Topography of Cortical Activation with Mirror Visual Feedback and Electromyography-Triggered Electrical Stimulation:...

Stroke often results in lasting upper limb deficits. Mirror visual feedback (MVF) supports motor recovery, and electromyography-triggered electrical stimulation (ES) could enhance engagement. However, the effects in healthy older adults, age-matched to typical patient cohorts, remain insufficiently understood. We tested MVF and MVF + ES using functional near-infrared spectroscopy.

Seventeen right-handed older adults performed left-wrist flexion under three visual conditions: circle fixation, viewing the right hand at rest, and mirror viewing, with/without electrical stimulation to the right-wrist flexors time-locked to left-forearm electromyography. Oxygenated hemoglobin (oxy-Hb) was recorded over the bilateral inferior frontal gyrus (IFG), precentral gyrus (PrG), postcentral gyrus (PoG), supramarginal gyrus (SMG), superior parietal lobule (SPL), and supplementary motor area. Effects were assessed with linear mixed-effects models (stimulation × visual condition); pairwise comparisons of estimated marginal means used Fisher's least significant difference. Left-forearm electromyography verified comparable effort across conditions.

Linear mixed-effects models revealed left-lateralized increases in oxy-Hb, most prominently under mirror viewing with stimulation. Post hoc tests showed high oxy-Hb in the left IFG, PrG, PoG, SMG, and SMA. The left EMG did not differ.

In healthy older adults, MVF paired with EMG-triggered ES enhances frontoparietal-motor engagement beyond MVF alone, with recruitment shaped by visuo-proprioceptive congruence. These findings support mechanistic plausibility and motivate dose-response optimization and patient-focused trials testing behavioral transfer in stroke.