Pedotti et al. J Neurophysiol 98: 3688-3695, 2007). Using various forms of noninvasive brain stimulation in conjunction with a motor learning paradigm, Cantarero et al. (J Neurosci 33: 12862-12869, 2013) recently provided novel evidence to support the hypothesis that retention of motor skill is contingent upon this postlearning occlusion.

Problems in planning bimanually incongruent grasp postures relate to simultaneous response specification processes.

The purpose of the current experiments was to examine whether the problems associated with grasp posture planning during bimanually incongruent movements are due to crosstalk at the motor programming level. Participants performed a grasping and placing task in which they grasped two objects from a table and placed them onto a board to targets that required identical (congruent) or non-identical degrees of rotation (incongruent). The interval between the presentation of the first stimulus and the second stimulus (stimulus onset asynchrony: SOA) was manipulated. Results demonstrate that the problems associated with bimanually incongruent grasp posture planning are reduced at SOA durations longer than 1000ms, indicating that the costs associated with bimanual incongruent movements arise from crosstalk at the motor programming level. In addition, reach-to-grasp times were shorter, and interlimb limb coupling was higher, for congruent, compared to incongruent, object end-orientation conditions in both Experiment 1 and 2. The bimanual interference observed during reach-to-grasp execution is postulated to arise from limitations in the visual motor system or from conceptual language representations. The present results emphasize that bimanual interference arises from constraints active at multiple levels of the neurobiological-cognitive system.