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Ventura S, Tessari A, Castaldini S, Magni E, Turolla A, Baños R, Lullini G. Effectiveness of a Virtual Reality rehabilitation in stroke patients with sensory-motor and proprioception upper limb deficit: A study protocol. PLoS One 2024; 19:e0307408. [PMID: 39133660 PMCID: PMC11318908 DOI: 10.1371/journal.pone.0307408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 07/02/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Stroke is the second leading cause of death in Europe. In the case of stroke survival (almost 70%), only 25% of patients recover completely, while the remaining 75% will undergo a rehabilitation phase that varying from months to years. The primary outcomes of a stroke involve motor impairment in the upper limbs, resulting in a partial or complete inability to move the limb on the right or left side, depending on the affected hemisphere. Furthermore, the motor deficit distorts the proprioception of the body and the embodiment ability of the injured limb. This could be rehabilitated through the paradigm of body illusion that modulates the motor rehabilitation. The present protocol aims to investigate the effectiveness of a Virtual Reality system for sensorimotor and proprioception upper limb deficit compared to a traditional upper limb rehabilitation program. METHOD This study has a randomized and controlled design with control and experimental groups, and 4 measurement times: pre-intervention, immediately after the intervention, and two follow-ups (at 6 and 12 months). The inclusion criteria are: (a) Being 18 to 85 years old, both males and females; (b) Suffering from ischemic or haemorrhagic stroke; (c) The stroke event must have occurred from two to eighteen months before recruitment; (d) Patients must have moderate to severe upper limb motor deficit, and the alteration of sensorimotor and proprioception abilities of the injury upper limb; (e) Patients must understand and sign the written consent for enrolment. The rehabilitation last four weeks with three sessions per week at Bellaria Hospital of Bologna (Italy). The VR protocol uses two types of technology: immersive and non-immersive, and the control group follow the traditional rehabilitation program.
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Affiliation(s)
- Sara Ventura
- Instituto Polibienestar, University of Valencia, Valencia, Spain
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Alessia Tessari
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Sara Castaldini
- UOC di Medicina Riabilitativa e Neuro-riabilitazione, IRCCS Istituto delle Scienze Neurologiche di Bologna, Azienda USL Bologna, Bologna, Italy
| | - Elisabetta Magni
- UOC di Medicina Riabilitativa e Neuro-riabilitazione, IRCCS Istituto delle Scienze Neurologiche di Bologna, Azienda USL Bologna, Bologna, Italy
| | - Andrea Turolla
- Department of Biomedical and Neuromotor Sciences–DIBINEM, University of Bologna, Bologna, Italy
| | - Rosa Baños
- Instituto Polibienestar, University of Valencia, Valencia, Spain
| | - Giada Lullini
- UOC di Medicina Riabilitativa e Neuro-riabilitazione, IRCCS Istituto delle Scienze Neurologiche di Bologna, Azienda USL Bologna, Bologna, Italy
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Hussain F, Khursheed M, Afzal S, Khan MU, Hasan A, Hasnain SM. Effects of Virtual Reality-Based Mirror Therapy on Upper Extremity Motor Function, Manual Performance and Gross Manual Dexterity Among Stroke Patients: A Meta-Analysis. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2024; 17:1219-1234. [PMID: 39257864 PMCID: PMC11385280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
In recent years, innovative technologies have gained prominence in stroke patient rehabilitation worldwide, with virtual reality-based mirror therapy (VRBMT) emerging as a notable example. Hence, the present study aims to determine the efficacy of VRBMT on upper extremity motor function, manual performance, and gross manual dexterity among stroke patients. The systematic search utilized Population, Intervention, Comparison, Outcome, and Design (PICOD) paradigm, and the study searched was based on 2012-2023, utilizing different databases. The meta-analysis data was evaluated using MedCalc version 18.11.3. The Pooled effect size mean was statistically examined using a fixed and random effect model. Among the 6 studies selected, 4 studies involving upper-limb stroke patients were identified between the VRBMT. Pooled analysis of VRBMT revealed no significant effect on motor function [standardized mean difference (SMD) 0.815; 95% CI 0.00 to 81.37; P = 0.5562]. The remaining 2 of 6 studies participated in the study of the manual performance stroke patients (SMD 0.869; 95% CI 0.00 to 93.22; P = 0.0684). The pooled analysis of VRBMT revealed no significant effect. The last 2 of 6 included studies on gross manual dexterity in stroke. The pooled analysis also showed no significant effects on VRBMT (SMD 0.198; 95% CI 0.00 to 0.00; P = 0.6951). The present study concluded although VRBMT exhibits potential as a novel method for stroke rehabilitation, its effects on gross manual dexterity, manual performance, and upper extremity motor function are not statistically significant may be due to a limited number of studies on VRBMT in stroke patients.
