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Licensed Unlicensed Requires Authentication Published by De Gruyter March 27, 2020

Role of kinaesthetic motor imagery in mirror-induced visual illusion as intervention in post-stroke rehabilitation

  • Umar M. Bello ORCID logo EMAIL logo , Stanley J. Winser and Chetwyn C.H. Chan


Mirror-induced visual illusion obtained through mirror therapy is widely used to facilitate motor recovery after stroke. Activation of primary motor cortex (M1) ipsilateral to the moving limb has been reported during mirror-induced visual illusion. However, the mechanism through which the mirror illusion elicits motor execution processes without movements observed in the mirrored limb remains unclear. This study aims to review evidence based on brain imaging studies for testing the hypothesis that neural processes associated with kinaesthetic motor imagery are attributed to ipsilateral M1 activation. Four electronic databases were searched. Studies on functional brain imaging, investigating the instant effects of mirror-induced visual illusion among stroke survivors and healthy participants were included. Thirty-five studies engaging 78 stroke survivors and 396 healthy participants were reviewed. Results of functional brain scans (n = 20) indicated that half of the studies (n = 10, 50%) reported significant changes in the activation of ipsilateral M1, which mediates motor preparation and execution. Other common neural substrates included primary somatosensory cortex (45%, kinaesthesia), precuneus (40%, image generation and self-processing operations) and cerebellum (20%, motor control). Similar patterns of ipsilateral M1 activations were observed in the two groups. These neural substrates mediated the generation, maintenance, and manipulation of motor-related images, which were the key processes in kinaesthetic motor imagery. Relationships in terms of shared neural substrates and mental processes between mirror-induced visual illusion and kinaesthetic motor imagery generate new evidence on the role of the latter in mirror therapy. Future studies should investigate the imagery processes in illusion training for post-stroke patients.


We would like to thank the University Research Facility in Behavioural and Systems Neuroscience (UBSN) for providing technical support on data management and analyses. We also thank Mr. Jack Jiaqi Zhang for assisting in the article search and screening processes. Work of the first author was supported by PhD studentships of Hong Kong Polytechnic University.

  1. Conflict of interest statement: All authors declare no conflicts of interest.


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2019-11-18
Accepted: 2020-01-15
Published Online: 2020-03-27
Published in Print: 2020-08-27

©2020 Walter de Gruyter GmbH, Berlin/Boston

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