Electromyographic biofeedback and visual feedback in myofunctional therapy: usage profile by speech-language-hearing pathologists / Biofeedback eletromiográfico e feedback visual na terapia miofuncional: perfil de uso pelos fonoaudiólogos

ABSTRACT Purpose: to identify the usage profile of mirrors and electromyographic biofeedback to support myofunctional therapy by speech-language-hearing therapists who work with oral-motor function in Brazil. Methods: a quantitative cross-sectional study with an online (SurveyMonkey) questionnaire, which was structured with questions on the use of mirrors and/or electromyographic biofeedback. A descriptive analysis was made, and the Mann-Whitney U test and the chi-square test were applied (p < 0.05). Results: most professionals (23 [82.14%]) used mirrors, whereas only five (17.85%) used electromyographic biofeedback. The electromyographic biofeedback was used at some point with all age groups, to treat mastication and swallowing functions and facial mimics. Dysphagia and facial palsy were regularly or occasionally treated with it. The patients' perception was significantly associated with the use of either instrument. The electromyographic biofeedback group showed a consensus among patients, while approximately half of the mirror group (12 [52.17%]) were indifferent to its use. Conclusion: the profile showed young adult professionals, who used national equipment. The findings reinforce the need for research on complementary therapeutic procedures in the field of oral-motor functions, particularly, electromyographic biofeedback.

RESUMO Objetivo: identificar o perfil de uso do espelho e do Biofeedback Eletromiográfico como suporte à terapia miofuncional por Fonoaudiólogos atuantes na área de Motricidade Orofacial no Brasil. Métodos: estudo quantitativo e transversal, por meio da aplicação de questionário online (plataforma SurveyMonkey). O questionário foi estruturado com perguntas sobre o uso do espelho e/ou do Biofeedback Eletromiográfico. Foi realizada análise descritiva e aplicação dos Testes U de Mann-Whitney e Qui-quadrado (p<0,05). Resultados: a maioria dos profissionais, 23 (82,14%), utiliza o espelho, enquanto apenas cinco (17,85%) utilizam o biofeedback eletromiográfico. O Biofeedback Eletromiográfico é eventualmente utilizado em todas as faixas etárias, assim como para as funções de mastigação, deglutição e mímica facial. As patologias referidas com uso regular e eventual foram a disfagia e a paralisia facial. Houve associação significante na percepção dos pacientes em relação ao uso de algum dos instrumentos, porém no grupo do Biofeedback Eletromiográfico houve consenso entre os pacientes e, no grupo espelho, aproximadamente metade 12 (52,17%) achou indiferente. Conclusão: o perfil encontrado foi de profissionais adultos jovens, com uso de instrumentação nacional. Os achados reforçam a necessidade de pesquisas voltadas aos procedimentos terapêuticos complementares na área de Motricidade Orofacial, sobretudo Biofeedback Eletromiográfico.

Speech training based on mirror neuron theory can improve children′s functional articulation disorders / 中华物理医学与康复杂志

Objective:To observe the effect of speech training based on mirror neuron theory on children with functional articulation disorder (FAD).Methods:Fifty children with FAD were randomly divided into a training group and a control group, each of 25. Both groups received 30 minutes of conventional speech training 5 times a week for 24 weeks, while the training group was additionally given 20 minutes of speech training based on mirror neuron theory simultaneously. Before and after the intervention, both groups were evaluated using the articulation speech ability assessment scale and the oral motor ability assessment scale.Results:Before the treatment, there were no significant differences between the 2 groups in any of the measurements. After the treatment, significant improvement was observed in all of the measurements for both groups, but at that point the training group′s articulation, motor ability of the lower jaw, tongue and lips were all significantly superior to the control group′s averages.Conclusions:Speech training based on mirror neuron theory can significantly improve the articulation, intelligibility and oral motor functioning of children with functional articulation disorder.

Antropogénesis de la intersubjetividad / Anthropogenesis of intersubjectivity

Este trabajo analiza el doble vínculo entre antropogénesis e intersubjetividad desde un punto de vista antropológico, psicológico y cognitivo. Primero, se examina la significación psicológica y cognitiva de la muerte a partir de la discusión de la evidencia paleoantropológica de los primeros enterramientos del hombre de neandertal. Asimismo, se precisa su importancia en el origen del pensamiento simbólico y la constitución de la intersubjetividad. Segundo, se analiza y fundamenta el concepto de representación intersubjetiva como constructo metapsicológico que define la constitución de la subjetividad. Se profundiza en el carácter psico-cognitivo y bio-cultural de las representaciones intersubjetivas en el proceso de la antropogénesis. Tercero, se analizan los desarrollos de la teoría de las neuronas espejo y la teoría de la mente, las cuales brindan el fundamento neurocientífico y psicosocial de las representaciones intersubjetivas. Se concluye con la formulación de interrogantes para un programa de investigación interdisciplinario en antropogénesis de la intersubjetividad(AU)

