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Nunes JD, Vourvopoulos A, Blanco-Mora DA, Jorge C, Fernandes JC, Bermudez i Badia S, Figueiredo P. Brain activation by a VR-based motor imagery and observation task: An fMRI study. PLoS One 2023; 18:e0291528. [PMID: 37756271 PMCID: PMC10529559 DOI: 10.1371/journal.pone.0291528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 08/07/2023] [Indexed: 09/29/2023] Open
Abstract
Training motor imagery (MI) and motor observation (MO) tasks is being intensively exploited to promote brain plasticity in the context of post-stroke rehabilitation strategies. This may benefit from the use of closed-loop neurofeedback, embedded in brain-computer interfaces (BCI's) to provide an alternative non-muscular channel, which may be further augmented through embodied feedback delivered through virtual reality (VR). Here, we used functional magnetic resonance imaging (fMRI) in a group of healthy adults to map brain activation elicited by an ecologically-valid task based on a VR-BCI paradigm called NeuRow, whereby participants perform MI of rowing with the left or right arm (i.e., MI), while observing the corresponding movement of the virtual arm of an avatar (i.e., MO), on the same side, in a first-person perspective. We found that this MI-MO task elicited stronger brain activation when compared with a conventional MI-only task based on the Graz BCI paradigm, as well as to an overt motor execution task. It recruited large portions of the parietal and occipital cortices in addition to the somatomotor and premotor cortices, including the mirror neuron system (MNS), associated with action observation, as well as visual areas related with visual attention and motion processing. Overall, our findings suggest that the virtual representation of the arms in an ecologically-valid MI-MO task engage the brain beyond conventional MI tasks, which we propose could be explored for more effective neurorehabilitation protocols.
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Affiliation(s)
- João D. Nunes
- INESC TEC - Institute for Systems and Computer Engineering, Technology and Science, and Faculty of Engineering, University of Porto, Porto, Portugal
| | - Athanasios Vourvopoulos
- Institute for Systems and Robotics - Lisboa, and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Diego Andrés Blanco-Mora
- Faculdade de Ciências Exatas e da Engenharia, N-LINCS Madeira — ARDITI, Universidade da Madeira, Funchal, Portugal
| | - Carolina Jorge
- Faculdade de Ciências Exatas e da Engenharia, N-LINCS Madeira — ARDITI, Universidade da Madeira, Funchal, Portugal
| | - Jean-Claude Fernandes
- Central Hospital of Funchal, Physical Medicine and Rehabilitation Service, Funchal, Portugal
| | - Sergi Bermudez i Badia
- Faculdade de Ciências Exatas e da Engenharia, N-LINCS Madeira — ARDITI, Universidade da Madeira, Funchal, Portugal
| | - Patrícia Figueiredo
- Institute for Systems and Robotics - Lisboa, and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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García‐Ramos BR, Villarroel R, González‐Mora JL, Revert C, Modroño C. Neurofunctional correlates of a neurorehabilitation system based on eye movements in chronic stroke impairment levels: A pilot study. Brain Behav 2023; 13:e3049. [PMID: 37434341 PMCID: PMC10454340 DOI: 10.1002/brb3.3049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/06/2023] [Accepted: 04/18/2023] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Rehabilitation after a stroke is widely considered fundamental to improve secondary functional impairments. Accessible methods based on motor learning, motor transfer and virtual environments are necessary to help to improve stroke patients' quality of life. OBJECTIVES Continuing the line of our previous studies, this work investigated the effect of our new and innovative game-based virtual reality training using the control of virtual objects with gaze in three chronic stroke survivors. METHODS All participants performed an eye-controlled virtual training task for 4 weeks. Pre- and post-training evaluation were carried out with the Fugl-Meyer Assessment for upper extremity scale as well as performing a tracking task inside an MRI scanner with a MRI-compatible eye-tracker or a joystick. RESULTS Neural results for each participant show the increase of activity in the motor cortex, basal ganglia and cerebellum for both effectors (hand or eye). CONCLUSION These promising results have a potential application as a new game-based neurorehabilitation approach to enhance the motor activity of stroke patients.
