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

Sequence representations after action-imagery practice of one-finger movements are effector-independent

Action-imagery practice (AIP) is often less effective than action-execution practice (AEP). We investigated whether this is due to a different time course of learning of different types of sequence representations in AIP and AEP. Participants learned to sequentially move with one finger to ten targets, which were visible the whole time. All six sessions started with a test. In the first four sessions, participants performed AIP, AEP, or control-practice (CP). Tests involved the practice sequence, a mirror sequence, and a different sequence, which were performed both with the practice hand and the other (transfer) hand. In AIP and AEP, movement times (MTs) in both hands were significantly shorter in the practice sequence than in the other sequences, indicating sequence-specific learning. In the transfer hand, this indicates effector-independent visual-spatial representations. The time course of the acquisition of effector-independent visual-spatial representations did not significantly differ between AEP and AIP. In AEP (but not in AIP), MTs in the practice sequence were significantly shorter in the practice hand than in the transfer hand, indicating effector-dependent representations. In conclusion, effector-dependent representations were not acquired after extensive AIP, which may be due to the lack of actual feedback. Therefore, AIP may replace AEP to acquire effector-independent visual-spatial representations, but not to acquire effector-dependent representations.

Effect of Self-Controlled and Regulated Feedback on Motor Skill Performance and Learning: A Meta-Analytic Study

The purpose of this study was to use the meta-analytic approach to assess the effectiveness of self-controlled (SC) and regulated (R) feedback on motor skill performance (MSP). Random effects model using the standardized mean difference effect size (ES) was used to pool results. A total of 86 ES, retrieved from 18 studies, were calculated and separated into three types of feedback: SC, R, and yoked group (YG). In acquisition phase, SC (ES = 1.872; CI_95% = 1.014, 2.730), R (ES = 0.852; CI_95% = 0.614, 1.090), and YG (ES = 1.492; CI_95% = 0.266, 2.718) significantly improved MSP. In retention phase, SC and YG had a nonsignificant decrease in MSP, R (ES = -0.819; CI_95% = -1.207, -0.430) significantly decrease MSP. Several factors were analyzed as moderator variables. Results suggest that SC feedback enhances learning.

Effects of mirror training on motor performance in healthy individuals: a systematic review and meta-analysis

Objective

Mirror training (MTr) is a rehabilitation technique for patients with neurological diseases. There is no consensus on its effects on motor function in healthy individuals. This systematic review and meta-analysis considers the effects of MTr on motor function in healthy individuals.

Design

This is a systematic review and meta-analysis.

Data sources

We searched six databases for studies assessing the effects of MTr on motor function in healthy individuals, published between January 1995 and December 2018. The Cochrane risk of bias was used to assess the quality of the studies. A meta-analysis was conducted with narrative synthesis.

Eligibility criteria for selecting studies

English-language randomised controlled trials reporting the behavioural results in healthy individuals were included.

Results

Fourteen randomised controlled trials involving 538 healthy individuals were eligible. Two short-term studies showed MTr was inferior to passive vision pattern (standardised mean difference 0.57 (95% CI 0.06 to 1.08), I²=0%, p=0.03). The methods varied and there is limited evidence supporting the effectiveness of MTr compared with three alternative training patterns, with insufficient evidence to support analyses of age, skill level or hand dominance.

Conclusion

The limited evidence that MTr affects motor performance in healthy individuals is weak and inconsistent among studies. It is unclear whether the effects of MTr on motor performance are more pronounced than the direct vision pattern, passive vision pattern or action observation. Further studies are needed to explore the short-term and long-term benefits of MTr and its effects on motor learning in healthy individuals.

PROSPERO registration number

CRD42019128881.

Neuroplastic and motor behavioral changes after intermanual transfer training of non-dominant hand: A prospective fMRI study

BACKGROUND

Intermanual transfer of learning is an important movement basis for a keyboard and instrument playing movement. However, the issue of where neural plastic mechanism occurs in the brain after intermanual transfer training remains both controversial and unresolved.

OBJECTIVE

The aim of present study is to investigate the neuroplastic mechanism associated with the interlimb transfer learning from non-dominant hand to dominant hand.