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Affiliation(s)
- Fouzia Hussain
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
| | - Mahnoor Khursheed
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
| | - Sumera Afzal
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
| | - Muhammad Usman Khan
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
| | - Ahad Hasan
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
| | - Syed Meeran Hasnain
- Ziauddin College of Physical Therapy, Ziauddin University, Karachi, PAKISTAN
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Arman S, Menekseoglu AK, Sezgin B, Ozgur B, Capan N, Oral A. The effects of virtual reality-mediated tendon and nerve gliding exercises in the conservative management of carpal tunnel syndrome: a double-blind randomized placebo controlled trial. Eur J Phys Rehabil Med 2024; 60:458-469. [PMID: 38551521 PMCID: PMC11255877 DOI: 10.23736/s1973-9087.24.08432-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/27/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common condition resulting from compression of the median nerve at the wrist. First-line treatment typically involves conservative management, which commonly includes splinting and gliding exercises. Emerging evidence suggests the potential benefits of using virtual reality (VR) in rehabilitation. AIM This study aimed to assess the effects of VR-mediated tendon and nerve gliding exercises on the conservative treatment of CTS, compared to video-assisted (sham virtual) and home-based gliding exercises. DESIGN This study was a prospective, double-blind, randomized, placebo controlled interventional trial. SETTING The study was conducted in the Department of Physical Medicine and Rehabilitation at a university hospital. POPULATION The study included patients with mild to moderate CTS. METHODS The study included a total of 54 hands from 33 patients. The participants were randomly allocated into three groups: the VR-mediated group (VG), the sham VR-mediated group (SG), and the control (home-based) group (CG). Both intervention groups engaged in gliding exercises utilizing a Leap Motion Controller-based VR system and instructional videos, under the supervision of a physical therapist. The VR system was activated for the VG and deactivated for the SG. Exercises were performed twice weekly for eight weeks. The CG received a brochure describing the gliding exercises. Primary outcomes were symptom severity measured by the Numerical Rating Scale (NRS) and the Boston Carpal Tunnel Questionnaire (BCTQ), along with nerve conduction studies. Secondary outcomes included muscle strength (hand grip, key pinch), sensory measures (static two-point discrimination, vibration), and quality of life. RESULTS Both the VG and SG showed significant improvements in NRS and BCTQ scores compared to the CG in within-group comparisons. Nighttime symptoms improved significantly in the VG compared to the CG in between-group analyses. Electrophysiological findings showed no significant changes. CONCLUSIONS An eight-week VR-mediated exercise program may enhance tendon and nerve gliding exercise effectiveness, particularly for nighttime symptoms in CTS patients. CLINICAL REHABILITATION IMPACT In the future, challenging exercises requiring time and supervision could be effectively performed through VR, offering an alternative to traditional methods.
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Affiliation(s)
- Sina Arman
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye -
| | - Ahmet K Menekseoglu
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Baran Sezgin
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Burhan Ozgur
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Nalan Capan
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Aydan Oral
- Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
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Biswas A, Rao PD, Madhavan S, Natarajan M, Solomon JM. Video parameters for action observation training in stroke rehabilitation: a scoping review. Disabil Rehabil 2024; 46:1256-1265. [PMID: 37021345 DOI: 10.1080/09638288.2023.2191016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/08/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE Action observation training (AOT) is a therapeutic approach used in stroke rehabilitation. Videos form the core of AOT, and knowledge of constituent parameters is essential to make the intervention robust and generalizable. Currently, there is a dearth of available information on video parameters to be used for AOT. Our purpose was to identify and describe the parameters that constitute AOT videos for stroke rehabilitation. METHOD Electronic databases like PubMed, CINAHL, Scopus, Web of Science, ProQuest, and Ovid SP from inception to date according to PRISMA-ScR guidelines. Title, abstract, and full-text screening were done independently by two authors, with a third author for conflict resolution. Data on video parameters like length, quality, perspective, speed, screen size and distance, sound, and control videos were extracted. RESULTS Seventy studies were included in this review. The most-reported parameters were video length (85.71%) and perspective of view (62.85%). Movement speed (7.14%) and sound (8.57%) were the least reported. Static landscapes or geometrical patterns were found suitable as control videos. CONCLUSION Most video parameters except for length and perspective of view remain underreported in AOT protocols. Future studies with better descriptions of video parameters are required for comprehensive AOT interventions and result generalisation.