This work analyzes the double bind between anthropogenesis and intersubjectivity from an anthropological, psychological, and cognitive point of view. First, we examine the psychological and cognitive significance of death from the discussion of the paleoanthropological evidence of the first Neanderthal burials. Likewise, we describe its importance in the origin of symbolic thought and the constitution of intersubjectivity. Second, we analyze the concept of intersubjective representation as a metapsychological construct that defines the constitution of subjectivity. We explore the psycho-cognitive and bio-cultural character of intersubjective representations in the process of anthropogenesis. Third, we discuss the contribution of mirror neuron theory and theory of mind, which provide the neuroscientific and psychosocial foundations for intersubjective representations. We conclude with a guideline for an interdisciplinary research program on the anthropogenesis of intersubjectivity(AU)

Desarrollo Positivo en Jóvenes Involucrados en Voluntariado y su Relación con las Neuronas Espejo / Positive Development in Young People Involved in Volunteering and Its Relation to Mirror Neurons / Desenvolvimento Positivo em Jovens Envolvidos em Voluntariado e sua Relação com os Neurônios Espelho

Resumen En este estudio se analizó el efecto del desarrollo positivo sobre la contribución en jóvenes, y se identificaron las diferencias entre los jóvenes que han realizado actividades de voluntariado y los que no las han realizado; además se analizó la activación de las neuronas espejo. Participaron 121 universitarios, 28.9% hombres y 71.1% mujeres, con una media de edad de 21.51 años. Se utilizó la escala de Desarrollo Positivo en Adolescentes y de Contribución, además de un instrumento conformado por dos conjuntos de estímulos visuales. Los resultados corroboraron el efecto de las 5 c's sobre la contribución y se encontraron diferencias significativas en la escala de carácter y en dos dimensiones de contribución, donde los jóvenes que realizan actividades de voluntariado puntuaron más alto que aquellos que no las realizan. Se comprobó que existe activación en la zona correspondiente a las neuronas espejo, lo cual se relaciona con procesos empáticos. Se concluye que existe una relación entre las actividades de voluntariado y el desarrollo positivo en jóvenes universitarios.

Abstract The study analyzed the effect of positive development on contribution in young people and identified the differences between those who have done volunteer work and those who have not. It also studied the activation of the mirror neurons system. Participants were 121 university students, 28.9% male and 71.1% female, with an average age of 21.51. The Positive Youth Development Scale and the Contribution Scale were used, in addition to an instrument made up of two sets of visual stimuli. The results confirmed the effect of the 5 Cs on the contribution dimension and significant differences were found in the character scale and in two dimensions of contribution, in which young people who do volunteer work got higher scores than those who do not. The study confirmed that there was activation in the zone corresponding to the mirror neurons system, which is related to empathetic processes, and concluded that there was a relation between volunteering activities and the positive development of university students.

Resumo Neste estudo, foi analisado o efeito do desenvolvimento positivo sobre a contribuição em jovens e foram identificadas as diferenças entre os jovens que realizaram atividades de voluntariado e os que não as realizaram; além disso, foi analisada a ativação dos neurônios espelho. Participaram 121 universitários, 28.9 % homens e 71.1% mulheres, com uma média de idade de 21.51 anos. Foi utilizada a Escala de Desenvolvimento Positivo em Adolescentes e de Contribuição, ainda de um instrumento conformado por dois conjuntos de estímulos visuais. Os resultados corroboraram o efeito das 5 c's sobre a contribuição e foram verificadas diferenças significativas na escala de caráter e em duas dimensões de contribuição, em que os jovens que realizam atividades de voluntariado pontuaram mais alto que aqueles que não as realizam. Foi comprovado que existe ativação na zona correspondente aos neurônios espelho, o que está relacionado com processos empáticos. Conclui-se que existe uma relação entre as atividades de voluntariado e o desenvolvimento positivo em jovens universitários.

Effect of visual feedback training using mirror neuron theory on limb function and activities of daily living in patients with hemiplegia during early stroke / 中国基层医药

Objective@#To explore the effect of visual feedback training using mirror neuron theory in patients with hemiplegia in early stroke.@*Methods@#From July 2014 to July 2017, 122 early stroke patients with hemiplegic stroke in the First People's Hospital of Wenling were selected in the study.After the patients' condition was stable, visual feedback training based on mirror neuron theory was performed.The functional status of upper limbs before and after treatment was evaluated by the simplified Fugl-Meyer motor function evaluation.The modified Ashworth scale was used to evaluate the upper limb muscle tension before and after treatment.The Barthel index was used to evaluate the ability of daily living activities before and after treatment.@*Results@#The FMA score of patients after treatment was (35.74±11.24)points, which was significantly higher than that before treatment [(28.81±9.68)points, t=5.160, P=0.000]. The BI score after treatment was (76.24±14.77)points, which was significantly higher than before treatment[(52.93±12.28)points, t=13.404, P=0.000]. After treatment, the muscle tension of the flexor elbow muscle group was (1.57±0.76)grades, which was significantly lower than before treatment [(3.24±0.72)grades, t=17.619, P=0.000]. The forearm pronation muscle group muscle tension grade was (2.14±0.96)grades, which was significantly lower than before treatment [(3.28±0.75)grades, t=10.336, P=0.000].@*Conclusion@#Visual feedback training based on mirror neuron theory can help improve the upper limb function of patients with hemiplegia in early stroke, alleviate the symptoms of paralysis, improve the ability of daily living activities of patients, and has positive effect on promoting their rehabilitation.

