{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T20:27:10Z","timestamp":1781814430495,"version":"3.54.5"},"reference-count":56,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T00:00:00Z","timestamp":1730678400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health, Italy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: The aim of this study was to identify the neural pattern activation during mirror therapy (MT) and explore any cortical reorganization and reducing asymmetry of hemispheric activity for upper limb rehabilitation in post-stroke patients. Methods: A box containing a mirror was placed between the arms of the patients to create the illusion of normal motion in the affected limb by reflecting the image of the unaffected limb in motion. We measured the cerebral hemodynamic response using near-infrared spectroscopy (NIRS). We enrolled ten right-handed stroke patients. They observed healthy hand movements in the mirror (MT condition) while performing various tasks (MT condition), and then repeated the same tasks with the mirror covered (N-MT condition). Results: Significant activation of some brain areas was observed in the right and left hemiparesis groups for the MT condition, while lower levels of activation were observed for the N-MT condition. The results showed significant differences in hemodynamic response based on oxygenated (HbO) concentrations between MT and N-MT conditions across all tasks in sensorimotor areas. These neural circuits were activated despite the motor areas being affected by the brain injury, indicating that the reflection of movement in the mirror helped to activate them. Conclusions: These results suggest that MT promotes cortical activations of sensory motor areas in affected and non-affected brain sides in subacute post-stroke patients, and it encourages the use of these tools in clinical practice.<\/jats:p>","DOI":"10.3390\/jcm13216612","type":"journal-article","created":{"date-parts":[[2024,11,4]],"date-time":"2024-11-04T10:57:20Z","timestamp":1730717840000},"page":"6612","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Applications of Near Infrared Spectroscopy and Mirror Therapy for Upper Limb Rehabilitation in Post-Stroke Patients: A Brain Plasticity Pilot Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Caterina","family":"Formica","sequence":"first","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9501-3258","authenticated-orcid":false,"given":"Simona","family":"De Salvo","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nunzio","family":"Muscar\u00e0","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0282-405X","authenticated-orcid":false,"given":"Lilla","family":"Bonanno","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca Antonia","family":"Arcadi","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana","family":"Lo Buono","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8897-2853","authenticated-orcid":false,"given":"Giuseppe","family":"Acri","sequence":"additional","affiliation":[{"name":"Dipartimento di Scienze Biomediche, Odontoiatriche, e delle Immagini Morfologiche e Funzionali, Universit\u00e0 degli Studi di Messina, c\/o A.O.U. Policlinico \u2018G. Martino\u2019 Via Consolare Valeria 1, 98125 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Quartarone","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Marino","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino Pulejo, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"634","DOI":"10.2471\/BLT.16.181636","article-title":"Stroke: A global response is needed","volume":"94","author":"Johnson","year":"2016","journal-title":"Bull. World Health Organ."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1055\/s-0038-1649503","article-title":"Global Burden of Stroke","volume":"38","author":"Katan","year":"2018","journal-title":"Semin. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1177\/1747493016676285","article-title":"Global stroke statistics","volume":"12","author":"Thrift","year":"2017","journal-title":"Int. J. Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e67","DOI":"10.1161\/CIR.0000000000000558","article-title":"Heart Disease and Stroke Statistics\u20142018 Update: A Report From the American Heart Association","volume":"137","author":"Benjamin","year":"2018","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Veerbeek, J.M., van Wegen, E., van Peppen, R., Van der Wees, P.J., Hendriks, E., Rietberg, M., and Kwakkel, G. (2014). What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0087987"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2418","DOI":"10.1161\/STROKEAHA.120.029606","article-title":"Burden of Stroke in Europe","volume":"51","author":"Wafa","year":"2020","journal-title":"Stroke"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1007\/s12178-018-9498-8","article-title":"Centers for Disease Control and Prevention 2017 Guidelines for Prevention of Surgical Site Infections: Review and Relevant Recommendations","volume":"11","author":"Rachala","year":"2018","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3540","DOI":"10.1161\/STROKEAHA.113.002987","article-title":"Australian Public\u2019s Awareness of Stroke Warning Signs Improves After National Multimedia Campaigns","volume":"44","author":"Bray","year":"2013","journal-title":"Stroke"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"33S","DOI":"10.1177\/1545968311410942","article-title":"Neurological Principles and Rehabilitation of Action Disorders: Rehabilitation interventions","volume":"25","author":"Pomeroy","year":"2011","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"6S","DOI":"10.1177\/1545968311410940","article-title":"Neurological Principles and Rehabilitation of Action Disorders: Computation, anatomy, and physiology (CAP) model","volume":"25","author":"Frey","year":"2011","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Marek, K., Redlicka, J., Miller, E., and Zubrycki, I. (2023). Objectivizing Measures of Post-Stroke Hand Rehabilitation through Multi-Disciplinary Scales. J. Clin. Med., 12.","DOI":"10.3390\/jcm12237497"},{"key":"ref_12","first-page":"128641","article-title":"Rehabilitation with Poststroke Motor Recovery: A Review with a Focus on Neural Plasticity","volume":"2013","author":"Takeuchi","year":"2013","journal-title":"Stroke Res. Treat."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1016\/j.apmr.2023.12.013","article-title":"Effects of Hand Motor Interventions on Cognitive Outcomes Post-stroke: A Systematic Review and Bayesian Network Meta-analysis","volume":"105","author":"Romero","year":"2024","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1191\/0269215504cr843oa","article-title":"The impact of physical therapy on functional outcomes after stroke: What\u2019s the evidence?","volume":"18","author":"Kwakkel","year":"2004","journal-title":"Clin. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/s00221-005-2226-9","article-title":"Mirror, mirror on the wall: Viewing a mirror reflection of unilateral hand movements facilitates ipsilateral M1 excitability","volume":"163","author":"Garry","year":"2005","journal-title":"Exp. Brain Res."},{"key":"ref_16","first-page":"CD008449","article-title":"Mirror therapy for improving motor function after stroke","volume":"7","author":"Thieme","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jpain.2012.09.007","article-title":"The Effects of Graded Motor Imagery and Its Components on Chronic Pain: A Systematic Review and Meta-Analysis","volume":"14","author":"Bowering","year":"2013","journal-title":"J. Pain"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"272","DOI":"10.3344\/kjp.2012.25.4.272","article-title":"Mirror Therapy for Phantom Limb Pain","volume":"25","author":"Kim","year":"2012","journal-title":"Korean J. Pain"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1177\/15459683221081430","article-title":"Effects of a Virtual Reality\u2013Based Mirror Therapy Program on Improving Sensorimotor Function of Hands in Chronic Stroke Patients: A Randomized Controlled Trial","volume":"36","author":"Hsu","year":"2022","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1177\/1545968311427917","article-title":"Functional Plasticity Induced by Mirror Training","volume":"26","author":"Hamzei","year":"2012","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/1755-7682-6-41","article-title":"The mirror neuron system in post-stroke rehabilitation","volume":"6","author":"Carvalho","year":"2013","journal-title":"Int. Arch. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"410","DOI":"10.2340\/16501977-1127","article-title":"A comparison of neural mechanisms in mirror therapy and movement observation therapy","volume":"45","author":"Wang","year":"2013","journal-title":"J. Rehabil. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"593","DOI":"10.3233\/NRE-130999","article-title":"Cerebral activation evoked by the mirror illusion of the hand in stroke patients compared to normal subjects","volume":"33","author":"Wang","year":"2013","journal-title":"NeuroRehabilitation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.neubiorev.2018.08.003","article-title":"Neural correlates of action: Comparing meta-analyses of imagery, observation, and execution","volume":"94","author":"Hardwick","year":"2018","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Antonioni, A., Raho, E.M., Straudi, S., Granieri, E., Koch, G., and Fadiga, L. (2024). The cerebellum and the Mirror Neuron System: A matter of inhibition? From neurophysiological evidence to neuromodulatory implications. Narrat. Rev. Neurosci. Biobehav. Rev., 164.","DOI":"10.1016\/j.neubiorev.2024.105830"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1177\/1545968314554622","article-title":"Cortical Mechanisms of Mirror Therapy After Stroke","volume":"29","author":"Rossiter","year":"2015","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_27","first-page":"421","article-title":"Potential determinants of efficacy of mirror therapy in stroke patients\u2014A pilot study","volume":"33","author":"Brunetti","year":"2015","journal-title":"Restor. Neurol. Neurosci."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Mehnert, J., Brunetti, M., Steinbrink, J., Niedeggen, M., and Dohle, C. (2013). Effect of a mirror-like illusion on activation in the precuneus assessed with functional near-infrared spectroscopy. J. Biomed. Opt., 18.","DOI":"10.1117\/1.JBO.18.6.066001"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12984-022-00988-7","article-title":"Increasing motor cortex activation during grasping via novel robotic mirror hand therapy: A pilot fNIRS study","volume":"19","author":"Kim","year":"2022","journal-title":"J. NeuroEngineering Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1111\/j.1460-9568.2001.01385.x","article-title":"Action observation activates premotor and parietal areas in a somatotopic manner: An fMRI study","volume":"13","author":"Buccino","year":"2001","journal-title":"Eur. J. Neurosci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1002\/bip.360010302","article-title":"Absorption spectra of nucleotides, polynucleotides, and nucleic acids in the far ultraviolet","volume":"1","author":"Voet","year":"1963","journal-title":"Biopolymers"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.neuroimage.2008.08.036","article-title":"NIRS-SPM: Statistical parametric mapping for near-infrared spectroscopy","volume":"44","author":"Ye","year":"2009","journal-title":"Neuroimage"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"010401","DOI":"10.1117\/1.NPh.3.1.010401","article-title":"Commentary on the statistical properties of noise and its implication on general linear models in functional near-infrared spectroscopy","volume":"3","author":"Huppert","year":"2016","journal-title":"Neurophotonics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"Mini-mental state: A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2340\/1650197771331","article-title":"The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance","volume":"7","author":"Leyman","year":"1975","journal-title":"Scand. J. Rehabil. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/0003-9993(93)90119-U","article-title":"A validation of the Functional Independence Measurement and its performance among rehabilitation inpatients","volume":"74","author":"Dodds","year":"1993","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.neuroimage.2013.06.016","article-title":"Statistical analysis of fNIRS data: A comprehensive review","volume":"85","author":"Tak","year":"2014","journal-title":"Neuroimage"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1109\/TSP.2019.2899289","article-title":"Robust Hemodynamic Response Function Estimation From fNIRS Signals","volume":"67","author":"Seghouane","year":"2019","journal-title":"IEEE Trans. Signal Process."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"N91","DOI":"10.1088\/0031-9155\/51\/5\/N02","article-title":"The modified Beer\u2013Lambert law revisited","volume":"51","author":"Kocsis","year":"2006","journal-title":"Phys. Med. Biol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1002\/lsm.20178","article-title":"Measurement of the coagulation dynamics of bovine liver using the modified microscopic Beer\u2013Lambert law","volume":"36","author":"Terenji","year":"2005","journal-title":"Lasers Surg. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.neuroimage.2013.05.106","article-title":"Time domain functional NIRS imaging for human brain mapping","volume":"85","author":"Torricelli","year":"2014","journal-title":"Neuroimage"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.neuroimage.2009.01.033","article-title":"Real-time imaging of human brain function by near-infrared spectroscopy using an adaptive general linear model","volume":"46","author":"Abdelnour","year":"2009","journal-title":"Neuroimage"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Hu, X.S., Hong, K.S., Ge, S.S., and Jeong, M.Y. (2010). Kalman estimator- and general linear model-based on-line brain activation mapping by near-infrared spectroscopy. Biomed. Eng. Online, 9.","DOI":"10.1186\/1475-925X-9-82"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1786","DOI":"10.1161\/STROKEAHA.107.504779","article-title":"Enhanced Gait-Related Improvements After Therapist- Versus Robotic-Assisted Locomotor Training in Subjects With Chronic Stroke","volume":"39","author":"Hornby","year":"2008","journal-title":"Stroke"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Raciti, L., Pignolo, L., Perini, V., Pullia, M., Porcari, B., Latella, D., Isgr\u00f2, M., Naro, A., and Calabr\u00f2, R.S. (2022). Improving Upper Extremity Bradykinesia in Parkinson\u2019s Disease: A Randomized Clinical Trial on the Use of Gravity-Supporting Exoskeletons. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092543"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1589\/jpts.20.141","article-title":"Sensorimotor Cortex Activation during Mirror Therapy in Healthy Right-Handed Subjects: A Study with Near-Infrared Spectroscopy","volume":"20","author":"Imai","year":"2008","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1002\/hbm.21110","article-title":"Hemispheric asymmetries of motor versus nonmotor processes during (visuo)motor control","volume":"32","author":"Callaert","year":"2011","journal-title":"Hum. Brain Mapp."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"101817","DOI":"10.1016\/j.rehab.2024.101817","article-title":"Event-related desynchronization during action observation is an early predictor of recovery in subcortical stroke: An EEG study","volume":"67","author":"Antonioni","year":"2024","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.cognition.2016.01.008","article-title":"Stimulation over primary motor cortex during action observation impairs effector recognition","volume":"149","author":"Naish","year":"2016","journal-title":"Cognition"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1177\/15500594231209397","article-title":"A Multimodal Analysis to Explore Upper Limb Motor Recovery at 4 Weeks After Stroke: Insights From EEG and Kinematics Measures","volume":"55","author":"Antonioni","year":"2024","journal-title":"Clin. EEG Neurosci."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/1545968314546134","article-title":"Reflections on Mirror Therapy","volume":"29","author":"Deconinck","year":"2015","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"7812148","DOI":"10.1155\/2019\/7812148","article-title":"Neurorehabilitation: Neural Plasticity and Functional Recovery 2018","volume":"2019","author":"Fujiwara","year":"2019","journal-title":"Neural Plast."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Gurgone, S., De Salvo, S., Bonanno, L., Muscar\u00e0, N., Acri, G., Caridi, F., Paladini, G., Borzelli, D., Brigand\u00ec, A., and La Torre, D. (2024). Changes in cerebral cortex activity during a simple motor task after MRgFUS treatment in patients affected by essential tremor and Parkinson\u2019s disease: A pilot study using functional NIRS. Phys. Med. Biol., 69.","DOI":"10.1088\/1361-6560\/ad164e"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"871296","DOI":"10.1155\/2011\/871296","article-title":"Cortical Plasticity during Motor Learning and Recovery after Ischemic Stroke","volume":"2011","author":"Hosp","year":"2011","journal-title":"Neural Plast."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e32526","DOI":"10.1097\/MD.0000000000032526","article-title":"Case report of anosognosia for hemiplegia: A fMRI study","volume":"101","author":"Formica","year":"2022","journal-title":"Medicine"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/bs.pbr.2017.08.008","article-title":"Changes in brain activity during action observation and motor imagery: Their relationship with motor learning","volume":"234","author":"Mizuguchi","year":"2017","journal-title":"Prog. Brain Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6612\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:27:55Z","timestamp":1760113675000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/21\/6612"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,4]]},"references-count":56,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13216612"],"URL":"https:\/\/doi.org\/10.3390\/jcm13216612","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,4]]}}}