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Affiliation(s)
- Arunima Biswas
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Prajna D Rao
- College of Physiotherapy, Srinivas University, Mangalore, India
| | - Sangeetha Madhavan
- Department of Physical Therapy, University of Illinois, Chicago, IL, USA
| | - Manikandan Natarajan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
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Sokołowska B. Being in Virtual Reality and Its Influence on Brain Health-An Overview of Benefits, Limitations and Prospects. Brain Sci 2024; 14:72. [PMID: 38248287 PMCID: PMC10813118 DOI: 10.3390/brainsci14010072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/17/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Dynamic technological development and its enormous impact on modern societies are posing new challenges for 21st-century neuroscience. A special place is occupied by technologies based on virtual reality (VR). VR tools have already played a significant role in both basic and clinical neuroscience due to their high accuracy, sensitivity and specificity and, above all, high ecological value. OBJECTIVE Being in a digital world affects the functioning of the body as a whole and its individual systems. The data obtained so far, both from experimental and modeling studies, as well as (clinical) observations, indicate their great and promising potential, but apart from the benefits, there are also losses and negative consequences for users. METHODS This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework across electronic databases (such as Web of Science Core Collection; PubMed; and Scopus, Taylor & Francis Online and Wiley Online Library) to identify beneficial effects and applications, as well as adverse impacts, especially on brain health in human neuroscience. RESULTS More than half of these articles were published within the last five years and represent state-of-the-art approaches and results (e.g., 54.7% in Web of Sciences and 63.4% in PubMed), with review papers accounting for approximately 16%. The results show that in addition to proposed novel devices and systems, various methods or procedures for testing, validation and standardization are presented (about 1% of articles). Also included are virtual developers and experts, (bio)(neuro)informatics specialists, neuroscientists and medical professionals. CONCLUSIONS VR environments allow for expanding the field of research on perception and cognitive and motor imagery, both in healthy and patient populations. In this context, research on neuroplasticity phenomena, including mirror neuron networks and the effects of applied virtual (mirror) tasks and training, is of interest in virtual prevention and neurogeriatrics, especially in neurotherapy and neurorehabilitation in basic/clinical and digital neuroscience.
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Affiliation(s)
- Beata Sokołowska
- Bioinformatics Laboratory, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
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Aderinto N, Olatunji G, Abdulbasit MO, Edun M, Aboderin G, Egbunu E. Exploring the efficacy of virtual reality-based rehabilitation in stroke: a narrative review of current evidence. Ann Med 2023; 55:2285907. [PMID: 38010358 PMCID: PMC10836287 DOI: 10.1080/07853890.2023.2285907] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Stroke rehabilitation presents a complex challenge, necessitating innovative approaches to optimise functional recovery. Virtual Reality-Based Rehabilitation (VRBR) has emerged as a promising intervention that capitalises on immersive technology to engage stroke survivors in their recovery journey. This review aims to examine the efficacy of VRBR in stroke rehabilitation, focusing on its advantages and challenges. METHODS A comprehensive search of relevant literature was conducted to gather evidence on the efficacy of VRBR in stroke survivors. Studies that investigated the impact of VRBR on patient engagement, functional recovery, and overall rehabilitation outcomes were included. The review also assessed the ability of VRBR to simulate real-life scenarios and facilitate essential daily activities for stroke survivors. RESULTS The review highlights that VRBR offers a unique immersive experience that enhances patient engagement and motivation during rehabilitation. The immersive nature of VRBR fosters a sense of presence, which can positively impact treatment adherence and outcomes. Moreover, VRBR's capacity to replicate real-world scenarios provides stroke survivors with opportunities to practice vital daily activities, promoting functional independence. In contrast, conventional rehabilitation methods lack the same level of engagement and real-world simulation. CONCLUSION VRBR holds promise as an efficacious intervention in stroke rehabilitation. Its immersive nature enhances patient engagement and motivation, potentially leading to better treatment adherence and outcomes. The ability of VRBR to simulate real-life scenarios offers a unique platform. However, challenges such as cost, equipment, patient suitability, data privacy, and acceptance must be addressed for successful integration into stroke rehabilitation practice.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, LadokeAkintola University of Technology, Ogbomoso, Nigeria
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | | | - Mariam Edun
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Gbolahan Aboderin
- Department of Medicine and Surgery, LadokeAkintola University of Technology, Ogbomoso, Nigeria
| | - Emmanuel Egbunu
- Department of Medicine and Surgery, Federal Medical Centre Bida, Niger, Nigeria
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Temporiti F, Calcagno A, Coelli S, Marino G, Gatti R, Bianchi AM, Galli M. Early sleep after action observation and motor imagery training boosts improvements in manual dexterity. Sci Rep 2023; 13:2609. [PMID: 36788349 PMCID: PMC9929332 DOI: 10.1038/s41598-023-29820-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
The systematic observation and imagination of actions promotes acquisition of motor skills. Furthermore, studies demonstrated that early sleep after practice enhances motor learning through an offline stabilization process. Here, we investigated behavioral effects and neurodynamical correlates of early sleep after action observation and motor imagery training (AO + MI-training) on motor learning in terms of manual dexterity. Forty-five healthy participants were randomized into three groups receiving a 3 week intervention consisting of AO + MI-training immediately before sleeping or AO + MI-training at least 12 h before sleeping or a control stimulation. AO + MI-training implied the observation and motor imagery of transitive manual dexterity tasks, whereas the control stimulation consisted of landscape video-clips observation. Manual dexterity was assessed using functional tests, kinematic and neurophysiological outcomes before and after the training and at 1-month follow-up. AO + MI-training improved manual dexterity, but subjects performing AO + MI-training followed by early sleep had significantly larger improvements than those undergoing the same training at least 12 h before sleeping. Behavioral findings were supported by neurodynamical correlates during motor performance and additional sleep-dependent benefits were also detected at 1 month follow-up. These findings introduce a new approach to enhance the acquisition of new motor skills or facilitate recovery in patients with motor impairments.
