Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Mirror neurons and their clinical relevance

Nature Clinical Practice Neurology volume 5, pages 24–34 (2009)Cite this article

Abstract

One of the most exciting events in neurosciences over the past few years has been the discovery of a mechanism that unifies action perception and action execution. The essence of this 'mirror' mechanism is as follows: whenever individuals observe an action being done by someone else, a set of neurons that code for that action is activated in the observers' motor system. Since the observers are aware of the outcome of their motor acts, they also understand what the other individual is doing without the need for intermediate cognitive mediation. In this Review, after discussing the most pertinent data concerning the mirror mechanism, we examine the clinical relevance of this mechanism. We first discuss the relationship between mirror mechanism impairment and some core symptoms of autism. We then outline the theoretical principles of neurorehabilitation strategies based on the mirror mechanism. We conclude by examining the relationship between the mirror mechanism and some features of the environmental dependency syndromes.

Key Points

  • The mirror mechanism is a neural system that unifies action perception and action execution

  • The mirror mechanism is organized into two main cortical networks, the first being formed by the parietal lobe and premotor cortices, and the second by the insula and anterior cingulate cortex

  • The role of the mirror mechanism is to provide a direct understanding of the actions and emotions of others without higher order cognitive mediation

  • Limited development of the mirror mechanism seems to determine some of the core aspects of autism spectrum disorders

  • The recently demonstrated link between limited development of the mirror mechanism and that of some aspects of the motor system suggests that rehabilitation in children with austism spectrum disorder should take into account both motor and cognitive strategies

  • The use of action-observation-based protocols could represent a new rehabilitation strategy to treat motor deficits after stroke

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: A cytoarchitectonic map of the monkey cortex and an example of a mirror neuron.
Figure 2: Action-constrained neurons in the monkey IPL.
Figure 3: The parietofrontal mirror system in humans.
Figure 4: Absence of mirror EEG responses in autism.
Figure 5: Motor behavior in typically developing children and children with ASD.

Similar content being viewed by others

References

  1. Jacob P and Jeannerod M (2005) The motor theory of social cognition: a critique. Trends Cogn Sci 9: 21–25

    Article  Google Scholar 

  2. Csibra G and Gergely G (2007) 'Obsessed with goals': functions and mechanisms of teleological interpretation of actions in humans. Acta Psychol (Amst) 124: 60–78

    Article  Google Scholar 

  3. Frith CD (2007) The social brain? Philos Trans R Soc Lond B Biol Sci 362: 671–678

    Article  Google Scholar 

  4. Damasio A and Meyer K (2008) Behind the looking-glass. Nature 10: 167–168

    Article  Google Scholar 

  5. Brass M et al. (2007) Investigating action understanding: inferential processes versus action simulation. Curr Biol 17: 2117–2121

    Article  CAS  Google Scholar 

  6. Keysers C and Gazzola V (2007) Integrating simulation and theory of mind: from self to social cognition. Trends Cogn Sci 11: 194–196

    Article  Google Scholar 

  7. Liepelt R et al. (2008) How do we infer others' goals from non-stereotypic actions? The outcome of context-sensitive inferential processing in right inferior parietal and posterior temporal cortex. Neuroimage 43: 784–792

    Article  Google Scholar 

  8. Rizzolatti G and Craighero L (2004) The mirror-neuron system. Annu Rev Neurosci 27: 169–192

    Article  CAS  Google Scholar 

  9. Fabbri-Destro M and Rizzolatti G (2008) The mirror system in monkeys and humans. Physiology 23: 171–179

    Article  Google Scholar 

  10. Perrett DI et al. (1989) Frameworks of analysis for the neural representation of animate objects and actions. J Exp Biol 146: 87–113

    CAS  PubMed  Google Scholar 

  11. Jellema T et al. (2000) Neural representation for the perception of the intentionality of action. Brain Cogn 442: 280–302

