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Feingold-Polak R, Barzel O, Levy-Tzedek S. A robot goes to rehab: a novel gamified system for long-term stroke rehabilitation using a socially assistive robot-methodology and usability testing. J Neuroeng Rehabil 2021; 18:122. [PMID: 34321035 PMCID: PMC8316882 DOI: 10.1186/s12984-021-00915-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 07/19/2021] [Indexed: 01/18/2023] Open
Abstract
Background Socially assistive robots (SARs) have been proposed as a tool to help individuals who have had a stroke to perform their exercise during their rehabilitation process. Yet, to date, there are no data on the motivating benefit of SARs in a long-term interaction with post-stroke patients. Methods Here, we describe a robot-based gamified exercise platform, which we developed for long-term post-stroke rehabilitation. The platform uses the humanoid robot Pepper, and also has a computer-based configuration (with no robot). It includes seven gamified sets of exercises, which are based on functional tasks from the everyday life of the patients. The platform gives the patients instructions, as well as feedback on their performance, and can track their performance over time. We performed a long-term patient-usability study, where 24 post-stroke patients were randomly allocated to exercise with this platform—either with the robot or the computer configuration—over a 5–7 week period, 3 times per week, for a total of 306 sessions. Results The participants in both groups reported that this rehabilitation platform addressed their arm rehabilitation needs, and they expressed their desire to continue training with it even after the study ended. We found a trend for higher acceptance of the system by the participants in the robot group on all parameters; however, this difference was not significant. We found that system failures did not affect the long-term trust that users felt towards the system. Conclusions We demonstrated the usability of using this platform for a long-term rehabilitation with post-stroke patients in a clinical setting. We found high levels of acceptance of both platform configurations by patients following this interaction, with higher ratings given to the SAR configuration. We show that it is not the mere use of technology that increases the motivation of the person to practice, but rather it is the appreciation of the technology’s effectiveness and its perceived contribution to the rehabilitation process. In addition, we provide a list of guidelines that can be used when designing and implementing other technological tools for rehabilitation. Trial registration: This trial is registered in the NIH ClinicalTrials.gov database. Registration number NCT03651063, registration date 21.08.2018. https://clinicaltrials.gov/ct2/show/NCT03651063.
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Affiliation(s)
- Ronit Feingold-Polak
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oren Barzel
- Sheba Medical Center, Ramat Gan, Israel.,Adi-Negev Rehabilitation Center, Nahalat Eran, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ono Academic College, Kiryat Ono, Israel
| | - Shelly Levy-Tzedek
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer-Sheva, Israel. .,Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel. .,Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany.
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Ganesh A, Ospel JM, Marko M, van Zwam WH, Roos YBWEM, Majoie CBLM, Goyal M. From Three-Months to Five-Years: Sustaining Long-Term Benefits of Endovascular Therapy for Ischemic Stroke. Front Neurol 2021; 12:713738. [PMID: 34381418 PMCID: PMC8350336 DOI: 10.3389/fneur.2021.713738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: During the months and years post-stroke, treatment benefits from endovascular therapy (EVT) may be magnified by disability-related differences in morbidity/mortality or may be eroded by recurrent strokes and non-stroke-related disability/mortality. Understanding the extent to which EVT benefits may be sustained at 5 years, and the factors influencing this outcome, may help us better promote the sustenance of EVT benefits until 5 years post-stroke and beyond. Methods: In this review, undertaken 5 years after EVT became the standard of care, we searched PubMed and EMBASE to examine the current state of the literature on 5-year post-stroke outcomes, with particular attention to modifiable factors that influence outcomes between 3 months and 5 years post-EVT. Results: Prospective cohorts and follow-up data from EVT trials indicate that 3-month EVT benefits will likely translate into lower 5-year disability, mortality, institutionalization, and care costs and higher quality of life. However, these group-level data by no means guarantee maintenance of 3-month benefits for individual patients. We identify factors and associated “action items” for stroke teams/systems at three specific levels (medical care, individual psychosocioeconomic, and larger societal/environmental levels) that influence the long-term EVT outcome of a patient. Medical action items include optimizing stroke rehabilitation, clinical follow-up, secondary stroke prevention, infection prevention/control, and post-stroke depression care. Psychosocioeconomic aspects include addressing access to primary care, specialist clinics, and rehabilitation; affordability of healthy lifestyle choices and preventative therapies; and optimization of family/social support and return-to-work options. High-level societal efforts include improving accessibility of public/private spaces and transportation, empowering/engaging persons with disability in society, and investing in treatments/technologies to mitigate consequences of post-stroke disability. Conclusions: In the longtime horizon from 3 months to 5 years, several factors in the medical and societal spheres could negate EVT benefits. However, many factors can be leveraged to preserve or magnify treatment benefits, with opportunities to share responsibility with widening circles of care around the patient.