METHODS

Twenty healthy right-handed adults were classified into either the control group (no-training) or the experimental group (training serial button-press motor task, SPMT), 5 days a week for two consecutive weeks. SPMT involved pressing the numbers 1, 2, 3, and 4 in a random sequence, which was presented in the monitor screen. Outcome measures included movement accuracy (MA), movement time (MT), and the fMRI data using a 3T MRI scanner. Repeated measures of analysis of variance (ANOVA) and non-parametric tests were used at p <0.05.

RESULTS

Motor performances in the MA and MT were significantly more improved in the experimental group than in the control group (p <0.05). Neuroimaging data revealed a distributed subcortical and cortical motor network including the SMA-thalamus (VL/VL)-basal ganglia-cerebellum loop, suggesting a differential and time-dependent neural network utilized during intermanual transfer learning.

CONCLUSION

Pre-training intermanual transfer learning involved a form of declarative (or explicit) motor learning, which was primarily mediated by the cortical motor network, whereas post-training involved a form of procedural knowledge, which activated subcortical and cortical motor network regions, including the SMA-thalamus (VL/VL)-basal ganglia-cerebellum loop.

The Effects of Mirror Feedback during Target Directed Movements on Ipsilateral Corticospinal Excitability

Mirror visual feedback (MVF) training is a promising technique to promote activation in the lesioned hemisphere following stroke, and aid recovery. However, current outcomes of MVF training are mixed, in part, due to variability in the task undertaken during MVF. The present study investigated the hypothesis that movements directed toward visual targets may enhance MVF modulation of motor cortex (M1) excitability ipsilateral to the trained hand compared to movements without visual targets. Ten healthy subjects participated in a 2 × 2 factorial design in which feedback (veridical, mirror) and presence of a visual target (target present, target absent) for a right index-finger flexion task were systematically manipulated in a virtual environment. To measure M1 excitability, transcranial magnetic stimulation (TMS) was applied to the hemisphere ipsilateral to the trained hand to elicit motor evoked potentials (MEPs) in the untrained first dorsal interosseous (FDI) and abductor digiti minimi (ADM) muscles at rest prior to and following each of four 2-min blocks of 30 movements (B1–B4). Targeted movement kinematics without visual feedback was measured before and after training to assess learning and transfer. FDI MEPs were decreased in B1 and B2 when movements were made with veridical feedback and visual targets were absent. FDI MEPs were decreased in B2 and B3 when movements were made with mirror feedback and visual targets were absent. FDI MEPs were increased in B3 when movements were made with mirror feedback and visual targets were present. Significant MEP changes were not present for the uninvolved ADM, suggesting a task-specific effect. Analysis of kinematics revealed learning occurred in visual target-directed conditions, but transfer was not sensitive to mirror feedback. Results are discussed with respect to current theoretical mechanisms underlying MVF-induced changes in ipsilateral excitability.

Neural Correlates of Mirror Visual Feedback-Induced Performance Improvements: A Resting-State fMRI Study

Mirror visual feedback (MVF) is a promising approach to enhance motor performance without training in healthy adults as well as in patients with focal brain lesions. There is preliminary evidence that a functional modulation within and between primary motor cortices as assessed with transcranial magnetic stimulation (TMS) might be one candidate mechanism mediating the observed behavioral effects. Recently, studies using task-based functional magnetic resonance imaging (fMRI) have indicated that MVF-induced functional changes might not be restricted to the primary motor cortex (M1) but also include higher order regions responsible for perceptual-motor coordination and visual attention. However, aside from these instantaneous task-induced brain changes, little is known about learning-related neuroplasticity induced by MVF. Thus, in the present study, we assessed MVF-induced functional network plasticity with resting-state fMRI (rs-fMRI). We performed rs-fMRI of 35 right-handed, healthy adults before and after performing a complex ball-rotation task. The primary outcome measure was the performance improvement of the untrained left hand (LH) before and after right hand (RH) training with MVF (mirror group [MG], n = 17) or without MVF (control group [CG], n = 18). Behaviorally, the MG showed superior performance improvements of the untrained LH. In resting-state functional connectivity (rs-FC), an interaction analysis between groups showed changes in left visual cortex (V1, V2) revealing an increase of centrality in the MG. Within group comparisons showed further functional alterations in bilateral primary sensorimotor cortex (SM1), left V4 and left anterior intraparietal sulcus (aIP) in the MG, only. Importantly, a correlation analysis revealed a linear positive relationship between MVF-induced improvements of the untrained LH and functional alterations in left SM1. Our results suggest that MVF-induced performance improvements are associated with functional learning-related brain plasticity and have identified additional target regions for non-invasive brain stimulation techniques, a finding of potential interest for neurorehabilitation.