    Article  Google Scholar 

  12. Rizzolatti G et al. (1988) Functional organization of inferior area 6 in the macaque monkey: II: area F5 and the control of distal movements. Exp Brain Res 71: 491–507

    Article  CAS  Google Scholar 

  13. Crutcher MD and Alexander GE (1990) Movement-related neuronal activity selectively coding either direction or muscle pattern in three motor areas of the monkey. J Neurophysiol 64: 151–163

    Article  CAS  Google Scholar 

  14. Alexander GE and Crutcher MD (1990) Neural representations of the target (goal) of visually guided arm movements in three motor areas of the monkey. J Neurophysiol 64: 164–178

    Article  CAS  Google Scholar 

  15. Kakei S et al. (1999) Muscle and movement representations in the primary motor cortex. Science 285: 2136–2139

    Article  CAS  Google Scholar 

  16. Kakei S et al. (2001) Direction of action is represented in the ventral premotor cortex. Nat Neurosci 4: 1020–1025

    Article  CAS  Google Scholar 

  17. Hoshi E and Tanji J (2000) Integration of target and body-part information in the premotor cortex when planning action. Nature 408: 466–470

    Article  CAS  Google Scholar 

  18. Umiltà MA et al. (2008) When pliers become fingers in the monkey motor system. Proc Natl Acad Sci USA 105: 2209–2213

    Article  Google Scholar 

  19. Fogassi L et al. (2005) Parietal lobe: from action organization to intention understanding. Science 308: 662–667

    Article  CAS  Google Scholar 

  20. Fogassi L et al. (2007) Time course of neuronal activity reflecting the final goal of observed and executed action sequences in monkey parietal and premotor cortex [abstract #636.4]. Presented at the 37th Annual Meeting of the Society for Neuroscience: 2007 November 3–7, San Diego, CA, USA

  21. Rizzolatti G et al. (2001) Neurophysiological mechanisms underlying the understanding and imitation of action. Nat Rev Neurosci 2: 661–670

    Article  CAS  Google Scholar 

  22. Kohler E et al. (2002) Hearing sounds, understanding actions: action representation in mirror neurons. Science 297: 846–848

    Article  CAS  Google Scholar 

  23. Umiltà MA et al. (2001) “I know what you are doing”: a neurophysiological study. Neuron 32: 91–101

    Google Scholar 

  24. Buccino G et al. (2001) Action observation activates premotor and parietal areas in a somatotopic manner: an fMRI study. Eur J Neurosci 13: 400–404

    CAS  PubMed  Google Scholar 

  25. Penfield W and Rasmussen T (1950) The Cerebral Cortex of Man: a Clinical Study of Localization of Function. New York: Macmillan

    Google Scholar 

  26. Woolsey CN et al. (1979) Localization of somatic sensory and motor areas of human sensory cortex as determined by direct recording of evoked potentials and electrical stimulation. J Neurosurg 51: 476–506

    Article  CAS  Google Scholar 

  27. Filimon F et al. (2007) Human cortical representations for reaching: mirror neurons for execution, observation, and imagery. Neuroimage 37: 1315–1328

    Article  Google Scholar 

  28. Gazzola V et al. (2007) The anthropomorphic brain: the mirror neuron system responds to human and robotic actions. Neuroimage 35: 1674–1684

    Article  CAS  Google Scholar 

  29. Hamilton AF and Grafton ST (2006) Goal representation in human anterior intraparietal sulcus. J Neurosci 26: 1133–1137

    Article  CAS  Google Scholar 

  30. Gazzola V et al. (2007) Aplasics born without hands mirror the goal of hand actions with their feet. Curr Biol 17: 1235–1240

    Article  CAS  Google Scholar 

  31. Iacoboni M et al. (2005) Grasping the intentions of others with one's own mirror neuron system. PLoS Biol 3: 529–535

    Article  CAS  Google Scholar 

  32. Hamilton AF and Grafton ST (2008) Action outcomes are represented in human inferior frontoparietal cortex. Cereb Cortex 18: 1160–1168