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Affiliation(s)
| | - Rebeca Villarroel
- Departamento de Ciencias Médicas BásicasUniversidad de la LagunaTenerifeSpain
| | - José L. González‐Mora
- Departamento de Ciencias Médicas BásicasUniversidad de la LagunaTenerifeSpain
- Instituto de Tecnologías BiomédicasUniversidad de la LagunaTenerifeSpain
- Instituto Universitario de NeurocienciaUniversidad de la LagunaTenerifeSpain
| | - Consuelo Revert
- Departamento de Medicina Física y FarmacologíaUniversidad de la LagunaTenerifeSpain
| | - Cristián Modroño
- Departamento de Ciencias Médicas BásicasUniversidad de la LagunaTenerifeSpain
- Instituto de Tecnologías BiomédicasUniversidad de la LagunaTenerifeSpain
- Instituto Universitario de NeurocienciaUniversidad de la LagunaTenerifeSpain
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Grosprêtre S, Eon P, Marcel-Millet P. Virtual reality does not fool the brain only: spinal excitability changes during virtually simulated falling. J Neurophysiol 2023; 129:368-379. [PMID: 36515975 DOI: 10.1152/jn.00383.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Virtual reality (VR) is known to induce substantial activation of brain's motor regions. It remains unclear to what extent virtual reality can trigger the sensorimotor system, and more particularly, whether it can affect lower nervous levels. In this study, we aimed to assess whether VR simulation of challenging and stressful postural situations (Richie's plank experience) could interfere with spinal excitability of postural muscles in 15 healthy young participants. The H-reflex of the triceps surae muscles was elicited with electrical nerve stimulation while participants were standing and wearing a VR headset. Participants went through several conditions, during which stimulations were evoked: standing still (noVR), standing in VR on the ground (groundVR), standing on the edge of a building (plankVR), and falling from the building (fallingVR). Myoelectrical activity of the triceps surae muscles was measured throughout the experiment. Leg and head movements were also measured by means of accelerometers to account for body oscillations. First, no differences in head rotations and myoelectrical activity were to be noted between conditions. Second, triceps H-reflex (HMAX/MMAX) was not affected from noVR to groundVR and plankVR. The most significant finding was a drastic decrease in H-reflex during falling (-47 ± 26.9% between noVR and fallingVR, P = 0.015). It is suggested that experiencing a postural threat in VR efficiently modulates spinal excitability, despite remaining in a quiet standing posture. This study suggests that simulated falling mimics the neural adjustments observed during actual postural challenge tasks.NEW & NOTEWORTHY The present study showed a modulation of spinal excitability induced by virtual reality (VR). In the standing position, soleus H-reflex was downmodulated during a simulated falling, in the absence of apparent changes in body oscillations. Since the same behavior is usually observed during real falling, it was suggested that the visual cues provided by VR were sufficiently strong to lead the neuromuscular system to mimic the actual modulation.