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Affiliation(s)
- Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | | | - Martha Marko
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | | | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Llorens R, Fuentes MA, Borrego A, Latorre J, Alcañiz M, Colomer C, Noé E. Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:108. [PMID: 34210347 PMCID: PMC8252292 DOI: 10.1186/s12984-021-00896-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Functional impairments derived from the non-use of severely affected upper limb after stroke have been proposed to be mitigated by action observation and imagination-based techniques, whose effectiveness is enhanced when combined with transcranial direct current stimulation (tDCS). Preliminary studies in mildly impaired individuals in the acute phase post-stroke show intensified effects when action is facilitated by tDCS and mediated by virtual reality (VR) but the effectiveness in cases of severe impairment and chronic stroke is unknown. This study investigated the effectiveness of a combined tDCS and VR-based intervention in the sensorimotor function of chronic individuals post-stroke with persistent severe hemiparesis compared to conventional physical therapy. METHODS Twenty-nine participants were randomized into an experimental group, who received 30 minutes of the combined tDCS and VR-based therapy and 30 minutes of conventional physical therapy, or a control group, who exclusively received conventional physical therapy focusing on passive and active assistive range of motion exercises. The sensorimotor function of all participants was assessed before and after 25 one-hour sessions, administered three to five times a week, using the upper extremity subscale of the Fugl-Meyer Assessment, the time and ability subscales of the Wolf Motor Function Test, and the Nottingham Sensory Assessment. RESULTS A clinically meaningful improvement of the upper limb motor function was consistently revealed in all motor measures after the experimental intervention, but not after conventional physical therapy. Similar limited effects were detected in the sensory function in both groups. CONCLUSION The combined tDCS and VR-based paradigm provided not only greater but also clinically meaningful improvement in the motor function (and similar sensory effects) in comparison to conventional physical therapy.
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Affiliation(s)
- Roberto Llorens
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain.
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain.
| | - María Antonia Fuentes
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
| | - Adrián Borrego
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain
| | - Jorge Latorre
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
| | - Mariano Alcañiz
- Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain
| | - Carolina Colomer
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
| | - Enrique Noé
- NEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales Vithas, Callosa d'En Sarrià 12, 46007, València, Spain
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Takeo Y, Hara M, Shirakawa Y, Ikeda T, Sugata H. Sequential motor learning transfers from real to virtual environment. J Neuroeng Rehabil 2021; 18:107. [PMID: 34193177 PMCID: PMC8247210 DOI: 10.1186/s12984-021-00903-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Skill acquisition of motor learning between virtual environments (VEs) and real environments (REs) may be related. Although studies have previously examined the transfer of motor learning in VEs and REs through the same tasks, only a small number of studies have focused on studying the transfer of motor learning in VEs and REs by using different tasks. Thus, detailed effects of the transfer of motor skills between VEs and REs remain controversial. Here, we investigated the transfer of sequential motor learning between VEs and REs conditions. Methods Twenty-seven healthy volunteers performed two types of sequential motor learning tasks; a visually cued button-press task in RE (RE task) and a virtual reaching task in VE (VE task). Participants were randomly assigned to two groups in the task order; the first group was RE task followed by VE task and the second group was VE task followed by RE task. Subsequently, the response time in RE task and VE task was compared between the two groups respectively. Results The results showed that the sequential reaching task in VEs was facilitated after the sequential finger task in REs. Conclusions These findings suggested that the sequential reaching task in VEs can be facilitated by a motor learning task comprising the same sequential finger task in REs, even when a different task is applied.
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Affiliation(s)
- Yuhi Takeo
- Department of Rehabilitation, Oita University Hospital, Oita, Japan.,Graduate School of Welfare and Health Science, Oita University, Oita, Japan
| | - Masayuki Hara
- Graduate School of Science and Engineering, Saitama University, 255 Shimo-Okubo, Sakura-ku, 338-8570, Saitama City, Saitama, Japan
| | - Yuna Shirakawa
- Faculty of Welfare and Health Science, Oita University, 700, Dannoharu, 870-1192, Oita, Japan
| | - Takashi Ikeda
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, Japan
| | - Hisato Sugata
- Graduate School of Welfare and Health Science, Oita University, Oita, Japan. .,Faculty of Welfare and Health Science, Oita University, 700, Dannoharu, 870-1192, Oita, Japan.