    Article  Google Scholar 

  33. Fadiga L et al. (1995) Motor facilitation during action observation: a magnetic stimulation study. J Neurophysiol 73: 2608–2611

    Article  CAS  Google Scholar 

  34. Strafella AP and Paus T (2000) Modulation of cortical excitability during action observation: a transcranial magnetic stimulation study. Neuroreport 11: 2289–2292

    Article  CAS  Google Scholar 

  35. Dayan E et al. (2007) Neural representations of kinematic laws of motion: evidence for action-perception coupling. Proc Natl Acad Sci USA 104: 20582–20587

    Article  CAS  Google Scholar 

  36. Gallese V et al. (2004) A unifying view of the basis of social cognition. Trends Cogn Sci 8: 396–403

    Article  Google Scholar 

  37. Singer T (2006) The neuronal basis and ontogeny of empathy and mind reading: review of literature and implications for future research. Neurosci Biobehav Rev 30: 855–863

    Article  Google Scholar 

  38. Mesulam MM and Mufson EJ (1982) Insula of the old world monkey: I: architectonics in the insulo-orbito-temporal component of the paralimbic brain. J Comp Neurol 212: 1–22

    Article  CAS  Google Scholar 

  39. Frontera JG (1956) Some results obtained by electrical stimulation of the cortex of the island of Reil in the brain of the monkey (Macaca mulatta). J Comp Neurol 105: 365–394

    Article  CAS  Google Scholar 

  40. Showers MJ and Laurer EW (1961) Somatovisceral motor patterns in the insula. J Comp Neurol 117: 107–115

    Article  CAS  Google Scholar 

  41. Penfield W and Faulk ME (1955) The insula; further observations on its function. Brain 78: 445–470

    Article  CAS  Google Scholar 

  42. Krolak-Salmon P et al. (2003) An attention modulated response to disgust in human ventral anterior insula. Ann Neurol 53: 446–453

    Article  Google Scholar 

  43. Fadiga L et al. (2002) Speech listening specifically modulates the excitability of tongue muscles: a TMS study. Eur J Neurosci 15: 399–402

    Article  Google Scholar 

  44. Kanner L (1943) Autistic disturbances of affective contact. Nerv Child 2: 217–250

    Google Scholar 

  45. Tuchman R and Rapin I (2002) Epilepsy in autism. Lancet Neurol 1: 352–358

    Article  Google Scholar 

  46. Hobson RP (1993) Autism and the Development of Mind. Hillsdale, NJ: Erlbaum

    Google Scholar 

  47. Minshew NJ and Williams DL (2007) The new neurobiology of autism: cortex, connectivity, and neuronal organization. Arch Neurol 64: 945–950

    Article  Google Scholar 

  48. Altschuler EL et al. (1997) Mu wave blocking by observation of movement and its possible use as a tool to study theory of other minds [abstract #67.23]. Presented at the 30th Annual Meeting of the Society for Neuroscience: 2000 November 4–9, New Orleans, LA, USA

  49. Williams JHG et al. (2001) Imitation, mirror neurons and autism. Neurosci Biobehav Rev 25: 287–295

    Article  CAS  Google Scholar 

  50. Oberman LM et al. (2005) EEG evidence for mirror neuron dysfunction in autism spectrum disorders. Brain Res Cogn Brain Res 24: 190–198

    Article  Google Scholar 

  51. Nishitani N et al. (2004) Abnormal imitation-related cortical activation sequences in Asperger's syndrome. Ann Neurol 55: 558–562

    Article  Google Scholar 

  52. Theoret H et al. (2005) Impaired motor facilitation during action observation in individuals with autism spectrum disorder. Curr Biol 15: R84–R85

    Article  CAS  Google Scholar 

  53. Dapretto M et al. (2006) Understanding emotions in others: mirror neuron dysfunction in children with autism spectrum disorders. Nat Neurosci 9: 28–30

    Article  CAS  Google Scholar 

  54. Martineau J et al. (2008) Impaired cortical activation in autistic children: is the mirror neuron system involved? Int J Psychophysiol 68: 35–40