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Affiliation(s)
- Sidney Grosprêtre
- Laboratory Culture Sport Health and Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comté, Besançon, France
| | - Pauline Eon
- Laboratory Culture Sport Health and Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comté, Besançon, France
| | - Philémon Marcel-Millet
- Laboratory Culture Sport Health and Society (C3S-UR 4660), Sport and Performance Department, University of Franche-Comté, Besançon, France
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Marques-Sule E, Arnal-Gómez A, Buitrago-Jiménez G, Suso-Martí L, Cuenca-Martínez F, Espí-López GV. Effectiveness of Nintendo Wii and Physical Therapy in Functionality, Balance, and Daily Activities in Chronic Stroke Patients. J Am Med Dir Assoc 2021; 22:1073-1080. [PMID: 33639116 DOI: 10.1016/j.jamda.2021.01.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/03/2021] [Accepted: 01/18/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The aim of this study was to assess whether a virtual rehabilitation program using Nintendo Wii added to conventional physical therapy improved functionality, balance, and daily activities in chronic stroke survivors, when compared with conventional physical therapy. DESIGN We undertook a randomized controlled clinical trial. The participants of this study were randomized to 2 groups: (1) conventional physical therapy (CPTG), which included exercises related to functionality, balance, and activities of daily living; and (2) virtual reality with Nintendo Wii (VRWiiG), which included balance training with the Wii Balance Board and upper limb exercises with the Wii Sports package, added to conventional physical therapy. SETTING AND PARTICIPANTS This study was conducted in a university rehabilitation clinic and 29 stroke survivors were admitted. METHODS Both interventions lasted 4 weeks, 2 sessions per week. Assessments were performed at baseline and at the end of the study, including functionality [Timed up and go (TUG)], balance [Tinetti Performance-Oriented Mobility Assessment (POMA)], Berg Balance Scale (BBS), and activities of daily living [Fugl-Meyer Upper Limb Motor Assessment, Barthel Index, Frenchay Activity Index (FAI)]. RESULTS Regarding TUG, POMA, and BBS, the analysis of variance showed significant differences for time and group∗time interaction. Post hoc analysis showed between-group differences (P = .044, d = -0.78; P = .012, d = 1.00; P = .042, d = 0.79, respectively) and within-group differences only in the VRWiiG (P < .001, d = 0.75; P < .001, d = -0.76; P < .001, d = -0.57, respectively). Regarding activities of daily living, post hoc analysis showed within-group differences only in VRWiiG. CONCLUSIONS AND IMPLICATIONS Our study showed promising results in functionality, balance, and activities of daily living when adding virtual reality with Nintendo Wii to conventional physical therapy in chronic stroke survivors. All procedures were approved by the Human Research Ethics Committee of the University of Valencia (H1518177391901). ClinicalTrials.gov database (NLM identifier NCT04144556).
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Affiliation(s)
- Elena Marques-Sule
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain; Physiotherapy in Motion, Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Anna Arnal-Gómez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Gloria Buitrago-Jiménez
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Valencia, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ferran Cuenca-Martínez
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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Mekbib DB, Debeli DK, Zhang L, Fang S, Shao Y, Yang W, Han J, Jiang H, Zhu J, Zhao Z, Cheng R, Ye X, Zhang J, Xu D. A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke. Ann N Y Acad Sci 2021; 1493:75-89. [PMID: 33442915 DOI: 10.1111/nyas.14554] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
Given the rising incidence of stroke, several technology-driven methods for rehabilitation have recently been developed. Virtual reality (VR) is a promising therapeutic technology among them. We recently developed a neuroscientifically grounded VR system to aid recovery of motor function poststroke. The developed system provides unilateral and bilateral upper extremity (UE) training in a fully immersive virtual environment that may stimulate and activate mirror neurons (MNs) in the brain necessary for UE rehabilitation. Twenty-three participants were randomized to a VR group (n = 12) to receive VR intervention (8 h within 2 weeks) plus 8-h occupational therapy (OT) or a control group (n = 11) to receive time-matched OT alone. Treatment effects on motor recovery and cortical reorganization were investigated using the Barthel Index (BI), Fugl-Meyer Upper Extremity (FM-UE), and resting-state fMRI. Both groups significantly improved BI (P < 0.05), reflecting the recovery of UE motor function. The VR group revealed significant improvements on FM-UE scores (P < 0.05) than the control group. Neural activity increased after the intervention, particularly in the brain areas implicating MNs, such as in the primary motor cortex. Overall, results suggested that using a neuroscientifically grounded VR system might offer additional benefits for UE rehabilitation in patients receiving OT.