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Doumas I, Everard G, Dehem S, Lejeune T. Serious games for upper limb rehabilitation after stroke: a meta-analysis. J Neuroeng Rehabil 2021; 18:100. [PMID: 34130713 PMCID: PMC8204490 DOI: 10.1186/s12984-021-00889-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 05/31/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Approximately two thirds of stroke survivors maintain upper limb (UL) impairments and few among them attain complete UL recovery 6 months after stroke. Technological progress and gamification of interventions aim for better outcomes and constitute opportunities in self- and tele-rehabilitation. OBJECTIVES Our objective was to assess the efficacy of serious games, implemented on diverse technological systems, targeting UL recovery after stroke. In addition, we investigated whether adherence to neurorehabilitation principles influenced efficacy of games specifically designed for rehabilitation, regardless of the device used. METHOD This systematic review was conducted according to PRISMA guidelines (PROSPERO registration number: 156589). Two independent reviewers searched PubMed, EMBASE, SCOPUS and Cochrane Central Register of Controlled Trials for eligible randomized controlled trials (PEDro score ≥ 5). Meta-analysis, using a random effects model, was performed to compare effects of interventions using serious games, to conventional treatment, for UL rehabilitation in adult stroke patients. In addition, we conducted subgroup analysis, according to adherence of included studies to a consolidated set of 11 neurorehabilitation principles. RESULTS Meta-analysis of 42 trials, including 1760 participants, showed better improvements in favor of interventions using serious games when compared to conventional therapies, regarding UL function (SMD = 0.47; 95% CI = 0.24 to 0.70; P < 0.0001), activity (SMD = 0.25; 95% CI = 0.05 to 0.46; P = 0.02) and participation (SMD = 0.66; 95% CI = 0.29 to 1.03; P = 0.0005). Additionally, long term effect retention was observed for UL function (SMD = 0.42; 95% CI = 0.05 to 0.79; P = 0.03). Interventions using serious games that complied with at least 8 neurorehabilitation principles showed better overall effects. Although heterogeneity levels remained moderate, results were little affected by changes in methods or outliers indicating robustness. CONCLUSION This meta-analysis showed that rehabilitation through serious games, targeting UL recovery after stroke, leads to better improvements, compared to conventional treatment, in three ICF-WHO components. Irrespective of the technological device used, higher adherence to a consolidated set of neurorehabilitation principles enhances efficacy of serious games. Future development of stroke-specific rehabilitation interventions should further take into consideration the consolidated set of neurorehabilitation principles.
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Affiliation(s)
- Ioannis Doumas
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium
| | - Gauthier Everard
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium
| | - Stéphanie Dehem
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Secteur des Sciences de la Santé, Université Catholique de Louvain, Avenue Mounier 53, 1200, Brussels, Belgium.
- Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
- Université Catholique de Louvain, Louvain Bionics, 1348, Louvain-la-Neuve, Belgium.
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Ito K, Uehara S, Yuasa A, Kim CM, Kitamura S, Ushizawa K, Tanabe S, Otaka Y. Electromyography-controlled gamified exercise system for the distal upper extremity: a usability assessment in subacute post-stroke patients. Disabil Rehabil Assist Technol 2021:1-6. [PMID: 34102940 DOI: 10.1080/17483107.2021.1936663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Movement repetition is known to play a key role in promoting functional improvements or maintaining functional levels in post-stroke hemiparetic patients. However, repetitive movements tend to be monotonous, making it challenging for patients to continue. Here, we developed a new gamified system to allow patients perform repetitive movements with enjoyment. The present study aimed to examine the usability of the system in subacute stroke patients. METHOD The exercise system comprised an electromyography-controlled operating system that enabled users to play a virtual game by repetitive finger and wrist movements on the affected side. A total of 13 patients with upper-limb hemiparesis underwent a single bout of exercise using the system and assessed its usability, satisfactoriness, enjoyability, etc. using the System Usability Scale (SUS), Quebec User Evaluation of Satisfaction with assistive Technology (QUEST)-like questionnaire, and numerical rating scale (NRS). RESULTS All the participants, who had a wide range of paretic levels, were able to perform the exercise using the system. Participants scored the system a median of 85.0 for SUS and 4.2 for the QUEST-like questionnaire, with an "excellent" in usability and "satisfied" in user satisfaction with the system. The median NRS scores for enjoyability, potential for continuous use, and effectiveness were 8.0, 9.0, and 9.0, respectively, which were greater than the scores for usual rehabilitation training for the upper extremity. CONCLUSIONS The novel electromyography-controlled gamified exercise system may have sufficient usability and enjoyability to motivate patients with a wide range of paretic levels to perform repetitive finger and wrist movements.IMPLICATIONS FOR REHABILITATIONThe electromyography-controlled gamified exercise system had overall positive perspectives on the usability of the system.This exercise system could help motivate patients with a wide range of paretic levels to perform repetitive finger and wrist movements.