Effect of visual feedback training using mirror neuron theory on limb function and activities of daily living in patients with hemiplegia during early stroke / 中国基层医药

Objective To explore the effect of visual feedback training using mirror neuron theory in patients with hemiplegia in early stroke.Methods From July 2014 to July 2017,122 early stroke patients with hemiplegic stroke in the First Peopleˊs Hospital of Wenling were selected in the study.After the patientsˊcondition was stable, visual feedback training based on mirror neuron theory was performed.The functional status of upper limbs before and after treatment was evaluated by the simplified Fugl －Meyer motor function evaluation.The modified Ashworth scale was used to evaluate the upper limb muscle tension before and after treatment.The Barthel index was used to evaluate the ability of daily living activities before and after treatment.Results The FMA score of patients after treatment was (35.74 ±11.24)points,which was significantly higher than that before treatment [(28.81 ±9.68)points,t＝5.160, P＝0.000].The BI score after treatment was (76.24 ±14.77) points,which was significantly higher than before treatment[(52.93 ±12.28) points,t＝13.404,P＝0.000].After treatment,the muscle tension of the flexor elbow muscle group was (1.57 ±0.76)grades,which was significantly lower than before treatment [(3.24 ±0.72)grades, t＝17.619,P＝0.000].The forearm pronation muscle group muscle tension grade was (2.14 ±0.96)grades,which was significantly lower than before treatment [(3.28 ±0.75) grades,t＝10.336,P＝0.000].Conclusion Visual feedback training based on mirror neuron theory can help improve the upper limb function of patients with hemiplegia in early stroke,alleviate the symptoms of paralysis ,improve the ability of daily living activities of patients ,and has positive effect on promoting their rehabilitation.

Effect of Action Observation Therapy on Upper Limb Function in Children with Spastic Hemiplegic Cerebral Palsy / 中国康复理论与实践

@#Objective To explore the effect of action observation therapy (AOT) on upper limb function in children with spastic hemiplegic cerebral palsy,and the better program. Methods From March to November,2017,45 children with spastic hemiplegic cerebral palsy were randomly assigned to control group and AOT group.The control group was further divided into group A(n=11)and group B(n=11), and received conventional rehabilitation treatment and scenic-observation therapy, 20 minutes every time for group A,and 30 minutes every time for group B.AOT group was further divided into group C(n=10)and group D (n=11), and received AOT in addition, 20 minutes every time for group C, and 30 minutes every time for group D,five times each week for twelve weeks for all the groups.Before treatment,eight and twelve weeks af-ter treatment, they were assessed with hand grip strength, Upper Extremities Functions Test (UEFT), and Wee Functional Independence Measure(WeeFIM). Results After treatment,the hand grip strength and the score of UEFT were better in group D than in groups B and C(P<0.05),and were better at twelve weeks than at eight weeks(P<0.05).No significant difference was found in the score of WeeFIM among groups after treatment(P>0.05). Conclusion AOT could improve upper limp function in children with spastic hemiplegic cerebral palsy,and it's more ef-fective after more training.

Neurônios-espelho como possível base neurológica das habilidades sociais / Mirror neurons as a possible neurological basis of social skills / Neurona espejo como una posible base neurológica de las habilidades sociales

Os neurônios-espelho (NE), descobertos ao final da década de 1990, foram relacionados com o controle de ações fundamentais no repertório motor, como o manejo de comida e objetos e a comunicação por meio de expressões faciais. Posteriormente também se supôs que tivessem relação com comportamentos mais complexos, tais como a compreensão da intencionalidade do ato alheio. As habilidades sociais (HS) são comportamentos aprendidos em contato com o meio e que procuram adaptar o indivíduo a seu ambiente. Assim, é possível que haja relação entre o funcionamento dos NE e das HS. Este artigo visa a apresentar os conceitos de HS e NE, sugerindo uma relação entre ambos, podendo se constituir numa das bases biológicas do comportamento humano

Mirror Neurons (MN) were discovered at the end of the 1990’s and then related to primary motor actions control, such as handling food and objects, and the communication through facial expressions. Later it was supposed that they had relationship with more complex behaviors, such as understanding the intentionality of the act oblivious. Social skills (SK) are learnt behavior in contact with the environment and the individual seeking to adapt to its environment; thus, it is possible that there is a relationships between the operation of the MN and SK. This article aims to introduce the concepts of MN and SK, suggesting a relationship between them, can become one of the biological bases of human behavior