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Affiliation(s)
- Destaw B Mekbib
- Interdisciplinary Institute of Neuroscience and Technology (ZIINT), College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Dereje Kebebew Debeli
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, China
| | - Li Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shan Fang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yuling Shao
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Wei Yang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jiawei Han
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongjie Jiang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Junming Zhu
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhiyong Zhao
- MOE & Shanghai Key Laboratory of Brain Functional Genomics (East China Normal University), Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
- Shanghai Key Laboratory of Magnetic Resonance, Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Ruidong Cheng
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiangming Ye
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jianmin Zhang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongrong Xu
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York City, New York
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Lim H, Ku J. Superior Facilitation of an Action Observation Network by Congruent Character Movements in Brain-Computer Interface Action-Observation Games. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2020; 24:566-572. [PMID: 33275851 DOI: 10.1089/cyber.2020.0231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Action observation (AO) is a promising strategy for promoting motor function in neural rehabilitation. Recently, brain-computer interface (BCI)-AO game rehabilitation, which combines AO therapy with BCI technology, has been introduced to improve the effectiveness of rehabilitation. This approach can improve motor learning by providing feedback, which can be interactive in an observation task, and the game contents of the BCI-AO game paradigm can affect rehabilitation. In this study, the effects of congruent rather than incongruent feedback in a BCI-AO game on mirror neurons were investigated. Specifically, the mu suppression with congruent and incongruent BCI-AO games was measured in 17 healthy adults. The mu suppression in the central motor cortex was significantly higher with the congruent BCI-AO game than with the incongruent one. In addition, the satisfaction evaluation results were excellent for the congruent case. These results support the fact that providing feedback congruent with the motion of an action video facilitates mirror neuron activity and can offer useful guidelines for the design of BCI-AO games for rehabilitation.
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Affiliation(s)
- Hyunmi Lim
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Korea
| | - Jeonghun Ku
- Department of Biomedical Engineering, School of Medicine, Keimyung University, Daegu, Korea
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Mekbib DB, Zhao Z, Wang J, Xu B, Zhang L, Cheng R, Fang S, Shao Y, Yang W, Han J, Jiang H, Zhu J, Ye X, Zhang J, Xu D. Proactive Motor Functional Recovery Following Immersive Virtual Reality-Based Limb Mirroring Therapy in Patients with Subacute Stroke. Neurotherapeutics 2020; 17:1919-1930. [PMID: 32671578 PMCID: PMC7851292 DOI: 10.1007/s13311-020-00882-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Virtual reality (VR) is considered to be a promising therapeutic technology for the rehabilitation of upper extremities (UEs) post-stroke. Recently, we designed and then implemented a neuroscientifically grounded VR protocol for the rehabilitation of patients with stroke. The system provides unilateral and bilateral limb mirroring exercises in a fully immersive virtual environment that may stimulate and activate the mirror neuron system in the brain to help patients for their rehabilitation. Twelve patients with subacute stroke underwent the newly implemented VR treatment in addition to conventional rehabilitation for 8 consecutive weekdays. The treatment effect on brain reorganization and motor function was investigated using resting-state fMRI (rs-fMRI) and the Fugl-Meyer assessment for Upper Extremity (FM-UE), respectively. Fifteen healthy controls (HCs) also underwent rs-fMRI scanning one time. The study finally obtained usable data from 8 patients and 13 HCs. After the intervention, patients demonstrated significant improvement in their FM-UE scores (p values < 0.042). Voxel-wise functional connectivity (FC) analysis based on the rs-fMRI data found that HCs showed widespread bilateral FC patterns associated with the dominant hemispheric primary motor cortex (M1). However, the FC patterns in patients revealed intra-hemispheric association with the ipsilesional M1 seed and this association became visible in the contra-hemisphere after the intervention. Moreover, the change of FC values between the bilateral M1 was significantly correlated with the changes in FM-UE scores (p values < 0.037). We conclude that unilateral and bilateral limb mirroring exercise in an immersive virtual environment may enhance cortical reorganization and lead to improved motor function.
