Sports Medicine

, Volume 44, Issue 2, pp 159–178 | Cite as

Role of the Mirror-Neuron System in Cross-Education

  • Tjerk Zult
  • Glyn Howatson
  • Endre E. Kádár
  • Jonathan P. Farthing
  • Tibor HortobágyiEmail author
Review Article


The present review proposes the untested hypothesis that cross-education performed with a mirror increases the transfer of motor function to the resting limb compared with standard cross-education interventions without a mirror. The hypothesis is based on neuroanatomical evidence suggesting an overlap in activated brain areas when a unilateral motor task is performed with and without a mirror in the context of cross-education of the upper extremities. The review shows that the mirror-neuron system (MNS), connecting sensory neurons responding to visual properties of an observed action and motor neurons that discharge action potentials during the execution of a similar action, has the potential to enhance cross-education. After a literature search we narrowed the review to studies that examined healthy young adults who performed unilateral strength training and unilateral motor tasks with or without a mirror and assessed outcome measures in relation to the changes in brain activity, motor cortical excitability, and corticospinal excitability. We identified six chronic studies that examined the effects of unilateral strength training on neural adaptations and 15 cross-sectional studies that examined acute changes in brain activation, motor cortical and corticospinal excitability using imaging, electroencephalographic, magnetoencephalographic, and magnetic brain stimulation. There were two chronic and nine cross-sectional studies in which participants performed unilateral motor tasks while viewing the image of the active hand superimposed on the resting hand’s image. Collectively, the data suggest that the MNS is involved in cross-education and the hypothesis is tenable. However, future studies are needed to elucidate the precise mechanism of how the use of a mirror in a cross-education study augments transfer to the non-exercised limb. Recent studies show a strength-sparing effect in the immobilized arm after strength training of the free arm in healthy individuals, and improved bilateral function after unilateral exercise therapy in stroke patients. It is thus conceptually justified to conduct randomized clinical trials that supplement cross-education protocols with a mirror. Such a treatment could reduce muscle weakness caused by limb fractures, anterior-cruciate ligament reconstruction surgery, stroke, and other unilateral motor dysfunctions.


Transcranial Magnetic Stimulation Maximal Voluntary Contraction Strength Training Supplementary Motor Area Superior Temporal Sulcus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Jonathan Farthing was supported by sabbatical research travel funding from the University of Saskatchewan to visit the University of Groningen. No further sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review. The authors thank the reviewers for the detailed and insightful comments.

Supplementary material

40279_2013_105_MOESM1_ESM.doc (116 kb)
Table S1. Characteristics of the reviewed studies that assessed cross-education and neural adaptations after unilateral strength training (top six studies) and studies that assessed cortical activity, motor cortical excitability, or corticospinal excitability during unilateral strength exercises (bottom 15 studies). (DOC 116 kb)
40279_2013_105_MOESM2_ESM.doc (69 kb)
Table S2. Characteristics of the reviewed studies that assessed cross-education and cortical adaptations after chronic mirror training (top two studies) and studies that assessed cortical activity, motor cortical excitability, or corticospinal excitability during acute mirror training (bottom nine studies). (DOC 69 kb)


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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Tjerk Zult
    • 1
  • Glyn Howatson
    • 2
    • 3
  • Endre E. Kádár
    • 4
  • Jonathan P. Farthing
    • 5
  • Tibor Hortobágyi
    • 1
    • 2
    Email author
  1. 1.Center for Human Movement SciencesUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
  2. 2.Faculty of Health and Life SciencesNorthumbria UniversityNewcastle upon TyneUK
  3. 3.Water Research Group, School of Biological SciencesNorth West UniversityPotchefstroomSouth Africa
  4. 4.Department of PsychologyUniversity of PortsmouthPortsmouthUK
  5. 5.College of KinesiologyUniversity of SaskatchewanSaskatoonCanada

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