title: Neural interface of mirror therapy in chronic stroke patients: a functional magnetic resonance imaging study.
abstract: BACKGROUND
  Recovery in stroke is mediated by neural plasticity. Neuro-restorative therapies improve recovery after stroke by promoting repair and function. Mirror neuron system (MNS) has been studied widely in humans in stroke and phantom sensations.
  
  
  METHODS
  Study subjects included 20 patients with chronic stroke and 10 healthy controls. Patients had clinical disease-severity scores, functional magnetic resonance imaging (fMRI) and diffuse tensor imaging (DTI) at baseline, 8 and at 24 weeks. Block design with alternate baseline and activation cycles was used with a total of 90 whole brain echo planar imaging (EPI) measurements (timed repetition (TR) = 4520 ms, timed echo (TE) = 44 ms, slices = 31, slice thickness = 4 mm, EPI factor 127, matrix = 128 × 128, FOV = 230 mm). Whole brain T1-weighted images were acquired using 3D sequence (MPRage) with 120 contiguous slices of 1.0 mm thickness. The mirror therapy was aimed via laptop system integrated with web camera, mirroring the movement of the unaffected hand. This therapy was administered for 5 days in a week for 60-90 min for 8 weeks.
  
  
  RESULTS
  All the patients showed statistical significant improvement in Fugl Meyer and modified Barthel Index (P < 0.05) whereas the change in Medical Research Council (MRC) power grade was not significant post-therapy (8 weeks). There was an increase in the laterality index (LI) of ipsilesional BA 4 and BA 6 at 8 weeks exhibiting recruitment and focusing principles of neural plasticity.
  
  
  CONCLUSIONS
  Mirror therapy simulated the "action-observation" hypothesis exhibiting recovery in patients with chronic stroke. Therapy induced cortical reorganization was also observed from our study.
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. ashu.bhasin@gmail.com
authors.forename: Ashu
authors.initials: A
authors.lastname: Bhasin
authors.forename: M V
authors.initials: MV
authors.lastname: Padma Srivastava
authors.forename: Senthil S
authors.initials: SS
authors.lastname: Kumaran
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhatia
authors.forename: Sujata
authors.initials: S
authors.lastname: Mohanty
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply*; D002908:Chronic Disease; D056228:Feedback, Sensory / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D010100:Oxygen / Q000097:blood; D020521:Stroke / Q000473:pathology*; D000071939:Stroke Rehabilitation
chemical_list: D010100:Oxygen