Rehab without Motion?
Mirror Neurons and Rehabilitation for Dancers
As a ballet dancer since the age of two and having multiple injuries along the way, I remember having to sit out of many dance classes and rehearsals. The teachers always made me come and watch the entire class, even though I was not able to dance due to whichever injury I happened to have at that time. And I never understood why I had to go to class if I was not able to physically participate in class. It always seemed silly to me. As I was reading the April newsletter of the International Association of Dance Medicine and Science, this particular article sprung an interest in me. It was titled, “Mirror neurons: A tool for dancers’ rehabilitation or learning to move without moving?” and I thought, “I wonder if this explains why I was forced to sit and watch class? Was I actually rehabbing myself without even knowing it back then?” See what you think.
The article is by A. Couillandre PhD, PT, EA out of the Centre de Recherche sur le Sport et le Movement, Université Paris Ouest and it is quoted below:
“First of all, dance teachers have long known that when a dancer is injured, they should still come to dance class to observe action. In fact, an injured dancer might be able to maintain their skill despite being temporarily unable to move, simply by watching others dance[1]. Once recovered, they will find that the new movement they missed out on is not too hard to pick up or learn. Their body already seems to automatically create the movement from the memory traces they have created.
Mirror neurons are a special class of neurons discovered in the 1990s by Rizollati[2], identified in humans in Broca’s area, the inferior parietal lobe and ventral premotor cortex as well as in the caudal part of the inferior frontal gyrus, using non-invasive neuroelectrophysiological assessment or functional brain imaging techniques[3]. Emotions and empathy seem to operate according to a mirror mechanism. Additionally, mirror neurons respond when we perform an action and also when we see someone else perform that action. Thus, they are involved in execution (as in traditional motor learning), imitation[4], observation (as in observational learning)[5] and motor imagery[6,7].
Action observation is considered as a potential tool in rehabilitation because it is thought to improve motor function through repeated activation of mental motor representations. It is increasingly considered in rehabilitation contexts, specifically in neurology[8,9,10]. Some authors report that a passive rehabilitation technique, based on stimulation of the mirror-neuron system, has a beneficial effect in the treatment of patients with post-stroke motor deficits. A better understanding of mechanisms underlying action observation is essential for the optimization of functional outcome using this training condition. As a matter of fact, most effective conditions for stimulation of the mirror neurons network have been identified such as for example action observation type (active versus passive)11; subject’s motor experience and competence (expert versus naïve)[12,13]; posture (absence versus presence of postural congruency)[14]. In other words, action observation could have a positive impact on rehabilitation of motor deficits in dancers after injury. Practically, do not leave the dancer lonely at home when injured. Make them come to class with the intention to imitate (active action observation) movements and postures they are expert in, and that are quite complex yet close to their own posture. It is believed that this multi-sensory action-observation system should enable individuals to (re)learn impaired motor functions, such as walking, staying stable and of course dancing. Studies on dancers are needed in order to know if action observation can improve dancers injury recovery process.”
This is the current, cutting edge dance medicine research to date and it is very exciting. As physiatrists, we all know that mirror therapy has been proven to be helpful in a hemiplegic patient after sustaining a stroke. However, this has never been proven in dancers, only speculated. It is wonderful that studies like this are currently being done. It is research that the dance world has needed for years. I believe this research will lead to many more studies involving dancers and rehabilitation if it does show that active action observation does significantly change the course of their rehab after sustaining an injury.
Jouvana Currey, MD
University of California Irvine AAP’s RFC Medical Student Affairs Representative
This article was originally published in Issue #2 of Physiatry in Motion.
References
1. Ludden, JA. dance legend who still finds new directions. All Things Considered. 2004.
2. Mathon B. Mirror neurons: from anatomy to pathophysiological and therapeutic implications. Rev Neurol (Paris). 2013 Apr;169(4):285–90.
3. Sale P, Franceschini M. Action observation and mirror neuron network: a tool for motor stroke rehabilitation. Eur J Phys Rehabil Med. 2012;48:313–8.
4. Heiser M, Iacoboni M, Maeda F, Marcus J, Mazziotta JC. The essential role of Broca’s area in imitation. Eur J Neurosci. 2003 Mar;17(5):1123–8.
5. Grèzes J, Decety J. Functional anatomy of execution, mental simulation, observation, and verb generation of actions: a meta-analysis. Hum Brain Mapp. 2001 Jan;12(1):1–19.
6. Jackson PL, Lafleur MF, Malouin F, Richards C, Doyon J. Potential role of mental practice using motor imagery in neurologic rehabilitation. Arch Phys Med Rehabil. 2001 Aug;82(8):1133–41.
7. Jeannerod M. Neural simulation of action: a unifying mechanism for motor cognition. Neuroimage. 2001 Jul;14(1 Pt 2):S103–9.
8. Buccino G, Solodkin A, Small SL. Functions of the mirror neuron system: implications for neurorehabilitation. Cogn Behav Neurol. 2006 Mar;19(1):55–63.
9. Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. J Neural Transm (Vienna). 2007;114(10):1265–78. Epub 2007 Jun 20.
10. Pomeroy VM, Clark CA, Miller JS, Baron JC, Markus HS, Tallis RC. The potential for utilizing the “mirror neurone system” to enhance recovery of the severely affected upper limb early after stroke: a review and hypothesis. Neurorehabil Neural Repair. 2005 Mar;19(1):4–13.
11. Roosink M, Zijdewind I. Corticospinal excitability during observation and imagery of simple and complex hand tasks: implications for motor rehabilitation. Behav Brain Res. 2010 Nov 12;213(1):35–41.
12. Calvo-Merino B, Grèzes J, Glaser DE, Passingham RE, Haggard P. Seeing or doing? Influence of visual and motor familiarity in action observation. Curr Biol. 2006 Oct 10;16(19):1905–10. Erratum in: Curr Biol. 2006 Nov 21;16(22):2277.
13. Haslinger B, Erhard P, Altenmüller E, Schroeder U, Boecker H, Ceballos-Baumann AO. Transmodal sensorimotor networks during action observation in professional pianists. J Cogn Neurosci. 2005 Feb;17(2):282–93.
14. Alaerts K, Heremans E, Swinnen SP, Wenderoth N. How are observed actions mapped to the observer’s motor system? Influence of posture and perspective. Neuropsychologia. 2009 Jan;47(2):415–22.