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Affiliation(s)
- Destaw B Mekbib
- Interdisciplinary Institute of Neuroscience and Technology, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310000, China
| | - Zhiyong Zhao
- Shanghai Key Laboratory of Magnetic Resonance, Institute of Cognitive Neuroscience, East China Normal University, Shanghai, 200064, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, 310027, China
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Jianbao Wang
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, 310029, China
- Department of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology,, Zhejiang University School of Medicine, Hangzhou, 310029, China
| | - Bin Xu
- Key Laboratory of Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, 310029, China
- Interdisciplinary Institute of Neuroscience and Technology, Qiushi Academy for Advanced Studies, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310029, China
| | - Li Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Ruiding Cheng
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Shan Fang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Yuling Shao
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Wei Yang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Jiawei Han
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310029, China
| | - Hongjie Jiang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310029, China
| | - Junming Zhu
- Department of Neurology of the Second Affiliated Hospital, Interdisciplinary Institute of Neuroscience and Technology,, Zhejiang University School of Medicine, Hangzhou, 310029, China.
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310029, China.
| | - Xiangming Ye
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310014, China
| | - Jianmin Zhang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310029, China
| | - Dongrong Xu
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York, NY, 10032, USA.
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Modroño C, Socas R, Hernández-Martín E, Plata-Bello J, Marcano F, Pérez-González JM, González-Mora JL. Neurofunctional correlates of eye to hand motor transfer. Hum Brain Mapp 2020; 41:2656-2668. [PMID: 32166833 PMCID: PMC7294058 DOI: 10.1002/hbm.24969] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 11/09/2022] Open
Abstract
This work investigates the transfer of motor learning from the eye to the hand and its neural correlates by using functional magnetic resonance imaging (fMRI) and a sensorimotor task consisting of the continuous tracking of a virtual target. In pretraining evaluation, all the participants (experimental and control group) performed the tracking task inside an MRI scanner using their right hand and a joystick. After which, the experimental group practiced an eye-controlled version of the task for 5 days using an eye tracking system outside the MRI environment. Post-training evaluation was done 1 week after the first scanning session, where all the participants were scanned again while repeating the manual pretraining task. Behavioral results show that the training in the eye-controlled task produced a better performance not only in the eye-controlled modality (motor learning) but also in the hand-controlled modality (motor transfer). Neural results indicate that eye to hand motor transfer is supported by the motor cortex, the basal ganglia and the cerebellum, which is consistent with previous research focused on other effectors. These results may be of interest in neurorehabilitation to activate the motor systems and help in the recovery of motor functions in stroke or movement disorder patients.
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Affiliation(s)
- Cristián Modroño
- Departamento de Ciencias Médicas Básicas (Unidad Departamental de Fisiología), Facultad de Ciencias de La Salud, Universidad de La Laguna (ULL), Campus de Ofra, San Cristóbal de La Laguna (S/C de Tenerife), Spain.,Instituto Universitario de Neurociencia, San Cristóbal de La Laguna (S/C de Tenerife), Spain
| | - Rosario Socas
- Servicio de Rehabilitación, Hospital Universitario de Canarias, San Cristóbal de La Laguna (S/C de Tenerife), Spain
| | - Estefanía Hernández-Martín
- Departamento de Ciencias Médicas Básicas (Unidad Departamental de Fisiología), Facultad de Ciencias de La Salud, Universidad de La Laguna (ULL), Campus de Ofra, San Cristóbal de La Laguna (S/C de Tenerife), Spain.,Instituto Universitario de Neurociencia, San Cristóbal de La Laguna (S/C de Tenerife), Spain
| | - Julio Plata-Bello