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Affiliation(s)
- Kazuki Ito
- Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan
| | - Shintaro Uehara
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Akiko Yuasa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | | | - Shin Kitamura
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Kazuki Ushizawa
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan
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Effects of a Rehabilitation Program Using a Wearable Device on the Upper Limb Function, Performance of Activities of Daily Living, and Rehabilitation Participation in Patients with Acute Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115524. [PMID: 34063970 PMCID: PMC8196786 DOI: 10.3390/ijerph18115524] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 12/29/2022]
Abstract
This study investigated the effects of a rehabilitation program using a wearable device on upper limb function, the performance of activities of daily living, and rehabilitation participation in acute phase stroke patients. A total of 44 patients were randomly divided into two groups. The experimental group (n = 22) was requested to wear a glove-type device while they were administered a game-based virtual reality (VR) rehabilitation program of 30 mins per session, 5 sessions per week, for 4 weeks. The program was given in addition to conventional physical therapy. The control group (n = 22) was administered only conventional physical therapy. To examine the intervention effects, the Fugl-Meyer assessment scale, hand strength test, and Jebsen–Taylor hand function tests were performed to examine upper limb function. The Korean version of the modified Barthel Index was used to assess the performance of activities of daily living, and the Pittsburgh rehabilitation participation scale was used to estimate rehabilitation participation. Neither the experimental nor the control group showed significant differences in the pre-intervention homogeneity test, while both groups showed significant improvement in all post-intervention dependent variables. Notably, the experimental group showed a significantly greater improvement in the results of the hand strength test, Jebsen–Taylor hand function test, and Modified Barthel Index. The findings suggest that the rehabilitation program using a wearable device, in addition to conventional physical therapy, is more effective than conventional therapy alone for improving upper limb function, the performance of activities of daily living, and rehabilitation participation in acute phase stroke patients. Our findings suggest that the novel rehabilitation program using a wearable device will serve not only as an effective therapy for enhancing the upper limb function, the performance of activities of daily living, and rehabilitation participation in acute phase stroke patients but also as a highly useful intervention in actual clinical practice alongside conventional physical therapy.
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Picard-Deland C, Aumont T, Samson-Richer A, Paquette T, Nielsen T. Whole-body procedural learning benefits from targeted memory reactivation in REM sleep and task-related dreaming. Neurobiol Learn Mem 2021; 183:107460. [PMID: 34015442 DOI: 10.1016/j.nlm.2021.107460] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/20/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
Sleep facilitates memory consolidation through offline reactivations of memory traces. Dreaming may play a role in memory improvement and may reflect these memory reactivations. To experimentally address this question, we used targeted memory reactivation (TMR), i.e., application, during sleep, of a stimulus that was previously associated with learning, to assess whether it influences task-related dream imagery (or task-dream reactivations). Specifically, we asked if TMR or task-dream reactivations in either slow-wave (SWS) or rapid eye movement (REM) sleep benefit whole-body procedural learning. Healthy participants completed a virtual reality (VR) flying task prior to and following a morning nap or rest period during which task-associated tones were readministered in either SWS, REM sleep, wake or not at all. Findings indicate that learning benefits most from TMR when applied in REM sleep compared to a Control-sleep group. REM dreams that reactivated kinesthetic elements of the VR task (e.g., flying, accelerating) were also associated with higher improvement on the task than were dreams that reactivated visual elements (e.g., landscapes) or that had no reactivations. TMR did not itself influence dream content but its effects on performance were greater when coexisting with task-dream reactivations in REM sleep. Findings may help explain the mechanistic relationships between dream and memory reactivations and may contribute to the development of sleep-based methods to optimize complex skill learning.
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Affiliation(s)
- Claudia Picard-Deland
- Dream & Nightmare Laboratory, Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Québec, Canada; Department of Neuroscience, Université de Montréal, Montréal, Québec, Canada
| | - Tomy Aumont
- Dream & Nightmare Laboratory, Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Québec, Canada; Department of Biomedical Sciences, Université de Montréal, Montréal, Québec, Canada
| | - Arnaud Samson-Richer
- Dream & Nightmare Laboratory, Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Tyna Paquette
- Dream & Nightmare Laboratory, Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Québec, Canada
| | - Tore Nielsen
- Dream & Nightmare Laboratory, Center for Advanced Research in Sleep Medicine, CIUSSS-NÎM - Hôpital du Sacré-Coeur de Montréal, Québec, Canada; Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada.
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Rémy-Néris O, Le Jeannic A, Dion A, Médée B, Nowak E, Poiroux É, Durand-Zaleski I. Additional, Mechanized Upper Limb Self-Rehabilitation in Patients With Subacute Stroke: The REM-AVC Randomized Trial. Stroke 2021; 52:1938-1947. [PMID: 33910364 DOI: 10.1161/strokeaha.120.032545] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Olivier Rémy-Néris
- Physical and Rehabilitation Medicine Department (O.R.-N., B.M., É.P.), Brest University Hospital, France.,University of Brest, France (O.R.-N.).,Laboratory of Medical Information Processing, INSERM UMR 1101, Brest, France (O.R.-N., B.M.)
| | - Anaïs Le Jeannic
- Health Economics Clinical Research Unit (URC Eco), APHP, Paris, France (A.L.J., I.D.-Z.)
| | - Angelina Dion
- INSERM, CIC 1412 (A.D., E.N.), Brest University Hospital, France
| | - Béatrice Médée
- Physical and Rehabilitation Medicine Department (O.R.-N., B.M., É.P.), Brest University Hospital, France.,Laboratory of Medical Information Processing, INSERM UMR 1101, Brest, France (O.R.-N., B.M.)