Las neuronas-espejo (NE), descubiertas a finales de la década de 1990, estaban relacionadas con el control de las, como manipulación de alimentos y objetos, y la comunicación a través de las expresiones faciales. Posteriormente también se supuso que tenían relaciones con los comportamientos más complejos, como la comprensión de la intencionalidad del acto ajeno. Las habilidades sociales (HS) son los comportamiento aprendidos por el individuo en contacto con el medio ambiente y que buscan adaptar el individuo a su entorno. Por lo tanto, es posible que haya relación entre el funcionamiento de las NE y de las HS. En este artículo se pretende introducir los conceptos de la NE y HS, sugiriendo una relación entre ellos, pudiendo constituirse en una de las bases biológicas de la conducta humana

Action observation therapy improves upper extremity motor function after stroke / 中华物理医学与康复杂志

Objective To explore the effects of action observation therapy on upper-extremity motor function and ability in the activities of daily living after cerebral infarction.Methods Forty-one cerebral infarction survivors were randomly assigned to an observation group (n =21) or a control group (n =20).Both groups were given the conventional rehabilitation treatment,while the observation group additionally received action observation therapy 20 mins per day,6 times per week for 8 weeks.Before and after the 8 weeks of treatment,both groups were assessed using the Fugl-Meyer assessment (FMA),Wolf's motor function test (WMFT) and the modified Barthel index (MBI).Results Before the intervention there was no significant difference between the groups in any of the measurements.After the 8 weeks of treatment,all of the results in the treatment group were significantly better,on average,than those of the control group.Conclusions Action observation therapy can improve upper-extremity motor function and ability in the activities of daily living after stroke.

Action observation therapy can improve upper extremity motor function after stroke / 中华物理医学与康复杂志

Objective To explore the effects of action observation therapy on upper-extremity motor function after ischemic stroke and on the motor cortex using functional magnetic resonance imaging (fMRI).Methods Forty patients with ischemic stroke were randomly assigned to an observational group (n =20) or a control group (n =20).Both groups received conventional rehabilitation,while the observational group was additionally provided with action observation therapy for 8 weeks.Both groups were assessed using the Fugl-Meyer assessment (FMA) and the Barthel index (BI) before and after the 8 weeks of treatment and functional magnetic resonance imaging was performed before treatment.Two months after the treatment,nine patients of the experimental group and 8 of the control group who continued to receive their respective treatments after discharge were again assessed using functional magnetic resonance imaging.Results After the treatment the average FMA score and BI score of both the observational group and the control group had increased significantly.The increase in the average FMA score of the observational group was significantly greater than that of the control group.However,there was no significant difference between the two groups in the increases in BI score after 8 weeks of treatment.The fMRI results showed that there was a significantly greater rise in activity in the bilateral precentral gyrus,parietal lobe and the supplementary motor area of the patients in the observational group after the treatment compared with the control group.Conclusion Action observation therapy can improve upper extremity motor function and performance in the activities of daily living after ischemic stroke and induce changes in the excitability of the cerebral motor cortex.

Brain stimulation used as biofeedback in neuronal activation of the temporal lobe area in autistic children / Estimulação cerebral usada como biofeedback na ativação neural do lobo temporal em crianças autistas

ABSTRACT This study focused upon the functional capacity of mirror neurons in autistic children. 30 individuals, 10 carriers of the autistic syndrome (GCA), 10 with intellectual impairments (GDI), and 10 non-autistics (GCN) had registered eletroencephalogram from the brain area theoretically related to mirror neurons. Data collection procedure occurred prior to brain stimulation and after the stimulation session. During the second session, participants had to alternately process figures evoking neutral, happy, and/or sorrowful feelings. Results proved that, for all groups, the stimulation process in fact produced additional activation in the neural area under study. The level of activation was related to the format of emotional stimuli and the likelihood of boosting such stimuli. Since the increase of activation occurred in a model similar to the one observed for the control group, we may suggest that the difficulty people with autism have at expressing emotions is not due to nonexistence of mirror neurons.

RESUMO O estudo verificou a capacidade funcional dos neurônios-espelho em crianças autistas. 30 indivíduos, sendo 10 portadores da síndrome autista (GCA), 10 com deficiência intelectual (GDI), e 10 não-autistas (GCN) tiveram registrado o eletroencefalograma da área do cérebro relacionada teoricamente com os neurônios espelho. O procedimento de coleta de dados ocorreu antes e após uma sessão de estimulação cerebral. Durante a segunda coleta de dados, os participantes tiveram de processar alternadamente figuras evocando sentimentos neutros, felizes e tristes. Os resultados provaram que, para todos os grupos, o processo de estimulação de fato produziu ativação adicional na área neural em estudo. O nível de ativação foi relacionada com o formato dos estímulos emocionais. Uma vez que o aumento da ativação ocorreu em um modelo semelhante ao observado para o grupo controle, pode-se sugerir que as pessoas com autismo têm dificuldade em expressar emoções não devido à inexistência de neurônios-espelho.

Mirror therapy for upper limb rehabilitation in chronic patients after stroke / Terapia do espelho no membro superior de pacientes após acidente vascular cerebral

Abstract Introduction: Individuals with stroke sequelae present changes in the postural alignment and muscle strength associated with hemiplegia or hemiparesis. Mirror therapy is a technique that aims to improve the motor function of the paretic limb. Objective: The aim of this study was to evaluate the effect of mirror therapy, associated with conventional physiotherapy, for range of motion (ROM), degree of spasticity of the affected upper limb, and the level of independence in the activities of daily living (ADL) of chronic patients after stroke. Methods: This was a quasi-experimental (before and after) study. The study included ten stroke survivors undertaking physiotherapy and presenting with upper limb paresis. The following gauges were used for the present study: goniometry, the Modified Ashworth Scale, Fugl-Meyer and Barthel Index. Fifteen sessions were performed, each lasting 30 minutes, consisting of stretching of the flexor and extensor muscles of the wrist and elbow, pronators and supinators, followed by mirror therapy with gradual functional exercises. Results: Improvement was observed in all aspects studied, however with significant differences for ROM wrist extension (p = 0.04) and forearm supination (p = 0.03) Conclusion: It can be concluded that mirror therapy contributed to the participants' good performance in the aspects studied, mainly in relation to ROM of the affected upper limb.

Resumo Introdução: Indivíduos com sequelas de acidente vascular encefálico (AVE) apresentam alterações no alinhamento postural e força muscular associada a uma hemiplegia ou hemiparesia. A terapia de espelho é uma técnica que visa melhorar a função motora do membro parético. Objetivo: O objetivo deste estudo foi avaliar o efeito da terapia do espelho, associada à fisioterapia convencional, na amplitude de movimento (ADM), grau de espasticidade do membro superior acometido e no nível de independência das Atividades de Vida Diária (AVD) de paciente pós Acidente Vascular Cerebral (AVC). Métodos: Trata-se de um estudo quase experimental do tipo antes e depois. Participaram do estudo 10 pacientes pós AVC, os quais se encontrassem em atendimento fisioterapêutico e apresentassem paresia em membro superior. Para a avaliação utilizou-se goniometria, escala de Ashworth modificada, Fugl-Meyer e Índice de Barthel. Foram realizadas 15 sessões com duração de 30 minutos, compostas de alongamento dos músculos flexores e extensores de punho e cotovelo, pronadores e supinadores, seguidos da terapia do espelho com exercícios funcionais gradativos. Resultados: Observou-se melhora em todos os aspectos estudados, porém com diferenças estatisticamente significantes para ADM de extensão de punho (p = 0,04) e supinação de antebraço (p = 0,03). Conclusão: Pode-se concluir que a terapia do espelho contribuiu para que os participantes desta pesquisa obtivessem boa evolução nos aspectos estudados, principalmente em relação à ADM do membro superior acometido.

Neurología de la anticipación y sus implicaciones en el deporte / Anticipation neurology and its implications in sports

El movimiento es una acción que involucra interconexiones complejas, por lo cual se requiere profundizar en los procesos de adaptación, predicción y anticipación que permiten entender la importancia de estos aspectos desde sus bases filogenéticas y ontogenéticas hasta su implicación en movimientos complejos. Parte de la optimización de los procesos descritos se haya en la calidad de información aferente, la cual permite la relación con el entorno -especialmente la entrada visual- que reconoce un flujo de imágenes y una proyección al contexto en el que se está inmerso. Las estructuras e interconexiones implicadas en la anticipación y predicción de movimientos son descritas de modo que se evidencia la congruencia y continuidad del flujo de información que caracteriza esta especialidad neuromecánica de movimiento. Por otro lado, se aborda la integración de centros puntuales del sistema nervioso central y redes neuronales que permiten el entramado de procesos de aprendizaje por observación, además de proveer equilibrio y eficiencia al sistema en la recepción de estímulos y su relación con la generación de eferencias motoras que cumplan con objetivos específicos. En el ámbito deportivo estos procesos favorecen la eficiencia del gesto optimizando el movimiento.

Movement involves complex interconnections. It is required to deeply examine the adaptation, prediction and anticipation processes to understand their importance from the phylogenetic and ontogenetic bases, until its involvement in complex movements. Part of the optimization of these processes is found in the quality of afferent input, which allows the connection with the environment, in particular, the visual input, which recognizes an image stream and a projection to the context in which it is immersed. Those structures and interconnections involved in the anticipation and prediction of movements are described so that the consistency and the constant transfer of information that characterizes this field of neuromechanical movement speciality are evidenced. In addition, this article addresses the integration of specific centers from the Central Nervous System and the neural networks that allow the network of learning processes by observation, and that also provide balance and efficiency to the system in receiving stimuli and their relationship with the generation of motor efferents that accomplish specific objectives. In sports, these processes favor the gesture efficience optimizing the movement.