- Departamento de Ciencias Médicas Básicas (Unidad Departamental de Fisiología), Facultad de Ciencias de La Salud, Universidad de La Laguna (ULL), Campus de Ofra, San Cristóbal de La Laguna (S/C de Tenerife), Spain.,Servicio de Neurocirugía, Hospital Universitario de Canarias, San Cristóbal de La Laguna (S/C de Tenerife), Spain.,Instituto Universitario de Neurociencia, San Cristóbal de La Laguna (S/C de Tenerife), Spain
| | - Francisco Marcano
- Departamento de Ciencias Médicas Básicas (Unidad Departamental de Fisiología), Facultad de Ciencias de La Salud, Universidad de La Laguna (ULL), Campus de Ofra, San Cristóbal de La Laguna (S/C de Tenerife), Spain.,Instituto Universitario de Neurociencia, San Cristóbal de La Laguna (S/C de Tenerife), Spain
| | | | - José L González-Mora
- Departamento de Ciencias Médicas Básicas (Unidad Departamental de Fisiología), Facultad de Ciencias de La Salud, Universidad de La Laguna (ULL), Campus de Ofra, San Cristóbal de La Laguna (S/C de Tenerife), Spain.,Instituto Universitario de Neurociencia, San Cristóbal de La Laguna (S/C de Tenerife), Spain
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9
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Brain Computer Interface-Based Action Observation Game Enhances Mu Suppression in Patients with Stroke. ELECTRONICS 2019. [DOI: 10.3390/electronics8121466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Action observation (AO), based on the mirror neuron theory, is a promising strategy to promote motor cortical activation in neurorehabilitation. Brain computer interface (BCI) can detect a user’s intention and provide them with brain state-dependent feedback to assist with patient rehabilitation. We investigated the effects of a combined BCI-AO game on power of mu band attenuation in stroke patients. Nineteen patients with subacute stroke were recruited. A BCI-AO game provided real-time feedback to participants regarding their attention to a flickering action video using steady-state visual-evoked potentials. All participants watched a video of repetitive grasping actions under two conditions: (1) BCI-AO game and (2) conventional AO, in random order. In the BCI-AO game, feedback on participants’ observation scores and observation time was provided. In conventional AO, a non-flickering video and no feedback were provided. The magnitude of mu suppression in the central motor, temporal, parietal, and occipital areas was significantly higher in the BCI-AO game than in the conventional AO. The magnitude of mu suppression was significantly higher in the BCI-AO game than in the conventional AO both in the affected and unaffected hemispheres. These results support the facilitatory effects of the BCI-AO game on mu suppression over conventional AO.
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10
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Modroño C, Bermúdez S, Cameirão M, Pereira F, Paulino T, Marcano F, Hernández-Martín E, Plata-Bello J, Palenzuela N, Núñez-Pádron D, Pérez-González JM, González-Mora JL. Is it necessary to show virtual limbs in action observation neurorehabilitation systems? J Rehabil Assist Technol Eng 2019; 6:2055668319859140. [PMID: 31360538 PMCID: PMC6636217 DOI: 10.1177/2055668319859140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/28/2019] [Indexed: 11/21/2022] Open
Abstract
Introduction Action observation neurorehabilitation systems are usually based on the observation of a virtual limb performing different kinds of actions. In this way, the activity in the frontoparietal Mirror Neuron System is enhanced, which can be helpful to rehabilitate stroke patients. However, the presence of limbs in such systems might not be necessary to produce mirror activity, for example, frontoparietal mirror activity can be produced just by the observation of virtual tool movements. The objective of this work was to explore to what point the presence of a virtual limb impacts the Mirror Neuron System activity in neurorehabilitation systems. Methods The study was conducted by using an action observation neurorehabilitation task during a functional magnetic resonance imaging (fMRI) experiment with healthy volunteers and comparing two action observation conditions that: 1 – included or 2 – did not include a virtual limb. Results It was found that activity in the Mirror Neuron System was similar during both conditions (i.e. virtual limb present or absent). Conclusions These results open up the possibility of using new tasks that do not include virtual limbs in action observation neurorehabilitation environments, which can give more freedom to develop such systems.