| | - Emmanuel Nowak
- INSERM, CIC 1412 (A.D., E.N.), Brest University Hospital, France
| | - Élodie Poiroux
- Physical and Rehabilitation Medicine Department (O.R.-N., B.M., É.P.), Brest University Hospital, France
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Effect of Traditional plus Virtual Reality Rehabilitation on Prognosis of Stroke Survivors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Am J Phys Med Rehabil 2021; 101:217-228. [PMID: 33929347 DOI: 10.1097/phm.0000000000001775] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Virtual reality (VR) technology has begun to be gradually applied to clinical stroke rehabilitation. The study aims to evaluate the effect of traditional plus VR rehabilitation on motor function recovery, balance, and activities of daily living in stroke patients. METHOD Studies published in English prior to October 2020 were retrieved from PubMed, EMBASE, Web of Science, and the Cochrane Library. and used RevMan 5.3 software for meta-analysis. RESULT A total of 21 randomized controlled trials (RCTs) were included, which enrolled 619 patients. Traditional plus VR rehabilitation is better than traditional rehabilitation in upper limb motor function recovery measured by Fugl-Meyer Assessment-Upper Extremity (mean difference [MD] 3.49; 95% CI [1.24, 5.73]; P=.002) and manual dexterity assessed by Box & Block Test (MD 6.59; 95% CI [3.45, 9.74]; P<.0001); However, there is no significant difference from traditional rehabilitation in activities of daily living assessed by Functional Independence Measure (MD 0.38; 95% CI [-0.26, 1.02]; P=.25) and balance assessed by Berg Balance Scale (MD 2.18; 95% CI [-0.35, 4.71]; P=.09). CONCLUSION Traditional plus VR rehabilitation therapy is an effective method to improve the upper limb motor function and manual dexterity of patients with limb disorders after stroke, and immersive VR rehabilitation treatment may become a new option for rehabilitation after stroke.
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Voinescu A, Sui J, Stanton Fraser D. Virtual Reality in Neurorehabilitation: An Umbrella Review of Meta-Analyses. J Clin Med 2021; 10:1478. [PMID: 33918365 PMCID: PMC8038192 DOI: 10.3390/jcm10071478] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 01/08/2023] Open
Abstract
Neurological disorders are a leading cause of death and disability worldwide. Can virtual reality (VR) based intervention, a novel technology-driven change of paradigm in rehabilitation, reduce impairments, activity limitations, and participation restrictions? This question is directly addressed here for the first time using an umbrella review that assessed the effectiveness and quality of evidence of VR interventions in the physical and cognitive rehabilitation of patients with stroke, traumatic brain injury and cerebral palsy, identified factors that can enhance rehabilitation outcomes and addressed safety concerns. Forty-one meta-analyses were included. The data synthesis found mostly low- or very low-quality evidence that supports the effectiveness of VR interventions. Only a limited number of comparisons were rated as having moderate and high quality of evidence, but overall, results highlight potential benefits of VR for improving the ambulation function of children with cerebral palsy, mobility, balance, upper limb function, and body structure/function and activity of people with stroke, and upper limb function of people with acquired brain injury. Customization of VR systems is one important factor linked with improved outcomes. Most studies do not address safety concerns, as only nine reviews reported adverse effects. The results provide critical recommendations for the design and implementation of future VR programs, trials and systematic reviews, including the need for high quality randomized controlled trials to test principles and mechanisms, in primary studies and in meta-analyses, in order to formulate evidence-based guidelines for designing VR-based rehabilitation interventions.
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Affiliation(s)
- Alexandra Voinescu
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath BA2 7AY, UK;
| | - Jie Sui
- The School of Psychology, King’s College, University of Aberdeen, Aberdeen AB24 3FX, UK;
| | - Danaë Stanton Fraser
- Department of Psychology, University of Bath, 10 West, Claverton Down, Bath BA2 7AY, UK;
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62
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Cortés-Pérez I, Zagalaz-Anula N, Montoro-Cárdenas D, Lomas-Vega R, Obrero-Gaitán E, Osuna-Pérez MC. Leap Motion Controller Video Game-Based Therapy for Upper Extremity Motor Recovery in Patients with Central Nervous System Diseases. A Systematic Review with Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2021; 21:2065. [PMID: 33804247 PMCID: PMC7999275 DOI: 10.3390/s21062065] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 12/11/2022]
Abstract
Leap Motion Controller (LMC) is a virtual reality device that can be used in the rehabilitation of central nervous system disease (CNSD) motor impairments. This review aimed to evaluate the effect of video game-based therapy with LMC on the recovery of upper extremity (UE) motor function in patients with CNSD. A systematic review with meta-analysis was performed in PubMed Medline, Web of Science, Scopus, CINAHL, and PEDro. We included five randomized controlled trials (RCTs) of patients with CNSD in which LMC was used as experimental therapy compared to conventional therapy (CT) to restore UE motor function. Pooled effects were estimated with Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI). At first, in patients with stroke, LMC showed low-quality evidence of a large effect on UE mobility (SMD = 0.96; 95% CI = 0.47, 1.45). In combination with CT, LMC showed very low-quality evidence of a large effect on UE mobility (SMD = 1.34; 95% CI = 0.49, 2.19) and the UE mobility-oriented task (SMD = 1.26; 95% CI = 0.42, 2.10). Second, in patients with non-acute CNSD (cerebral palsy, multiple sclerosis, and Parkinson's disease), LMC showed low-quality evidence of a medium effect on grip strength (GS) (SMD = 0.47; 95% CI = 0.03, 0.90) and on gross motor dexterity (GMD) (SMD = 0.73; 95% CI = 0.28, 1.17) in the most affected UE. In combination with CT, LMC showed very low-quality evidence of a high effect in the most affected UE on GMD (SMD = 0.80; 95% CI = 0.06, 1.15) and fine motor dexterity (FMD) (SMD = 0.82; 95% CI = 0.07, 1.57). In stroke, LMC improved UE mobility and UE mobility-oriented tasks, and in non-acute CNSD, LMC improved the GS and GMD of the most affected UE and FMD when it was used with CT.