Análisis bibliométrico: la terapia de espejo como estrategia de intervención desde la terapia ocupacional en el ámbito clínico / Bibliometric Analysis: Mirror Therapy as an Occupational Therapy Intervention Strategy in the Clinical Setting / Análise bibliométrica: a terapia de espelho como estratégia de intervenção desde terapia ocupacional no âmbito clínic

Objetivo: Determinar la evidencia científica, a nivel nacional e internacional, sobre el uso de la terapia de espejo como herramienta de intervención, desde terapia ocupacional, en el área clínica; esto con el propósito de ofrecer soporte teórico para la implementación de esta estrategia en la práctica profesional. Materiales y métodos. Se realizó un estudio descriptivo donde se utilizó como estrategia de búsqueda descriptores de ciencias de la salud (DECS), tales como 'neuronas en espejo', 'terapia ocupacional', 'rehabilitación física' e 'imaginería motora'. Mediante el uso del boleano and se realizaron combinaciones en cinco bases de datos: Embase, Ebsco, OTseeker Science Direct y Medline. Los análisis fueron realizados mediante el establecimiento de frecuencias para variables como revista, país, tipo de estudio y años de publicación. Conclusiones: Dentro del análisis de la evidencia se encontró que la terapia de espejo es una modalidad de intervención, recientemente utilizada por diferentes profesiones de rehabilitación. A partir de 2004 se observa un incremento en la generación de evidencia científica de alto impacto sobre el tema, debido a la efectivde salud secundarias a la enfermedad cerebrovascular (ECV), la amputación de miembros, los síndromes dolorosos crónicos y la rehabilitación posquirúrgica. Durante el periodo analizado, se evidenció un incremento en la producción académica de alto nivel de evidencia. El 35,7 % de las publicaciones analizadas corresponden a ensayos clínicos controlados aleatorizados (ECCA) y el 42,9 % corresponden a revisiones sistemáticas. El uso de la terapia de espejo en terapia ocupacional es una modalidad de intervención que facilita procesos de rehabilitación funcional, promueve la independencia en la ejecución de actividades de la vida diaria y facilita procesos de participación social y adaptación al entorno.

Objective: To determine the national and international scientific evidence regarding the use of mirror therapy, as an occupational therapy intervention tool in the clinical setting, in order to acquire knowledge and implement this strategy in professional practice. Materials and methods: A descriptive study was conducted in which the research strategy was held through medical subject headings (MeSH), such as "mirror neuron", "occupational therapy", "physical rehabilitation" and "motor imagery". Through the use of the bolean and combinations in five different databases were performed: Embase, Ebsco, OTseeker, Science Direct and Medline. The analysis was elaborated by establishing frequencies of different variables such as journal, country, study type and publishing year. Conclusions: In the evidence analysis it was found that mirror therapy is an intervention modality recently used by different rehabilitation professionals. Since 2004, an increase in the generation of high impact scientific evidence about this subject has been recognized, due in part to the reported effectiveness in clinical practices, mainly the treatment of health conditions secondary to stroke, limb amputations, chronic pain syndromes, and post-surgical rehabilitation. During the reviewed period, an increase in high level academic evidence was observed: 35.7 % of the analyzed publications correspond to randomized controlled trials and 42.9 % are systematic reviews. The use of mirror therapy in occupational therapy is an intervention modality that facilitates functional rehabilitation processes, promotes independence in performing activities of daily living (ADL) and allows social participation and environment adaptation processes to happen.

Objetivo: Determinar a evidência científica no nível nacional e internacional sobre o uso da terapia de espelho, como ferramenta de intervenção desde terapia ocupacional na área clínica, com o propósito de oferecer suporte teórico para a implementação desta estratégia na prática profissional. Materiais e métodos: realizou-se um estudo descritivo onde se utilizou como estratégia de busca descritores de ciências da saúde (DeCS) tais como "neurônios em espelho", "terapia ocupacional", "reabilitação física" e "imagética motora". Mediante o uso do booleano and se realizaram combinações em cinco bases de dados: Embase, Ebsco, OT seeker Science Direct y Medline. As análises foram realizadas mediante o estabelecimento de frequências para variáveis como revista, país, tipo de estudo e anos de publicação. Conclusões: dentro da análise da evidência encontrou-se que a terapia de espelho é uma modalidade de intervenção recentemente utilizada por diferentes profissões de reabilitação. A partir do ano 2004 se observa um incremento a geração de evidência científica de alto impacto sobre o tema, devido à efetividade reportada na prática clínica, principalmente no tratamento de condições de saúde secundárias à doença cerebrovascular (ECV), amputação de membros, síndromes dolorosas crónicas, e reabilitação pós-cirúrgica. Durante o período analisado, evidenciou-se um incremento na produção académica de alto nível de evidência. O 35,7% das publicações analisadas correspondem a ensaios clínicos controlados aleatorizados (ECCA) e 42,9% correspondem a revisões sistemáticas. O uso da terapia de espelho em terapia ocupacional, é uma modalidade de intervenção que facilita processos de reabilitação funcional, promove a independência na execução de atividades da vida diária e facilita processos de participação social e adaptação ao entorno.