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Affiliation(s)
- Federico Temporiti
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Rozzano, Milan, Italy.
- Department of Electronic, Information and Bioengineering, Politecnico Di Milano, Via Ponzio 34, Milan, Italy.
| | - Alessandra Calcagno
- Department of Electronic, Information and Bioengineering, Politecnico Di Milano, Via Ponzio 34, Milan, Italy
| | - Stefania Coelli
- Department of Electronic, Information and Bioengineering, Politecnico Di Milano, Via Ponzio 34, Milan, Italy
| | - Giorgia Marino
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Rozzano, Milan, Italy
| | - Roberto Gatti
- Physiotherapy Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
| | - Anna Maria Bianchi
- Department of Electronic, Information and Bioengineering, Politecnico Di Milano, Via Ponzio 34, Milan, Italy
| | - Manuela Galli
- Department of Electronic, Information and Bioengineering, Politecnico Di Milano, Via Ponzio 34, Milan, Italy
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Serrano-López Terradas PA, Criado Ferrer T, Jakob I, Calvo-Arenillas JI. Quo Vadis, Amadeo Hand Robot? A Randomized Study with a Hand Recovery Predictive Model in Subacute Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:690. [PMID: 36613027 PMCID: PMC9820043 DOI: 10.3390/ijerph20010690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Early identification of hand-prognosis-factors at patient's admission could help to select optimal synergistic rehabilitation programs based on conventional (COHT) or robot-assisted (RAT) therapies. METHODS In this bi-phase cross-over prospective study, 58 stroke patients were enrolled in two randomized groups. Both groups received same treatments A + B (A = 36 COHT sessions for 10 weeks; B = 36 RAT sessions for 10 weeks; 45 min/session; 3 to 5 times per week). Outcome repeated measures by blinded assessors included FMUL, BBT, NHPT, Amadeo Robot (AHR) and AMPS. Statistical comparisons by Pearson's rank correlations and one-way analyses of variance (ANOVA) with Bonferroni posthoc tests, with size effects and statistic power, were reported. Multiple backward linear regression models were used to predict the variability of sensorimotor and functional outcomes. RESULTS Isolated COHT or RAT treatments improved hand function at 3 months. While "higher hand paresis at admission" affected to sensorimotor and functional outcomes, "laterality of injury" did not seem to affect the recovery of the hand. Kinetic-kinematic parameters of robot allowed creating a predictive model of hand recovery at 3 and 6 months from 1st session. CONCLUSIONS Hand impairment is an important factor in define sensorimotor and functional outcomes, but not lesion laterality, to predict hand recovery.
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Affiliation(s)
- Pedro Amalio Serrano-López Terradas
- Robotics Unit, Brain Damage Service, Hospital Beata María Ana, 28007 Madrid, Spain
- Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Occupational Thinks Research Group, Occupational Therapy Department, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Teresa Criado Ferrer
- Robotics Unit, Brain Damage Service, Hospital Beata María Ana, 28007 Madrid, Spain
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Mirror neurons 30 years later: implications and applications. Trends Cogn Sci 2022; 26:767-781. [PMID: 35803832 DOI: 10.1016/j.tics.2022.06.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/21/2022] [Accepted: 06/07/2022] [Indexed: 12/30/2022]
Abstract
Mirror neurons (MNs) were first described in a seminal paper in 1992 as a class of monkey premotor cells discharging during both action execution and observation. Despite their debated origin and function, recent studies in several species, from birds to humans, revealed that beyond MNs properly so called, a variety of cell types distributed among multiple motor, sensory, and emotional brain areas form a 'mirror mechanism' more complex and flexible than originally thought, which has an evolutionarily conserved role in social interaction. Here, we trace the current limits and envisage the future trends of this discovery, showing that it inspired translational research and the development of new neurorehabilitation approaches, and constitutes a point of no return in social and affective neuroscience.
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