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Affiliation(s)
- Irene Cortés-Pérez
- Centro Médico “Avenida II”, C/Julio Burell 18, 23700 Linares, Spain;
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Noelia Zagalaz-Anula
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Desirée Montoro-Cárdenas
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Rafael Lomas-Vega
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - Esteban Obrero-Gaitán
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
| | - María Catalina Osuna-Pérez
- Department of Health Sciences, University of Jaén, Paraje Las Lagunillas s/n, 23071 Jaén, Spain; (N.Z.-A.); (D.M.-C.); (R.L.-V.); (M.C.O.-P.)
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63
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Sandrone S, Carlson C. Gamification and game-based education in neurology and neuroscience: Applications, challenges, and opportunities. BRAIN DISORDERS 2021. [DOI: 10.1016/j.dscb.2021.100008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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64
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Additional Effects of Xbox Kinect Training on Upper Limb Function in Chronic Stroke Patients: A Randomized Control Trial. Healthcare (Basel) 2021; 9:healthcare9030242. [PMID: 33668355 PMCID: PMC7996301 DOI: 10.3390/healthcare9030242] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Xbox Kinect-based virtual reality, being a novel approach, has therapeutic benefits in rehabilitation and its use is encouraged in stroke rehabilitation of upper extremities. Objective: Primary aim of the current study is to investigate the additional effects of Xbox Kinect training in combination with routine physiotherapy exercises based on each component of Fugl-Meyer Assessment Scale for Upper Extremity (FMA-UE). Moreover, effect of upper limb rehabilitation on cognitive functions was also assessed. Methods: This study was a parallel arm randomized control trial. Fifty-six participants were recruited and randomly allocated to either an Xbox Kinect training group (XKGT) or exercise training group (ETG). Measures of concern were recorded using FMA-UE, Box and Block Test (BBT), and Montreal Cognitive Assessment (MOCA). Evaluation was conducted at baseline and after completion of intervention at the sixth week. Results: There were significant differences from pre- to post-intervention scores of FMA-UE and BBT (p < 0.001) in both groups, whereas no difference was observed for MOCA (XKTG p value 0.417, ETG p value 0.113). At six-week follow-up there were significant differences between both groups in FMA-UE total score (p < 0.001), volitional movement within synergies (p < 0.001), wrist (p = 0.021), hand (p = 0.047), grasp (p = 0.006) and coordination/speed (p = 0.004), favoring the Xbox Kinect training group. Conclusion: To conclude, results indicate repetitive use of the hemiparetic upper extremity by Xbox Kinect-based upper limb rehabilitation training in addition to conventional therapy has a promising potential to enhance upper limb motor function for stroke patients.
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65
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Ranavolo A, Serrao M, Draicchio F. Critical Issues and Imminent Challenges in the Use of sEMG in Return-To-Work Rehabilitation of Patients Affected by Neurological Disorders in the Epoch of Human-Robot Collaborative Technologies. Front Neurol 2020; 11:572069. [PMID: 33414754 PMCID: PMC7783040 DOI: 10.3389/fneur.2020.572069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/30/2020] [Indexed: 01/07/2023] Open
Abstract
Patients affected by neurological pathologies with motor disorders when they are of working age have to cope with problems related to employability, difficulties in working, and premature work interruption. It has been demonstrated that suitable job accommodation plans play a beneficial role in the overall quality of life of pathological subjects. A well-designed return-to-work program should consider several recent innovations in the clinical and ergonomic fields. One of the instrument-based methods used to monitor the effectiveness of ergonomic interventions is surface electromyography (sEMG), a multi-channel, non-invasive, wireless, wearable tool, which allows in-depth analysis of motor coordination mechanisms. Although the scientific literature in this field is extensive, its use remains significantly underexploited and the state-of-the-art technology lags expectations. This is mainly attributable to technical and methodological (electrode-skin impedance, noise, electrode location, size, configuration and distance, presence of crosstalk signals, comfort issues, selection of appropriate sensor setup, sEMG amplitude normalization, definition of correct sEMG-related outcomes and normative data) and cultural limitations. The technical and methodological problems are being resolved or minimized also thanks to the possibility of using reference books and tutorials. Cultural limitations are identified in the traditional use of qualitative approaches at the expense of quantitative measurement-based monitoring methods to design and assess ergonomic interventions and train operators. To bridge the gap between the return-to-work rehabilitation and other disciplines, several teaching courses, accompanied by further electrodes and instrumentations development, should be designed at all Bachelor, Master and PhD of Science levels to enhance the best skills available among physiotherapists, occupational health and safety technicians and ergonomists.
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Affiliation(s)
- Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
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66
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Amorim P, Santos BS, Dias P, Silva S, Martins H. Serious Games for Stroke Telerehabilitation of Upper Limb - A Review for Future Research. Int J Telerehabil 2020; 12:65-76. [PMID: 33520096 PMCID: PMC7757643 DOI: 10.5195/ijt.2020.6326] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Maintaining appropriate home rehabilitation programs after stroke, with proper adherence and remote monitoring is a challenging task. Virtual reality (VR) - based serious games could be a strategy used in telerehabilitation (TR) to engage patients in an enjoyable and therapeutic approach. The aim of this review was to analyze the background and quality of clinical research on this matter to guide future research. The review was based on research material obtained from PubMed and Cochrane up to April 2020 using the PRISMA approach. The use of VR serious games has shown evidence of efficacy on upper limb TR after stroke, but the evidence strength is still low due to a limited number of randomized controlled trials (RCT), a small number of participants involved, and heterogeneous samples. Although this is a promising strategy to complement conventional rehabilitation, further investigation is needed to strengthen the evidence of effectiveness and support the dissemination of the developed solutions.
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Affiliation(s)
- Paula Amorim
- Faculty of Health Sciences, University of Beira Interior, Portugal
| | - Beatriz Sousa Santos
- Institute of Electronics and Informatics Engineering of Aveiro.,Department of Electronics Telecommunications and Informatics, University of Aveiro, Portugal
| | - Paulo Dias
- Institute of Electronics and Informatics Engineering of Aveiro.,Department of Electronics Telecommunications and Informatics, University of Aveiro, Portugal
| | - Samuel Silva
- Institute of Electronics and Informatics Engineering of Aveiro
| | - Henrique Martins
- Faculty of Health Sciences, University of Beira Interior, Portugal
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67
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Gouveia e Silva EC, Lange B, Bacha JMR, Pompeu JE. Effects of the Interactive Videogame Nintendo Wii Sports on Upper Limb Motor Function of Individuals with Post-Polio Syndrome: A Randomized Clinical Trial. Games Health J 2020; 9:461-471. [DOI: 10.1089/g4h.2019.0192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Erika Christina Gouveia e Silva
- Neuroscience and Behaviour post graduation program of the Institute of Psicology of the University of Sao Paulo, Sao Paulo, Brazil
| | - Belinda Lange
- College of Nursing & Health Sciences, Flinders University, Adelaide, Australia
| | - Jéssica Maria Ribeiro Bacha
- Rehabilitation Science Post Graduation Program of the Department of Physical Therapy, Speech and Occupational Therapy of the School of Medicine of the University of Sao Paulo, Sao Paulo, Brazil
| | - José Eduardo Pompeu
- Department of Physical Therapy, Speech and Occupational Therapy of the School of Medicine of the University of Sao Paulo, Sao Paulo, Brazil
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68
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Clinical Application of Virtual Reality for Upper Limb Motor Rehabilitation in Stroke: Review of Technologies and Clinical Evidence. J Clin Med 2020; 9:jcm9103369. [PMID: 33096678 PMCID: PMC7590210 DOI: 10.3390/jcm9103369] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 12/17/2022] Open
Abstract
Neurorehabilitation for stroke is important for upper limb motor recovery. Conventional rehabilitation such as occupational therapy has been used, but novel technologies are expected to open new opportunities for better recovery. Virtual reality (VR) is a technology with a set of informatics that provides interactive environments to patients. VR can enhance neuroplasticity and recovery after a stroke by providing more intensive, repetitive, and engaging training due to several advantages, including: (1) tasks with various difficulty levels for rehabilitation, (2) augmented real-time feedback, (3) more immersive and engaging experiences, (4) more standardized rehabilitation, and (5) safe simulation of real-world activities of daily living. In this comprehensive narrative review of the application of VR in motor rehabilitation after stroke, mainly for the upper limbs, we cover: (1) the technologies used in VR rehabilitation, including sensors; (2) the clinical application of and evidence for VR in stroke rehabilitation; and (3) considerations for VR application in stroke rehabilitation. Meta-analyses for upper limb VR rehabilitation after stroke were identified by an online search of Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Library, and KoreaMed. We expect that this review will provide insights into successful clinical applications or trials of VR for motor rehabilitation after stroke.
