The neuronal correlates of mirror therapy: A functional magnetic resonance imaging study on mirror-induced visual illusions of ankle movements.

Recovery in stroke is mediated by neural plasticity. Mirror therapy is an effective method in the rehabilitation of stroke patients, but the mechanism is still obscure. To identify the neural networks associated with the effect of lower-limbs mirror therapy, we investigated a functional magnetic resonance imaging (fMRI) study of mirror-induced visual illusion of ankle movements. Five healthy controls and five left hemiplegic stroke patients performed tasks related to mirror therapy in the fMRI study. Neural activation was compared in a no-mirror condition and a mirror condition. All subjects in the experiment performed the task of flexing and extending the right ankle. In a mirror condition, movement of the left ankle was simulated by mirror reflection of right ankle movement. Changes in neural activation in response to mirror therapy were assessed both in healthy controls and stroke patients. We found strong activation of the motor cortex bilaterally in healthy controls, as well as significant activation of the ipsilateral sensorimotor cortex, the occipital gyrus, and the anterior prefrontal gyrus in stroke patients with respect to the non-mirror condition. We concluded that mirror therapy of ankle movements may induce neural activation of the ipsilesional sensorimotor cortex, and that cortical reorganization may be useful for motor rehabilitation in stroke.