Neural Regeneration Research ›› 2019, Vol. 14 ›› Issue (6): 1004-1012.doi: 10.4103/1673-5374.250580

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Aphasia rehabilitation based on mirror neuron theory: a randomized-block-design study of neuropsychology and functional magnetic resonance imaging

Wen-Li Chen 1, 2, Qian Ye 3 , Si-Cong Zhang 4 , Yang Xia 5 , Xi Yang 5 , Ti-Fei Yuan 6 , Chun-Lei Shan 4, 7, 8 , Jian-An Li 1   

  1. 1 Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
    2 Department of Rehabilitation Medicine, Zhangjiagang Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu Province, China
    3 School of Rehabilitation Sciences, Nanjing Normal University of Special Education, Nanjing, Jiangsu Province, China
    4 Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
    5 Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China
    6 Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
    7 School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
    8 Institute of Rehabilitation Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
  • Online:2019-06-15 Published:2019-06-15
  • Contact: Jian-An Li, MD, lijianan@carm.org.cn; Chun-Lei Shan, MD, shanclhappy@163.com.
  • Supported by:

    This work was supported by the National Natural Science Foundation of China, No. 81472163, 81874035 (to CLS); the General Project of University Philosophy and Social Science Research of China, No. 2016SJB740015 (to QY); the Science and Technology Plan Project of Zhangji¬agang city of China in 2016, No. ZKS1615 (to WLC); the Youth Science and Technology Project of Suzhou Health Development through Scientific Research and Education in 2018, No.KJXW2018059 (to WLC) .

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Abstract:

When watching someone performs an action, mirror neurons are activated in a way that is very similar to the activation that occurs when actually performing that action. Previous single-sample case studies indicate that hand-action observation training may lead to activation and re¬modeling of mirror neuron systems, which include important language centers, and may improve language function in aphasia patients. In this randomized-block-design experiment, we recruited 24 aphasia patients from, Zhongda Hospital, Southeast University, China. The patients were divided into three groups where they underwent hand-action observation and repetition, dynamic-object observation and repetition, or conven¬tional speech therapy. Training took place 5 days per week, 35 minutes per day, for 2 weeks. We assessed language function via picture naming tests for objects and actions and the Western Aphasia Battery. Among the participants, one patient, his wife and four healthy student volunteers underwent functional magnetic resonance imaging to analyze changes in brain activation during hand-action observation and dynamic-object observation. Results demonstrated that, compared with dynamic-object observation, hand-action observation led to greater performance with respect to the aphasia quotient and affiliated naming sub-tests and a greater Western Aphasia Battery test score. The overall effect was similar to that of conventional aphasia training, yet hand-action observation had advantages compared with conventional training in terms of vocabulary extraction and spontaneous speech. Thus, hand-action observation appears to more strongly activate the mirror neuron system compared with dynamic-object observation. The activated areas included Broca’s area, Wernicke’s area, and the supramarginal gyrus. These results suggest that hand-action observation combined with repetition might better improve language function in aphasia patients compared with dynamic-object observation combined with repetition. The therapeutic mechanism of this intervention may be associated with activation of additional mirror neuron systems, and may have implications for the possible repair and remodeling of damaged nerve networks. The study protocol was ap¬proved by the Ethical Committee of Nanjing Medical University, China (approval number: 2011-SRFA-086) on March 11, 2011. This trial has been registered in the ISRCTN Registry (ISRCTN84827527).

Key words: nerve regeneration, mirror neuron, hand-action observation, aphasia, rehabilitation, stroke, functional magnetic resonance imaging, neuropsychology, neural regeneration