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69
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Keller J, Štětkářová I, Macri V, Kühn S, Pětioký J, Gualeni S, Simmons СD, Arthanat S, Zilber P. Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury. J Neuroeng Rehabil 2020; 17:127. [PMID: 32919473 PMCID: PMC7488738 DOI: 10.1186/s12984-020-00754-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/02/2020] [Indexed: 01/02/2023] Open
Abstract
Background Individuals with acquired brain injuries (ABI) are in need of neurorehabilitation and neurorepair. Virtual anatomical interactivity (VAI) presents a digital game-like format in which ABI survivors with upper limb paresis use an unaffected limb to control a standard input device and a commonplace computer mouse to control virtual limb movements and tasks in a virtual world. Methods In a prospective cohort study, 35 ambulatory survivors of ABI (25/71% stroke, 10/29% traumatic brain injury) were enrolled. The subjects were divided into three groups: group A received VAI therapy only, group B received VAI and physical/occupational therapy (P/OT), and group C received P/OT only. Motor skills were evaluated by muscle strength (hand key pinch strength, grasp, and three-jaw chuck pinch) and active range of motion (AROM) of the shoulder, elbow, and wrist. Changes were analyzed by ANOVA, ANCOVA, and one-tailed Pearson correlation analysis. MRI data was acquired for group A, and volumetric changes in grey matter were analyzed using voxel-based morphometry (VBM) and correlated with quantified motor skills. Results AROM of the shoulder, elbow, and wrist improved in all three groups. VBM revealed grey matter increases in five brain areas: the tail of the hippocampus, the left caudate, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex. A positive correlation between the grey matter volumes in three cortical regions (motor and premotor and supplementary motor areas) and motor test results (power and AROM) was detected. Conclusions Our findings suggest that the VAI rehabilitation program significantly improved motor function and skills in the affected upper extremities of subjects with acquired brain injuries. Significant increases in grey matter volume in the motor and premotor regions of affected hemisphere and correlations of motor skills and volume in nonaffected brain regions were present, suggesting marked changes in structural brain plasticity. Trial registration The trial “Limitations of motor brain activity – use of virtual reality for simulation of therapeutic interventions” has been registered under reference number ISRCTN11757651.
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Affiliation(s)
- Jiří Keller
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic. .,Department of Neurology, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Ivana Štětkářová
- Department of Neurology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vince Macri
- 3D PreMotorSkill Technologies LLC, Tallahassee, FL, USA
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Jakub Pětioký
- REGIBASE, Prague, Czech Republic.,Rehabilitation Center, Kladruby, Czech Republic
| | - Stefano Gualeni
- Institute of Digital Games, University of Malta, Msida, Malta
| | - С Douglas Simmons
- School of Occupational Therapy, MCPHS University, Manchester, NH, USA
| | - Sajay Arthanat
- Department of Occupational Therapy, University of New Hampshire, Durham, NH, USA
| | - Paul Zilber
- 3D PreMotorSkill Technologies LLC, Tallahassee, FL, USA
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Lim H, Kim WS, Ku J. Transcranial Direct Current Stimulation Effect on Virtual Hand Illusion. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2020; 23:541-549. [PMID: 32478563 DOI: 10.1089/cyber.2019.0741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Virtual reality (VR) is effectively used to evoke the mirror illusion, and transcranial direct current stimulation (tDCS) synergistically facilitates this illusion. This study investigated whether a mirror virtual hand illusion (MVHI) induced by an immersive, first-person-perspective, virtual mirror system could be modulated by tDCS of the primary motor cortex. Fourteen healthy adults (average age 21.86 years ±0.47, seven men and seven women) participated in this study, and they experienced VR with and without tDCS-the tDCS and sham conditions, each of which takes ∼30 minutes-on separate days to allow the washout of the tDCS effect. While experiencing VR, the movements of the virtual left hand reflected the flexion and extension of the real right hand. Subsequently, electroencephalogram was recorded, the magnitude of the proprioceptive shift was measured, and the participants provided responses to a questionnaire regarding hand ownership. A significant difference in the proprioceptive shift was observed between the tDCS and sham conditions. In addition, there was significant suppression of the mu power in Pz, and augmentation of the beta power in the Pz, P4, O1, and O2 channels. The difference in proprioceptive deviation between the two conditions showed significant negative correlation with mu suppression over the left frontal lobe in the tDCS condition. Finally, the question "I felt that the virtual hand was my own hand" received a significantly higher score under the tDCS condition. In short, applying tDCS over the motor cortex facilitates the MVHI by activating the attentional network over the parietal and frontal lobes such that the MVHI induces more proprioceptive drift, which suggests that the combination of VR and tDCS can enhance the immersive effect in VR. This result provides better support for the use of the MVHI paradigm in combination with tDCS for recovery from illnesses such as stroke.
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Affiliation(s)
- Hyunmi Lim
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Republic of Korea
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