Mirror Visual Feedback Training Improves Intermanual Transfer in a Sport-Specific Task: A Comparison between Different Skill Levels

Mirror training therapy is a promising tool to initiate neural plasticity and facilitate the recovery process of motor skills after diseases such as stroke or hemiparesis by improving the intermanual transfer of fine motor skills in healthy people as well as in patients. This study evaluated whether these augmented performance improvements by mirror visual feedback (MVF) could be used for learning a sport-specific skill and if the effects are modulated by skill level. A sample of 39 young, healthy, and experienced basketball and handball players and 41 novices performed a stationary basketball dribble task at a mirror box in a standing position and received either MVF or direct feedback. After four training days using only the right hand, performance of both hands improved from pre- to posttest measurements. Only the left hand (untrained) performance of the experienced participants receiving MVF was more pronounced than for the control group. This indicates that intermanual motor transfer can be improved by MVF in a sport-specific task. However, this effect cannot be generalized to motor learning per se since it is modulated by individuals' skill level, a factor that might be considered in mirror therapy research.

Bilateral transfer phenomenon: A functional magnetic resonance imaging pilot study of healthy subjects

BACKGROUND

The bilateral transfer of a motor skill is a physiological phenomenon: the development of a motor skill with one hand can trigger the development of the same ability of the other hand.

OBJECTIVE

The purpose of this study was to verify whether bilateral transfer is associated with a specific brain activation pattern using functional magnetic resonance imaging (fMRI).

METHODS

The motor task was implemented as the execution of the Nine Hole Peg Test. Fifteen healthy subjects (10 right-handers and five left-handers) underwent two identical fMRI runs performing the motor task with the non-dominant hand. Between the first and the second run, each subject was intensively trained for five minutes to perform the same motor task with the dominant hand.

RESULTS

Comparing the two functional scans across the pool of subjects, a change of the motor activation pattern was observed. In particular, we observed, in the second run, a change in the activation pattern both in the cerebellum and in the cerebral cortex. We found activations in cortical areas involved in somatosensory integration, areas involved in procedural memory.

CONCLUSIONS

Our study shows, in a small group of healthy subjects, the modification of the fMRI activation pathway of a motor task performed by the non-dominant hand after intensive exercise performing the same task with the dominant hand.

Mirror Visual Feedback-Induced Performance Improvement and the Influence of Hand Dominance

Mirror visual feedback (MVF) is a promising technique in clinical settings that can be used to augment performance of an untrained limb. Several studies with healthy volunteers and patients using transcranial magnetic stimulation (TMS) or functional magnetic resonance imaging (fMRI) indicate that functional alterations within primary motor cortex (M1) might be one candidate mechanism that could explain MVF-induced changes in behavior. Until now, most studies have used MVF to improve performance of the non-dominant hand (NDH). The question remains if the behavioral effect of MVF differs according to hand dominance. Here, we conducted a study with two groups of young, healthy right-handed volunteers who performed a complex ball-rotation task while receiving MVF of the dominant (n = 16, group 1, MVF_DH) or NDH (n = 16, group 2, MVF_NDH). We found no significant differences in baseline performance of the untrained hand between groups before MVF was applied. Furthermore, there was no significant difference in the amount of performance improvement between MVF_DH and MVF_NDH indicating that the outcome of MVF seems not to be influenced by hand dominance. Thus our findings might have important implications in neurorehabilitation suggesting that patients suffering from unilateral motor impairments might benefit from MVF regardless of the dominance of the affected limb.