Revisitando el concepto de identificación proyectiva kleiniano desde una perspectiva intersubjetiva / Re-visiting the kleinian concept of projective identification from an intersubjective perspective

Se revisa brevemente la historia el concepto de Identificación Proyectiva, intentando ponerlo en relación con los actuales descubrimientos neurocientíficos acerca de las neuronas espejo y su rol en las raíces de la empatía humana. De esa exploración surgen ideas de cierta utilidad clínica para el trabajo con pacientes con núcleos psicóticos. Se plantean algunas reflexiones para la comprensión de la manera en la que se ven interferidos los procesos de simbolización en este tipo de pacientes, a partir del material clínico de un paciente afectado de Síndrome de Asperger.Palabras claves: Asperger, simbolización, espacio potencial, espacio transicional, identificación proyectiva, neuronas espejo, empatía, intersubjetividad, simulación encarnada.

The history of the projective identification concept is reviewed briefly, trying to put it in relation with current neuro-scientific findings about mirror neurons and his role in the human empathy roots. From this exploration appear ideas of clinical utility for working with patients with psychotic core. Some reflections are presented for the understanding of the way in that the symbolic processes are interfered with this kind of patients, from a clinical material of a patient affected by Asperger syndrome.

Interaction between affordance and handedness recognition: a chronometric study

The visualization of tools and manipulable objects activates motor-related areas in the cortex, facilitating possible actions toward them. This pattern of activity may underlie the phenomenon of object affordance. Some cortical motor neurons are also covertly activated during the recognition of body parts such as hands. One hypothesis is that different subpopulations of motor neurons in the frontal cortex are activated in each motor program; for example, canonical neurons in the premotor cortex are responsible for the affordance of visual objects, while mirror neurons support motor imagery triggered during handedness recognition. However, the question remains whether these subpopulations work independently. This hypothesis can be tested with a manual reaction time (MRT) task with a priming paradigm to evaluate whether the view of a manipulable object interferes with the motor imagery of the subject's hand. The MRT provides a measure of the course of information processing in the brain and allows indirect evaluation of cognitive processes. Our results suggest that canonical and mirror neurons work together to create a motor plan involving hand movements to facilitate successful object manipulation.

Effects of action observation therapy based on mirror neuron theory on upper limb function and the activities of daily living of stroke survivors / 中华物理医学与康复杂志

Objective To observe the effects of action observation therapy based on mirror neuron theory on upper-extremity motor function and performance in activities of daily living(ADL) after stroke.Methods Eightyone stroke patients were randomly assigned to an observational group (41 cases) or a control group (40cases).Both groups received conventional rehabilitation,and the observational group also received action observation therapy for 16 weeks,10 times per week.Upper-extremity motor function and ADL performance were assessed before treatment using the Fugl-Meyer assessment (FMA) and the Barthel index (BI) and then again after 4,8 and 16 weeks of treatment.Results The average FMA scores and BI scores in the observational group at the 4th week (32.50 ± 9.32 and 67.41 ± 16.81),the 8th week (36.35 ± 8.32 and 78.74 ± 15.63) and the 16 th week (41.32 ± 13.45 and 93.85 ± 13.45) had increased significantly compared with the pre-treatment assessment and were significantly better than at the same time point for the control group (P ＜ 0.05).Conclusion Action observation therapy based on mirror neuron theory can promote the recovery of upper-extremity motor function and ADL performance after stroke.

Effects of mirror therapy through functional activites and motor standards in motor function of the upper limb after stroke / Efecto de la terapia del espejo por mediante actividades funcionales y patrones motores em la función del miembro superior después de um accidente cerebrovascular / Efeito da terapia de espelho por meio de atividades funcionais e padrões motores na função do membro superior pós-acidente vascular encefálico

The study aimed to evaluate the effects of mirror therapy through functional activities and motor standards in upper limb function of chronic stroke subjects. Six patients with paresis of the arm within at least six months after stroke were randomly to a group of functional activities (GAF - n=3) and group of motor standards (GPM - n=3). Both groups performed 15 sessions of mirror therapy for 30 minutes, but the first one (GAF) were instructed to do the bilateral and symmetrical movements based on functional activities (i.e. games fitting) and the second one (GAP) made movements based on normal motor patterns (i.e. wrist flexion-extension). There was no statistical significance between pre- and post-treatment for both groups independently. However, analyzing the groups together (n=6), it was observed significance values in the cognitive and total MIF (p=0.002) pre- and post-mirror therapy. This study showed improvement in the functional impairment whatever the type of movement made during the mirror therapy.