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Affiliation(s)
- Cristián Modroño
- Departamento de Ciencias Médicas Básicas, Universidad de La Laguna, Tenerife, España
| | - Sergi Bermúdez
- Madeira Interactive Technologies Institute/LARSyS, Universidade da Madeira, Funchal, Portugal.,Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
| | - Mónica Cameirão
- Madeira Interactive Technologies Institute/LARSyS, Universidade da Madeira, Funchal, Portugal.,Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
| | - Fábio Pereira
- Madeira Interactive Technologies Institute/LARSyS, Universidade da Madeira, Funchal, Portugal.,Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
| | - Teresa Paulino
- Faculdade de Ciências Exatas e da Engenharia, Universidade da Madeira, Funchal, Portugal
| | - Francisco Marcano
- Departamento de Ciencias Médicas Básicas, Universidad de La Laguna, Tenerife, España
| | | | - Julio Plata-Bello
- Departamento de Ciencias Médicas Básicas, Universidad de La Laguna, Tenerife, España
| | - Nereida Palenzuela
- Departamento de Ciencias Médicas Básicas, Universidad de La Laguna, Tenerife, España
| | - Daniel Núñez-Pádron
- Departamento de Ciencias Médicas Básicas, Universidad de La Laguna, Tenerife, España
| | | | - José L González-Mora
- Departamento de Ciencias Médicas Básicas, Universidad de La Laguna, Tenerife, España
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Brihmat N, Tarri M, Quidé Y, Anglio K, Pavard B, Castel-Lacanal E, Gasq D, De Boissezon X, Marque P, Loubinoux I. Action, observation or imitation of virtual hand movement affect differently regions of the mirror neuron system and the default mode network. Brain Imaging Behav 2019; 12:1363-1378. [PMID: 29243119 DOI: 10.1007/s11682-017-9804-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Virtual reality (VR)-based paradigms use visual stimuli that can modulate visuo-motor networks leading to the stimulation of brain circuits. The aims of this study were to compare the changes in blood-oxygenation level dependent (BOLD) signal when watching and imitating moving real (RH) and virtual hands (VH) in 11 healthy participants (HP). No differences were found between the observation of RH or VH making this VR-based experiment a promising tool for rehabilitation protocols. VH-imitation involved more the ventral premotor cortex (vPMC) as part of the mirror neuron system (MNS) compared to execution and VH-observation conditions. The dorsal-anterior Precuneus (da-Pcu) as part of the Precuneus/posterior Cingulate Cortex (Pcu/pCC) complex, a key node of the Default Mode Network (DMN), was also less deactivated and therefore more involved. These results may reflect the dual visuo-motor roles for the vPMC and the implication of the da-Pcu in the reallocation of attentional and neural resources for bimodal task management. The ventral Pcu/pCC was deactivated regardless of the condition confirming its role in self-reference processes. Imitation of VH stimuli can then modulate the activation of specific areas including those belonging to the MNS and the DMN.
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Affiliation(s)
- Nabila Brihmat
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
| | - Mohamed Tarri
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Yann Quidé
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Ketty Anglio
- Department of Rehabilitation and Physical Medicine, Pôle Neurosciences, Centre Hospitalier Universitaire de Toulouse CHU, Toulouse, France
| | - Bernard Pavard
- Informatic Research Institute of Toulouse, IRIT, Université de Toulouse, CNRS, UPS, Toulouse, France
| | - Evelyne Castel-Lacanal
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Rehabilitation and Physical Medicine, Pôle Neurosciences, Centre Hospitalier Universitaire de Toulouse CHU, Toulouse, France
| | - David Gasq
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Rehabilitation and Physical Medicine, Pôle Neurosciences, Centre Hospitalier Universitaire de Toulouse CHU, Toulouse, France
| | - Xavier De Boissezon
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Rehabilitation and Physical Medicine, Pôle Neurosciences, Centre Hospitalier Universitaire de Toulouse CHU, Toulouse, France
| | - Philippe Marque
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.,Department of Rehabilitation and Physical Medicine, Pôle Neurosciences, Centre Hospitalier Universitaire de Toulouse CHU, Toulouse, France
| | - Isabelle Loubinoux
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
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12
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Calabrò RS, Naro A, Russo M, Leo A, De Luca R, Balletta T, Buda A, La Rosa G, Bramanti A, Bramanti P. The role of virtual reality in improving motor performance as revealed by EEG: a randomized clinical trial. J Neuroeng Rehabil 2017; 14:53. [PMID: 28592282 PMCID: PMC5463350 DOI: 10.1186/s12984-017-0268-4] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 06/01/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Many studies have demonstrated the usefulness of repetitive task practice by using robotic-assisted gait training (RAGT) devices, including Lokomat, for the treatment of lower limb paresis. Virtual reality (VR) has proved to be a valuable tool to improve neurorehabilitation training. The aim of our pilot randomized clinical trial was to understand the neurophysiological basis of motor function recovery induced by the association between RAGT (by using Lokomat device) and VR (an animated avatar in a 2D VR) by studying electroencephalographic (EEG) oscillations. METHODS Twenty-four patients suffering from a first unilateral ischemic stroke in the chronic phase were randomized into two groups. One group performed 40 sessions of Lokomat with VR (RAGT + VR), whereas the other group underwent Lokomat without VR (RAGT-VR). The outcomes (clinical, kinematic, and EEG) were measured before and after the robotic intervention. RESULTS As compared to the RAGT-VR group, all the patients of the RAGT + VR group improved in the Rivermead Mobility Index and Tinetti Performance Oriented Mobility Assessment. Moreover, they showed stronger event-related spectral perturbations in the high-γ and β bands and larger fronto-central cortical activations in the affected hemisphere. CONCLUSIONS The robotic-based rehabilitation combined with VR in patients with chronic hemiparesis induced an improvement in gait and balance. EEG data suggest that the use of VR may entrain several brain areas (probably encompassing the mirror neuron system) involved in motor planning and learning, thus leading to an enhanced motor performance. TRIAL REGISTRATION Retrospectively registered in Clinical Trials on 21-11-2016, n. NCT02971371 .
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Affiliation(s)
| | - Antonino Naro
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
| | | | - Antonino Leo
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
| | | | - Tina Balletta
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
| | - Antonio Buda
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Messina, Italy
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13
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Modroño C, Plata-Bello J, Zelaya F, García S, Galván I, Marcano F, Navarrete G, Casanova Ó, Mas M, González-Mora JL. Enhancing sensorimotor activity by controlling virtual objects with gaze. PLoS One 2015; 10:e0121562. [PMID: 25799431 PMCID: PMC4370397 DOI: 10.1371/journal.pone.0121562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/02/2015] [Indexed: 11/18/2022] Open
Abstract
This fMRI work studies brain activity of healthy volunteers who manipulated a virtual object in the context of a digital game by applying two different control methods: using their right hand or using their gaze. The results show extended activations in sensorimotor areas, not only when participants played in the traditional way (using their hand) but also when they used their gaze to control the virtual object. Furthermore, with the exception of the primary motor cortex, regional motor activity was similar regardless of what the effector was: the arm or the eye. These results have a potential application in the field of the neurorehabilitation as a new approach to generate activation of the sensorimotor system to support the recovery of the motor functions.
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Affiliation(s)
- Cristián Modroño
- Department of Physiology, School of Medicine, University of La Laguna, Santa Cruz de Tenerife, Spain
- * E-mail:
| | - Julio Plata-Bello
- Department of Neurosurgery, University Hospital of the Canary Islands, Santa Cruz de Tenerife, Spain
| | - Fernando Zelaya
- Centre for Neuroimaging Sciences, Institute of Psychiatry, King’s College London, London, United Kingdomm
| | - Sofía García
- Department of Physiology, School of Medicine, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Iván Galván
- Department of Physiology, School of Medicine, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Francisco Marcano
- Department of Physiology, School of Medicine, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Gorka Navarrete
- Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago de Chile, Chile
| | - Óscar Casanova
- Department of Physiology, School of Medicine, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Manuel Mas
- Department of Physiology, School of Medicine, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - José Luis González-Mora
- Department of Physiology, School of Medicine, University of La Laguna, Santa Cruz de Tenerife, Spain
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