Mirror Visual Feedback Selectively Attenuates Crossover Fatigue in Distal Upper Limb Musculature: A Randomized Controlled Crossover Investigation Comparing Children and Adults

TL;DR

Mirror visual feedback reduces crossover fatigue in hand muscles during handgrip exercises, with similar effects in children and adults.

Contribution

This study demonstrates that mirror visual feedback can selectively reduce crossover fatigue in distal upper limb musculature without age-dependent differences.

Findings

Mirror visual feedback maintained non-dominant handgrip force at rest-equivalent levels, unlike vision occlusion.

Crossover fatigue was significantly reduced in handgrip but not in elbow flexion or extension.

Children and adults showed similar magnitudes of mirror-induced fatigue attenuation.

Abstract

This investigation examined whether mirror visual feedback modulates crossover fatigue magnitude during unilateral handgrip exertion and whether efficacy demonstrates age-dependent and muscle-group-specific characteristics. Thirty-three participants stratified by developmental stage (adults: n = 17, 24.64 ± 5.38 years; children: n = 16, 11.87 ± 0.79 years) completed a randomized controlled crossover protocol incorporating three visual feedback conditions: mirror reflection of the exercised limb, occluded vision (no-mirror), and passive rest control. Participants performed unilateral dominant handgrip fatigue induction (20 × 6 s maximal voluntary isometric contractions) while bilateral force production was quantified pre-intervention and post-intervention across handgrip, elbow flexion, and elbow extension domains. Linear mixed-effects models with participant-specific random intercepts and slopes quantified Condition × Time × Limb interactions. In the non-exercised contralateral limb, linear mixed-effects models demonstrated that under the mirror condition, non-dominant handgrip force was maintained at rest-equivalent levels relative to control (+0.02 kg, 95% CI [−1.15, +1.17], p = 0.987, dz =+ 0.003), whereas vision occlusion induced significant crossover fatigue (−3.37 kg [−4.40, −2.35], p < 0.001, dz =− 1.16). All contrasts represent within-subject difference-of-differences in non-dominant limb change score (Post − Pre) extracted from the full factorial LMM via emmeans within the Limb = Non-dominant stratum pooled across age groups. The mirror versus no-mirror comparison yielded +3.38 kg [+2.43, +4.34], p < 0.001, dz =+ 1.26. Age-stratified analyses confirmed comparable effect magnitudes (adults: dz =+ 1.40; children: dz =+ 1.33). Muscle-group specificity emerged for handgrip but not elbow flexion (p = 0.068) or extension (p = 0.156). Age Group × Condition × Time × Limb interactions were non-significant (all p > 0.16), providing no evidence of age moderation within the tested developmental range. Mirror visual feedback constitutes an effective countermeasure against crossover fatigue in distal upper limb musculature. The magnitude of mirror-induced attenuation did not differ between children (aged 10–13 years) and adults within our sample, with no statistically detectable age moderation within the tested developmental range; formal equivalence testing was not conducted. Effects demonstrated anatomical selectivity, favoring hand musculature over proximal elbow musculature.

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