El objetivo del estudio fue evaluar los efectos de la aplicación de la terapia de espejo por medio de actividades funcionales y patrones motores del movimiento en la función motora del miembro superior de hemiparéticos crónicos pos-Accidente Vascular Encefálico (AVE). Seis pacientes con hemiparesía del brazo con al menos seis meses pos-AVE fueron asignados de modo aleatorio a un grupo de actividades funcionales (GAF - n=3) y un grupo de patrones motores (GPM - n=3). Ambos grupos realizaron 15 sesiones de terapia del espejo durante 30 minutos, pero el primero (GAF) fue orientado a hacer movimientos bilaterales y simétricos en base a las actividades funcionales (es decir, juegos de encaje) y el segundo (GPM), a hacer movimientos basados ​​en patrones motores normales (es decir, flexión-extensión de la muñeca). No hubo diferencias estadísticamente significativas entre pre y post-tratamiento para ambos grupos de forma independiente. Sin embargo, el análisis de los grupos en conjunto (n=6) demostró valores post-terapia significativos en la Medida de Independencia Funcional (MIF) cognitiva y total (p=0,002) pre y post-terapia de espejo. Este estudio mostró una mejoría en el deterioro funcional en cualquier tipo de movimiento realizado durante la terapia del espejo.

O objetivo do estudo foi avaliar os efeitos da aplicação da terapia de espelho por meio de atividades funcionais e padrões motores do movimento na função motora do membro superior de hemiparéticos crônicos pós-Acidente Vascular Encefálico (AVE). Seis pacientes com hemiparesia do braço com pelo menos seis meses pós-AVE foram randomizados para um grupo de atividades funcionais (GAF - n=3) e um grupo de padrões motores (GPM - n=3). Ambos os grupos realizaram 15 sessões de terapia de espelho por 30 minutos, mas o primeiro (GAF) foi instruído a fazer movimentos bilaterais e simétricos baseados em atividades funcionais (isto é, jogos de encaixe) e o segundo (GPM), a fazer movimentos baseados em padrões motores normais (isto é, flexão-extensão de punho). Não houve significância estatística entre o pré e o pós-tratamento para ambos os grupos de modo independente. No entanto, analisando os grupos em conjunto (n=6), foram observados valores significativos na medida de independência funcional (MIF) cognitiva e total (p=0,002) pré e pós-terapia de espelho. Este estudo mostrou melhora no comprometimento funcional seja qual for o tipo de movimento feito durante a terapia de espelho.

Experiência empática: da neurociência à espiritualidade / Empathic experience: from the neuroscience to spirituality / Experiéncia empática: de la neurociencia a la espiritualidad

O conceito de Empatia tem sido considerado um fenômeno de extrema importância para a sobrevivência, para as relações e para o desenvolvimento humano, firmando-se como um tema atual e de constantes transformações, especialmente devido aos renovados desafios da modernidade tardia. Nesta proposta, serão revistos alguns estudos/reflexões sobre a Empatia, pertencentes aos saberes da Neurociência (através das pesquisas sobre neurônios-espelho), da Psicologia Humanista (através das propostas da Abordagem Centrada na Pessoa) e da Espiritualidade (através da filosofia budista). Neste sentido, buscar-se-á ampliar o conceito de Empatia, utilizando as compreensões e articulações propostas pelas três dimensões estudadas...

The concept of empathy has been considered a phenomenon of extreme importance for the survival, relationships and human development and has emerged as a topic of current and constant change, especially due to new human challenges of late modernity. This paper presents reviewed studies/reflections on empathy, from the knowledge of Neuroscience (through research on mirror neurons), Humanistic Psychology (through the proposals of Person Centered Approach) and spirituality (through Buddhist philosophy). In this sense, it will seek to foster the concept of empathy, using the understandings and joint proposals by the three dimensions studied...

El concepto de empatía se ha considerado como un fenómeno de suma importancia para la supervivencia, las relaciones y el desarrollo humano, estableciéndose como un tema actual y de cambio constante, sobre todo debido a los nuevos retos de la modernidad tardía. En este trabajo se presentan estudios/reflexiones sobre la empatía, que pertenecen al conocimiento de la Neurociencia (a través de la investigación sobre las neuronas espejo), de la Psicología Humanista (a través de las propuestas del Enfoque Centrado en la Persona) y de la espiritualidad (a través de la filosofía budista). En este sentido, se tratará de ampliar el concepto de empatía, utilizando los acuerdos y propuestas conjuntas de las tres dimensiones estudiadas...

Mirror Therapy for Phantom Limb Pain

Phantom limb pain is a painful sensation that is perceived in a body part that no longer exists. To control this pain, many methods have been used such as medication, physical treatment, nerve block, neuromodulation, surgical treatment and mirror therapy. However, until now, there effects have been uncertain. We report the successful reduction of phantom limb pain using mirror therapy when other treatments initially failed to control the pain.