    Article  Google Scholar 

  55. Oberman LM et al. (2008) Modulation of mu suppression in children with autism spectrum disorders in response to familiar or unfamiliar stimuli: the mirror neuron hypothesis. Neuropsychologia 46: 1558–1565

    Article  Google Scholar 

  56. Avikainen S et al. (2003) Impaired mirror-image imitation in Asperger and high-funtioning autistic subjects. Curr Biol 13: 339–341

    Article  CAS  Google Scholar 

  57. Cattaneo L et al. (2007) Impairment of actions chains in autism and its possible role in intention understanding. Proc Natl Acad Sci USA 104: 17825–17830

    Article  CAS  Google Scholar 

  58. Iacoboni M et al. (1999) Cortical mechanisms of human imitation. Science 286: 2526–2528

    Article  CAS  Google Scholar 

  59. Buccino G et al. (2004) Neural circuits underlying imitation learning of hand actions: an event-related fMRI study. Neuron 42: 323–334

    Article  CAS  Google Scholar 

  60. Stefan K et al. (2005) Formation of a motor memory by action observation. J Neurosci 25: 9339–9346

    Article  CAS  Google Scholar 

  61. Stefan K et al. (2008) Concurrent action observation modulates practice-induced motor memory formation. Eur J Neurosci 27: 730–738

    Article  CAS  Google Scholar 

  62. Dobkin BH (2008) Training and exercise to drive poststroke recovery. Nat Clin Pract Neurol 4: 76–85

    Article  Google Scholar 

  63. Ertelt D et al. (2008) Action observation has a positive impact on rehabilitation of motor deficits after stroke. Neuroimage 36 (Suppl 2): T164–T173

    Google Scholar 

  64. Altschuler EL et al. (1999) Rehabilitation of hemiparesis after stroke with a mirror. Lancet 353: 2035–2036

    Article  CAS  Google Scholar 

  65. Yavuzer G et al. (2008) Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil 89: 393–398

    Article  Google Scholar 

  66. Moseley GL et al. (2008) Is mirror therapy all it is cracked up to be? Current evidence and future directions. Pain 138: 7–10

    Article  Google Scholar 

  67. Ropper AH and Brown RH (2005) Adams and Victor's Principles of Neurology. New York: McGraw-Hill

    Google Scholar 

  68. Lhermitte F (1986) Human autonomy and the frontal lobes: part II: patient behavior in complex and social situations: the “environmental dependency syndrome”. Ann Neurol 19: 335–343

    Article  CAS  Google Scholar 

  69. De Renzi E et al. (1996) Imitation and utilization behaviour. J Neurol Neurosurg Psychiatry 61: 396–400

    Article  CAS  Google Scholar 

  70. Ghika J et al. (1995) Environment-driven responses in progressive supranuclear palsy. J Neurol Sci 130: 104–111

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by European Union Contract 012738, Neurocom, by PRIN 2006 to GR and by Fondazione Monte Parma. MF-D was supported by Fondazione Cassa di Risparmio di Ferrara.

Author information

Authors and Affiliations

  1. G Rizzolatti is Professor of Human Physiology and chairs the Department of Neuroscience of the University of Parma, Parma, M Fabbri-Destro is a Psychologist at the University of Ferrara, Ferrara, and the University of Parma, and L Cattaneo is a Neurologist at the Center for Mind–Brain Sciences (CIMeC) in Rovereto, Italy.,

    Giacomo Rizzolatti, Maddalena Fabbri-Destro & Luigi Cattaneo

Authors
  1. Giacomo Rizzolatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maddalena Fabbri-Destro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luigi Cattaneo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giacomo Rizzolatti.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rizzolatti, G., Fabbri-Destro, M. & Cattaneo, L. Mirror neurons and their clinical relevance. Nat Rev Neurol 5, 24–34 (2009). https://doi.org/10.1038/ncpneuro0990

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpneuro0990

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing