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Ghani U, Niazi I, Signal N, Kumari N, Amjad I, Haavik H, Taylor D. The influence of multiple cognitive workload levels of an exergame on dorsal attention network connectivity at the source level. Physiol Behav 2024; 284:114628. [PMID: 38977259 DOI: 10.1016/j.physbeh.2024.114628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/16/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024]
Abstract
This study investigates how adding a cognitive task on a balance board (exergame) affects connectivity in the dorsal attention network (DAN) during an exergame task. Healthy young adults performed a soccer ball-moving task by tilting a balance board with their feet while their brain activity was measured using electroencephalography (EEG). In this exergame, the speed of obstacles in front of the goal manipulated the cognitive workload. Higher speed means a higher cognitive workload. The study found significant changes in functional connectivity within DAN regions, specifically in the alpha band. During the shift from easy to medium cognitive task, we observed a significant increase in connectivity (p= 0.0436) between the right inferior temporal (ITG R) and the Left middle temporal (MTG L). During the transition from easy to hard cognitive tasks, strengthened interactions (p= 0.0324) between inferior temporal (ITG) and parsopercularis (pOPPER) were found. This suggests that the proposed balanceboard-based exergame enhances the functionality of specific brain regions, such as ITG and MTG regions, and improves connectivity in the frontal cortex. We also found a correlation between brain activity and performance data, highlighting that increased cognitive workload resulted in decreased performance and heightened frontal alpha activity. These findings align with research suggesting that adding cognitive games to physical activity-based tasks in rehabilitation programs can boost brain activity, resulting in improved decision-making and visual processing skills. This information can help clinicians tailor rehabilitation methods that target specific brain regions.
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Affiliation(s)
- Usman Ghani
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand; Department of health and sciences, Auckland University of Technology (AUT), New Zealand.
| | - Imran Niazi
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand; Department of health and sciences, Auckland University of Technology (AUT), New Zealand; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Nada Signal
- Department of health and sciences, Auckland University of Technology (AUT), New Zealand
| | - Nitika Kumari
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Imran Amjad
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Heidi Haavik
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland, New Zealand
| | - Denise Taylor
- Department of health and sciences, Auckland University of Technology (AUT), New Zealand
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Toh FM, Lam WWT, Cruz Gonzalez P, Fong KNK. Effects of a Wearable-Based Intervention on the Hemiparetic Upper Limb in Persons With Stroke: A Randomized Controlled Trial. Neurorehabil Neural Repair 2024:15459683241283412. [PMID: 39328083 DOI: 10.1177/15459683241283412] [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: 09/28/2024]
Abstract
INTRODUCTION Wearables have emerged as a transformative rehabilitation tool to provide self-directed training in the home. Objective. In this study, we examined the efficacy of a novel wearable device, "Smart Reminder" (SR), to provide home-based telerehabilitation for hemiparetic upper limb (UL) training in persons with stroke. METHODS Forty stroke survivors from community support groups were randomized (stratified by the period after stroke onset and impairment severity) to either the SR group or the sham device group. Participants received either 20 hours of telerehabilitation using the SR device or training with pictorial handouts and a sham device over 4 weeks. In addition, all participants wore a standard accelerometer for 3 hours each day, 5 times a week, outside the prescribed training. Participants were assessed by a masked assessor at baseline, post-intervention (week 4), and follow-up (week 8). The outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test, Motor Activity Log, muscle strength, active range of motion and amount of movement of the UL, and compliance rate of training. RESULTS The SR group improved substantially in their FMA-UE scores after treatment (mean difference = 2.05, P = .036) compared to the sham group. Also, adherence to the training using the SR device was significantly higher, 97%, than the sham group, 82.3% (P = .038). CONCLUSION The 4-week telerehabilitation program using a "SR" device demonstrated potential efficacy in improving FMA-UE scores of the hemiparetic upper limb. However, it did not significantly enhance the performance of the affected limb in daily activities. The trial was registered on ClinicalTrial.gov (URL: http://www.clinicaltrials.gov) with the identifier NCT05877183.
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Affiliation(s)
- Fong Mei Toh
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
- Department of Rehabilitation, Yishun Community Hospital, Singapore, Singapore
| | - Winnie W T Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
- Research Centre for Assistive Technology, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Pablo Cruz Gonzalez
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore, Singapore
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
- Research Centre for Assistive Technology, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
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V H, Pk MPK, Mg R. Extended Reality in Revolutionizing Neurological Disease: A New Era for Chronic Condition Treatment. Cureus 2024; 16:e67633. [PMID: 39314602 PMCID: PMC11419588 DOI: 10.7759/cureus.67633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/20/2024] [Indexed: 09/25/2024] Open
Abstract
Extended reality (XR), which includes virtual reality (VR), augmented reality (AR), and mixed reality (MR), provides promising advancements in managing chronic neurological disorders such as Parkinson's disease (PD), multiple sclerosis (MS), Alzheimer's disease, and stroke. This review examines the impact of XR technologies on neurological care, highlighting their ability to create immersive, interactive environments that enhance rehabilitation through tailored motor and cognitive exercises. XR supports neuroplasticity by providing engaging, contextually relevant exercises and real-time feedback, offering innovative alternatives to traditional methods. The technical issues, clinical validation, and accessibility must be addressed despite the potential benefits. Future developments should focus on refining XR applications, integrating them with complementary technologies, and establishing robust policies to guide their effective and ethical use. XR is poised to revolutionize neurological rehabilitation, promising improved patient outcomes and transforming medical training.
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Affiliation(s)
- Hariharan V
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, IND
| | - Malini Prithiva Kumari Pk
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, IND
| | - Rajanandh Mg
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Chennai, IND
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Huang Q, Lin D, Huang S, Cao Y, Jin Y, Wu B, Fan L, Tu W, Huang L, Jiang S. Brain Functional Topology Alteration in Right Lateral Occipital Cortex Is Associated With Upper Extremity Motor Recovery. Front Neurol 2022; 13:780966. [PMID: 35309550 PMCID: PMC8927543 DOI: 10.3389/fneur.2022.780966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
Stroke is a chief cause of sudden brain damage that severely disrupts the whole-brain network. However, the potential mechanisms of motor recovery after stroke are uncertain and the prognosis of poststroke upper extremity recovery is still a challenge. This study investigated the global and local topological properties of the brain functional connectome in patients with subacute ischemic stroke and their associations with the clinical measurements. A total of 57 patients, consisting of 29 left-sided and 28 right-sided stroke patients, and 32 age- and gender-matched healthy controls (HCs) were recruited to undergo a resting-state functional magnetic resonance imaging (rs-fMRI) study; patients were also clinically evaluated with the Upper Extremity Fugl-Meyer Assessment (FMA_UE). The assessment was repeated at 15 weeks to assess upper extremity functional recovery for the patient remaining in the study (12 left- 20 right-sided stroke patients). Global graph topological disruption indices of stroke patients were significantly decreased compared with HCs but these indices were not significantly associated with FMA_UE. In addition, local brain network structure of stroke patients was altered, and the altered regions were dependent on the stroke site. Significant associations between local degree and motor performance and its recovery were observed in the right lateral occipital cortex (R LOC) in the right-sided stroke patients. Our findings suggested that brain functional topologies alterations in R LOC are promising as prognostic biomarkers for right-sided subacute stroke. This cortical area might be a potential target to be further validated for non-invasive brain stimulation treatment to improve poststroke upper extremity recovery.
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Affiliation(s)
- Qianqian Huang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Dinghong Lin
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Shishi Huang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yungang Cao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yun Jin
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Bo Wu
- Department of Information, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Linyu Fan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenzhan Tu
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
| | - Lejian Huang
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- *Correspondence: Lejian Huang
| | - Songhe Jiang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Intelligent Rehabilitation Research Center, China-USA Institute for Acupuncture and Rehabilitation, Wenzhou Medical University, Wenzhou, China
- Songhe Jiang
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Fluet G, Qiu Q, Patel J, Mont A, Cronce A, Yarossi M, Merians A, Adamovich S. Virtual Rehabilitation of the Paretic Hand and Arm in Persons With Stroke: Translation From Laboratory to Rehabilitation Centers and the Patient's Home. Front Neurol 2021; 12:623261. [PMID: 33584529 PMCID: PMC7876436 DOI: 10.3389/fneur.2021.623261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/04/2021] [Indexed: 12/18/2022] Open
Abstract
The anatomical and physiological heterogeneity of strokes and persons with stroke, along with the complexity of normal upper extremity movement make the possibility that any single treatment approach will become the definitive solution for all persons with upper extremity hemiparesis due to stroke unlikely. This situation and the non-inferiority level outcomes identified by many studies of virtual rehabilitation are considered by some to indicate that it is time to consider other treatment modalities. Our group, among others, has endeavored to build on the initial positive outcomes in studies of virtual rehabilitation by identifying patient populations, treatment settings and training schedules that will best leverage virtual rehabilitation's strengths. We feel that data generated by our lab and others suggest that (1) persons with stroke may adapt to virtual rehabilitation of hand function differently based on their level of impairment and stage of recovery and (2) that less expensive, more accessible home based equipment seems to be an effective alternative to clinic based treatment that justifies continued optimism and study.
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Affiliation(s)
- Gerard Fluet
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Qinyin Qiu
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Jigna Patel
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Ashley Mont
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Amanda Cronce
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Mathew Yarossi
- Department of Physical Therapy, Movement and Rehabilitation Science, Northeastern University, Boston, MA, United States
| | - Alma Merians
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Sergei Adamovich
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- New Jersey Institute of Technology, Newark, NJ, United States
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Hsieh YW, Lee MT, Lin YH, Chuang LL, Chen CC, Cheng CH. Motor Cortical Activity during Observing a Video of Real Hand Movements versus Computer Graphic Hand Movements: An MEG Study. Brain Sci 2020; 11:E6. [PMID: 33374670 PMCID: PMC7822490 DOI: 10.3390/brainsci11010006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
Abstract
Both action observation (AO) and virtual reality (VR) provide visual stimuli to trigger brain activations during the observation of actions. However, the mechanism of observing video movements performed by a person's real hand versus that performed by a computer graphic hand remains uncertain. We aimed to investigate the differences in observing the video of real versus computer graphic hand movements on primary motor cortex (M1) activation by magnetoencephalography. Twenty healthy adults completed 3 experimental conditions: the resting state, the video of real hand movements (VRH), and the video of computer graphic hand movements (CGH) conditions with the intermittent electrical stimuli simultaneously applied to the median nerve by an electrical stimulator. The beta oscillatory activity (~20 Hz) in the M1 was collected, lower values indicating greater activations. To compare the beta oscillatory activities among the 3 conditions, the Friedman test with Bonferroni correction (p-value < 0.017 indicating statistical significance) were used. The beta oscillatory activities of the VRH and CGH conditions were significantly lower than that of the resting state condition. No significant difference in the beta oscillatory activity was found between the VRH and CGH conditions. Observing hand movements in a video performed by a real hand and those by a computer graphic hand evoked comparable M1 activations in healthy adults. This study provides some neuroimaging support for the use of AO and VR in rehabilitation, but no differential activations were found.
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Affiliation(s)
- Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou 33305, Taiwan; (L.-L.C.); (C.-C.C.)
| | - Meng-Ta Lee
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Yu-Hsuan Lin
- Department of Physical Medicine and Rehabilitation, Cathay General Hospital, Taipei 10630, Taiwan;
| | - Li-Ling Chuang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou 33305, Taiwan; (L.-L.C.); (C.-C.C.)
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou 33305, Taiwan; (L.-L.C.); (C.-C.C.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chia-Hsiung Cheng
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou 33305, Taiwan
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Goldenkoff ER, McGregor HR, Mergos J, Gholizadeh P, Bridenstine J, Brown MJN, Vesia M. Reversal of Visual Feedback Modulates Somatosensory Plasticity. Neuroscience 2020; 452:335-344. [PMID: 33220339 DOI: 10.1016/j.neuroscience.2020.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/22/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022]
Abstract
Reversed visual feedback during unimanual training increases transfer of skills to the opposite untrained hand and modulates plasticity in motor areas of the brain. However, it is unclear if unimanual training with reversed visual feedback also affects somatosensory areas. Here we manipulated visual input during unimanual training using left-right optical reversing spectacles and tested whether unimanual training with reversed vision modulates somatosensory cortical excitability to facilitate motor performance. Thirty participants practiced a unimanual ball-rotation task using the right hand with either left-right reversed vision (incongruent visual and somatosensory feedback) or direct vision (congruent feedback) of the moving hand. We estimated cortical excitability in primary somatosensory cortex (S1) before and after unimanual training by measuring somatosensory evoked potentials (SEPs). This was done by electrically stimulating the median nerve in the wrist while participants rested, and recording potentials over both hemispheres using electroencephalography. Performance of the ball-rotation task improved for both the right (trained) and left (untrained) hand after training across both direct and reversed vision conditions. Participants with direct vision of the right hand during training showed SEPs amplitudes increased bilaterally. In contrast, participants in the reversed visual condition showed attenuated SEPs following training. The results suggest that cortical suppression of S1 activity supports skilled motor performance after unimanual training with reversed vision, presumably by sensory gating of afferent signals from the movement. This finding provides insight into the mechanisms by which visual input interacts with the sensorimotor system and induces neuroplastic changes in S1 to support skilled motor performance.
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Affiliation(s)
- Elana R Goldenkoff
- School of Kinesiology, Brain Behavior Lab, University of Michigan, Ann Arbor, USA
| | - Heather R McGregor
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
| | - Joshua Mergos
- School of Kinesiology, Intraoperative Neuromonitoring Program, University of Michigan, Ann Arbor, USA
| | - Puyan Gholizadeh
- School of Kinesiology, Brain Behavior Lab, University of Michigan, Ann Arbor, USA; School of Kinesiology, Intraoperative Neuromonitoring Program, University of Michigan, Ann Arbor, USA
| | - John Bridenstine
- School of Kinesiology, Brain Behavior Lab, University of Michigan, Ann Arbor, USA; School of Kinesiology, Intraoperative Neuromonitoring Program, University of Michigan, Ann Arbor, USA
| | - Matt J N Brown
- Department of Kinesiology, California State University Sacramento, Sacramento, USA
| | - Michael Vesia
- School of Kinesiology, Brain Behavior Lab, University of Michigan, Ann Arbor, USA.
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Yang Z, van Beijnum BJF, Li B, Yan S, Veltink PH. Estimation of Relative Hand-Finger Orientation Using a Small IMU Configuration. SENSORS (BASEL, SWITZERLAND) 2020; 20:s20144008. [PMID: 32707635 PMCID: PMC7412023 DOI: 10.3390/s20144008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 06/11/2023]
Abstract
Relative orientation estimation between the hand and its fingers is important in many applications, such as virtual reality (VR), augmented reality (AR) and rehabilitation. It is still quite a big challenge to do the estimation by only exploiting inertial measurement units (IMUs) because of the integration drift that occurs in most approaches. When the hand is functionally used, there are many instances in which hand and finger tips move together, experiencing almost the same angular velocities, and in some of these cases, almost the same accelerations are measured in different 3D coordinate systems. Therefore, we hypothesize that relative orientations between the hand and the finger tips can be adequately estimated using 3D IMUs during such designated events (DEs) and in between these events. We fused this extra information from the DEs and IMU data with an extended Kalman filter (EKF). Our results show that errors in relative orientation can be smaller than five degrees if DEs are constantly present and the linear and angular movements of the whole hand are adequately rich. When the DEs are partially available in a functional water-drinking task, the orientation error is smaller than 10 degrees.
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Affiliation(s)
- Zhicheng Yang
- Department of Biomedical Signals Systems, Technical Medical Centre, University of Twente, 7500 AE Enschede, The Netherlands; (B.-J.F.v.B.); (P.H.V.)
- School of Marine Science and Technology, Northwestern Polytechnical University, Xi’an 710072, China; (B.L.); (S.Y.)
| | - Bert-Jan F. van Beijnum
- Department of Biomedical Signals Systems, Technical Medical Centre, University of Twente, 7500 AE Enschede, The Netherlands; (B.-J.F.v.B.); (P.H.V.)
| | - Bin Li
- School of Marine Science and Technology, Northwestern Polytechnical University, Xi’an 710072, China; (B.L.); (S.Y.)
| | - Shenggang Yan
- School of Marine Science and Technology, Northwestern Polytechnical University, Xi’an 710072, China; (B.L.); (S.Y.)
| | - Peter H. Veltink
- Department of Biomedical Signals Systems, Technical Medical Centre, University of Twente, 7500 AE Enschede, The Netherlands; (B.-J.F.v.B.); (P.H.V.)
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Mann J. The medical avatar and its role in neurorehabilitation and neuroplasticity: A review. NeuroRehabilitation 2020; 46:467-482. [PMID: 32508340 DOI: 10.3233/nre-203063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND One of the most interesting emerging medical devices is the medical avatar - a digital representation of the patient that can be used toward myriad ends, the full potential of which remains to be explored. Medical avatars have been instantiated as telemedical tools used to establish a representation of the patient in tele-space, upon which data about the patient's health can be represented and goals and progress can be visually tracked. Manipulation of the medical avatar has also been explored as a means of increasing motivation and inducing neural plasticity. OBJECTIVE The article reviews the literature on body representation, simulation, and action-observation and explores how these components of neurorehabilitation are engaged by an avatar-based self-representation. METHODS Through a review of the literature on body representation, simulation, and action-observation and a review of how these components of neurorehabilitation can be engaged and manipulated with an avatar, the neuroplastic potential of the medical avatar is explored. Literature on the use of the medical avatar for neurorehabilitation is also reviewed. RESULTS This review demonstrates that the medical avatar has vast potentialities in neurorehabilitation and that further research on its use and effect is needed.
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Affiliation(s)
- Jessie Mann
- Virginia Tech Carilion Fralin Biomedical Research Institute, 2 Riverside Cr., Roanoke, VA 24016, USA. Tel.: + 1-201-423-3434; E-mail:
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Laffont I, Froger J, Jourdan C, Bakhti K, van Dokkum LEH, Gouaich A, Bonnin HY, Armingaud P, Jaussent A, Picot MC, Le Bars E, Dupeyron A, Arquizan C, Gelis A, Mottet D. Rehabilitation of the upper arm early after stroke: Video games versus conventional rehabilitation. A randomized controlled trial. Ann Phys Rehabil Med 2019; 63:173-180. [PMID: 31830535 DOI: 10.1016/j.rehab.2019.10.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few rehabilitation methods have proven their efficacy in increasing sensori-motor recovery and/or function of the upper limb (UL) after stroke. Video games (VGs) are promising tools in this indication. OBJECTIVE To compare UL rehabilitation by using VGs and conventional rehabilitation (CR) in patients with sub-acute stroke. DESIGN Single-blind, multicentric trial, with central randomization and stratification by center. SETTING Physical and rehabilitation medicine departments of 2 university hospitals. PARTICIPANTS Adults within 3 months after a first vascular cerebral accident, with UL Fugl Meyer Score (UL-FMS)<30/66 and without major cognitive impairment. INTERVENTION A 45-min additional session of conventional occupational therapy (OT) or a VG-based OT session as add-on therapy to usual rehabilitation programs, 5 days/week for 6 weeks. MAIN OUTCOME MEASURES Primary outcome: UL-FMS. Secondary outcome: Box and Block Test (BBT), Wolf Motor Function test (WMFT), Motor Activity Log (MAL), Barthel Index and quality of life (SF-36). RESULTS We included 51 patients (20 women) at a mean (SD) of 27.2 (19.4) days post-stroke (mean age 58 years [range 24-83]), 26 in the CR group and 25 in the VG group (23 in each group at 6-month follow-up). The mean duration of the additional rehabilitation session was similar in both groups: 29.3 (4.3) vs 28.0 (4.4) min in CR and VG groups. Shoulder pain occurred in 4 patients in the VG group versus 7 in the CR group. At day 45, gain in UL-FMS did not significantly differ between the groups (CR mean 17.8 [14.6] vs VG 24.1 [14.8]; P=0.10), whereas gain in BBT was doubled in the VG group (CR 7.4 [12.2] vs VG 15.7 [16.3]; P=0.02). At 6-month follow-up, the study was inconclusive about between-group differences in UL-FMS, BBT and other criteria. Post-hoc analysis showed that gains in UL-FMS or BBT were significantly higher in the VG than CR group for patients included within 30 days post-stroke. CONCLUSION In general, we cannot conclude that video gaming and conventional OT led to different long-term sensorimotor recovery of the UL after sub-acute stroke. However, when applied within the first month after stroke, video gaming was more efficient than conventional rehabilitation on both sensorimotor recovery and gross grasping function. TRIAL REGISTRATION ClinicalTrials.gov (NCT01554449).
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Affiliation(s)
- Isabelle Laffont
- PRM Department, University of Montpellier, Hôpital Lapeyronie, Montpellier University Hospital, 191, boulevard du Doyen-Gaston-Giraud, 34291 Montpellier cedex 05, France; IFRH, Euromov, University of Montpellier, Montpellier, France.
| | - Jerome Froger
- IFRH, Euromov, University of Montpellier, Montpellier, France; PRM Department, University of Montpellier, Nimes University Hospital, Grau du Roi, France
| | - Claire Jourdan
- PRM Department, University of Montpellier, Hôpital Lapeyronie, Montpellier University Hospital, 191, boulevard du Doyen-Gaston-Giraud, 34291 Montpellier cedex 05, France; IFRH, Euromov, University of Montpellier, Montpellier, France
| | - Karima Bakhti
- PRM Department, University of Montpellier, Hôpital Lapeyronie, Montpellier University Hospital, 191, boulevard du Doyen-Gaston-Giraud, 34291 Montpellier cedex 05, France; IFRH, Euromov, University of Montpellier, Montpellier, France
| | - Liesjet E H van Dokkum
- Neuro Imagery Department, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | | | - Huei Yune Bonnin
- PRM Department, University of Montpellier, Nimes University Hospital, Grau du Roi, France
| | - Philippe Armingaud
- PRM Department, University of Montpellier, Nimes University Hospital, Grau du Roi, France
| | - Audrey Jaussent
- Inserm, Clinical Research and Epidemiology Unit, University of Montpellier, Montpellier, France
| | - Marie Christine Picot
- Inserm, Clinical Research and Epidemiology Unit, University of Montpellier, Montpellier, France
| | - Emmanuelle Le Bars
- CNRS, L2C, University of Montpellier, Montpellier, France; Neuro Imagery Department, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Arnaud Dupeyron
- IFRH, Euromov, University of Montpellier, Montpellier, France; PRM Department, University of Montpellier, Nimes University Hospital, Grau du Roi, France
| | - Caroline Arquizan
- Neurology Department, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Anthony Gelis
- PRM Department, Propara Center, Montpellier, France; Epsylon, Paul Valery University, Montpellier, France
| | - Denis Mottet
- IFRH, Euromov, University of Montpellier, Montpellier, France
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11
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Ögün MN, Kurul R, Yaşar MF, Turkoglu SA, Avci Ş, Yildiz N. Effect of Leap Motion-based 3D Immersive Virtual Reality Usage on Upper Extremity Function in Ischemic Stroke Patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:681-688. [PMID: 31664343 DOI: 10.1590/0004-282x20190129] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/07/2019] [Indexed: 12/31/2022]
Abstract
Immersive virtual reality (VR) is a technology that provides a more realistic environmental design and object tracking than ordinary VR. The aim of this study was to investigate the effectiveness of immersive VR on upper extremity function in patients with ischemic stroke. Sixty-five patients with ischemic stroke were included in this randomized, controlled, double-blind study. Patients were randomly divided into VR (n = 33) and control (n = 32) groups. The VR group received 60 minutes of the upper extremity immersive VR rehabilitation program and the control group received 45 minutes of conventional therapy and 15 minutes of a sham VR program. Rehabilitation consisted of 18 sessions of therapy, three days per week, for six weeks. The outcome measures were the Action Research Arm Test (ARAT), Functional Independence Measure (FIM), Fugl-Meyer Upper Extremity Scale (FMUE) and Performance Assessment of Self-Care Skills (PASS). In both the VR and control groups all parameters except the PASS improved over time. However independent t-test results showed that all of the FMUE, ARAT, FIM and PASS scores were significantly higher in the VR group compared with the control (p < 0.05). The minimal clinically important difference (MCID) scores of the FMUE and ARAT were higher than the cut-off MCID scores described in the literature in the VR group, whereas the FIM scores were below the cut-off MCID scores. All scores in the control group were below the cut-off scores. Immersive VR rehabilitation appeared to be effective in improving upper extremity function and self-care skills, but it did not improve functional independence.
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Affiliation(s)
- Muhammed Nur Ögün
- Bolu Abant Izzet Baysal Universitesi; Nöroloji Anabilim Dalı, Bolu, Türkiye
| | - Ramazan Kurul
- Bolu Abant Izzet Baysal Universitesi; Sağlık Bilimleri Fakültesi, Fizik Tedavi ve Rehabilitasyon Yüksekokulu, Bolu, Türkiye
| | - Mustafa Fatih Yaşar
- Bolu Abant Izzet Baysal Universitesi; Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, Bolu, Türkiye
| | | | - Şebnem Avci
- Bolu Abant Izzet Baysal Universitesi; Sağlık Bilimleri Fakültesi, Fizik Tedavi ve Rehabilitasyon Yüksekokulu, Bolu, Türkiye
| | - Nebil Yildiz
- Bolu Abant Izzet Baysal Universitesi; Nöroloji Anabilim Dalı, Bolu, Türkiye
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12
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Levac DE, Huber ME, Sternad D. Learning and transfer of complex motor skills in virtual reality: a perspective review. J Neuroeng Rehabil 2019; 16:121. [PMID: 31627755 PMCID: PMC6798491 DOI: 10.1186/s12984-019-0587-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 09/05/2019] [Indexed: 12/11/2022] Open
Abstract
The development of more effective rehabilitative interventions requires a better understanding of how humans learn and transfer motor skills in real-world contexts. Presently, clinicians design interventions to promote skill learning by relying on evidence from experimental paradigms involving simple tasks, such as reaching for a target. While these tasks facilitate stringent hypothesis testing in laboratory settings, the results may not shed light on performance of more complex real-world skills. In this perspective, we argue that virtual environments (VEs) are flexible, novel platforms to evaluate learning and transfer of complex skills without sacrificing experimental control. Specifically, VEs use models of real-life tasks that afford controlled experimental manipulations to measure and guide behavior with a precision that exceeds the capabilities of physical environments. This paper reviews recent insights from VE paradigms on motor learning into two pressing challenges in rehabilitation research: 1) Which training strategies in VEs promote complex skill learning? and 2) How can transfer of learning from virtual to real environments be enhanced? Defining complex skills by having nested redundancies, we outline findings on the role of movement variability in complex skill acquisition and discuss how VEs can provide novel forms of guidance to enhance learning. We review the evidence for skill transfer from virtual to real environments in typically developing and neurologically-impaired populations with a view to understanding how differences in sensory-motor information may influence learning strategies. We provide actionable suggestions for practicing clinicians and outline broad areas where more research is required. Finally, we conclude that VEs present distinctive experimental platforms to understand complex skill learning that should enable transfer from therapeutic practice to the real world.
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Affiliation(s)
- Danielle E Levac
- Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, 407c Robinson Hall, 360 Huntington Ave, Boston, MA, 02115, USA.
| | - Meghan E Huber
- Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Ave, Bldg 3, Rm 143, Cambridge, MA, 02139, USA
| | - Dagmar Sternad
- Biology, Electrical and Computer Engineering, and Physics, Northeastern University, 503 Richards Hall, 360 Huntington Avenue, Boston, MA, 02118, USA
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13
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Johnson JF, Belyk M, Schwartze M, Pinheiro AP, Kotz SA. The role of the cerebellum in adaptation: ALE meta-analyses on sensory feedback error. Hum Brain Mapp 2019; 40:3966-3981. [PMID: 31155815 PMCID: PMC6771970 DOI: 10.1002/hbm.24681] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/01/2019] [Accepted: 05/09/2019] [Indexed: 02/04/2023] Open
Abstract
It is widely accepted that unexpected sensory consequences of self‐action engage the cerebellum. However, we currently lack consensus on where in the cerebellum, we find fine‐grained differentiation to unexpected sensory feedback. This may result from methodological diversity in task‐based human neuroimaging studies that experimentally alter the quality of self‐generated sensory feedback. We gathered existing studies that manipulated sensory feedback using a variety of methodological approaches and performed activation likelihood estimation (ALE) meta‐analyses. Only half of these studies reported cerebellar activation with considerable variation in spatial location. Consequently, ALE analyses did not reveal significantly increased likelihood of activation in the cerebellum despite the broad scientific consensus of the cerebellum's involvement. In light of the high degree of methodological variability in published studies, we tested for statistical dependence between methodological factors that varied across the published studies. Experiments that elicited an adaptive response to continuously altered sensory feedback more frequently reported activation in the cerebellum than those experiments that did not induce adaptation. These findings may explain the surprisingly low rate of significant cerebellar activation across brain imaging studies investigating unexpected sensory feedback. Furthermore, limitations of functional magnetic resonance imaging to probe the cerebellum could play a role as climbing fiber activity associated with feedback error processing may not be captured by it. We provide methodological recommendations that may guide future studies.
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Affiliation(s)
| | - Michel Belyk
- Maastricht University, Maastricht, the Netherlands.,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | | | - Ana P Pinheiro
- Faculdade de Psicologia - Universidade de Lisboa, Lisboa, Portugal
| | - Sonja A Kotz
- Maastricht University, Maastricht, the Netherlands.,Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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14
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Ramos AA, Hørning EC, Wilms IL. Simulated prism exposure in immersed virtual reality produces larger prismatic after-effects than standard prism exposure in healthy subjects. PLoS One 2019; 14:e0217074. [PMID: 31125360 PMCID: PMC6534293 DOI: 10.1371/journal.pone.0217074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/03/2019] [Indexed: 12/04/2022] Open
Abstract
Previous studies have shown that the size of the leftward bias after exposure to rightward prism-deviation (the prismatic after-effect) depends on the degree of rightward prism-deviation as well as the type of visual feedback receives during exposure to prism-deviation. In this study, we tested if it was possible to obtain a leftward bias in pointing precision using two different methods of creating diverted visual input by simulating a rightward prism diversion of visual input in immersive virtual reality. We compared the results to the leftward bias in pointing precision obtained after exposure to standard prism goggles deviating visual input 10 degrees to the right. Twenty healthy participants were subjected to one session of standard prism adaptation therapy under three different conditions of deviated visual input: 1) created by imitating a 10 degree leftward rotation of the head (VRR), 2) created by imitating a 2D leftward horizontal displacement of 10 degrees (VRS) and 3) a control condition using real right-deviating prisms (PCP). The study showed that the simulated prisms in the VRR and VRS conditions produced deviations in pointing precision of a similar size. However, exposure to the VRS and VRR conditions both produced larger prismatic after-effects than the exposure to real prism goggles. This research is important for the development and use of virtual reality systems in the rehabilitation of neglect after brain injury as it emphasizes that the adjustment to deviated visual input may be affected positively by the use of immersive virtual reality technology.
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Affiliation(s)
| | - Emil C. Hørning
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Inge L. Wilms
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
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15
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Abstract
OBJECTIVE This review evaluates the use of virtual reality (VR) tools in cognitive rehabilitation of stroke-affected individuals. METHODS Studies performed between 2010 and 2017 that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms "VR," "rehabilitation," and "stroke." RESULTS Stroke patients experienced significant improvement in many cognitive domains (such as executive and visual-spatial abilities and speech, attention, and memory skills) after the use of VR training. CONCLUSIONS Rehabilitation using new VR tools could positively affect stroke patient cognitive outcomes by boosting motivation and participation.
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16
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Maggio MG, Maresca G, De Luca R, Stagnitti MC, Porcari B, Ferrera MC, Galletti F, Casella C, Manuli A, Calabrò RS. The Growing Use of Virtual Reality in Cognitive Rehabilitation: Fact, Fake or Vision? A Scoping Review. J Natl Med Assoc 2019; 111:457-463. [PMID: 30739728 DOI: 10.1016/j.jnma.2019.01.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This review aims to evaluate the role of Virtual Reality (VR) in cognitive rehabilitation of different neurological diseases, and the accessibility to healthcare systems providing this type of treatment. METHOD OF RESEARCH Studies performed between 2003 and 2017 and fulfilling the selected criteria were found on PubMed, Scopus, Cochrane and Web of Sciences databases. The search combined the terms VR rehabilitation with different neurological disease. RESULTS Our findings showed that neurological patients performed significant improvement in many cognitive domains (executive and visual-spatial abilities; speech, attention and memory skills) following the use of VR training. CONCLUSIONS This review supports the idea that rehabilitation through new VR tools could positively affect neurological patients' outcomes, by boosting motivation and participation so to get a better response to treatment. In particular, VR can be used to enhance the effects of conventional therapies, promoting longer training sessions and a reduction in overall hospitalization time.
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Affiliation(s)
| | | | | | | | - Bruno Porcari
- IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
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17
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Alves SS, Ocamoto GN, de Camargo PS, Santos ATS, Terra AMSV. Effects of virtual reality and motor imagery techniques using Fugl Meyer Assessment scale in post-stroke patients. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.11.587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Suélen Santos Alves
- Physiotherapist, Neurofunctional Physical Therapy Laboratory, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Gabriela Nagai Ocamoto
- Physiotherapist, Neurofunctional Physical Therapy Laboratory, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Patrícia Silva de Camargo
- Physiotherapist, Neurofunctional Physical Therapy Laboratory, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - Adriana Teresa Silva Santos
- Teacher, Neurofunctional Physical Therapy Laboratory, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
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18
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Virtual Reality for Upper Limb Rehabilitation in Subacute and Chronic Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 99:834-842.e4. [PMID: 29453980 DOI: 10.1016/j.apmr.2018.01.023] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of reinforced feedback in virtual environment (RFVE) treatment combined with conventional rehabilitation (CR) in comparison with CR alone, and to study whether changes are related to stroke etiology (ie, ischemic, hemorrhagic). DESIGN Randomized controlled trial. SETTING Hospital facility for intensive rehabilitation. PARTICIPANTS Patients (N=136) within 1 year from onset of a single stroke (ischemic: n=78, hemorrhagic: n=58). INTERVENTIONS The experimental treatment was based on the combination of RFVE with CR, whereas control treatment was based on the same amount of CR. Both treatments lasted 2 hours daily, 5d/wk, for 4 weeks. MAIN OUTCOME MEASURES Fugl-Meyer upper extremity scale (F-M UE) (primary outcome), FIM, National Institutes of Health Stroke Scale (NIHSS), and Edmonton Symptom Assessment Scale (ESAS) (secondary outcomes). Kinematic parameters of requested movements included duration (time), mean linear velocity (speed), and number of submovements (peak) (secondary outcomes). RESULTS Patients were randomized in 2 groups (RFVE with CR: n=68, CR: n=68) and stratified by stroke etiology (ischemic or hemorrhagic). Both groups improved after treatment, but the experimental group had better results than the control group (Mann-Whitney U test) for F-M UE (P<.001), FIM (P<.001), NIHSS (P≤.014), ESAS (P≤.022), time (P<.001), speed (P<.001), and peak (P<.001). Stroke etiology did not have significant effects on patient outcomes. CONCLUSIONS The RFVE therapy combined with CR treatment promotes better outcomes for upper limb than the same amount of CR, regardless of stroke etiology.
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19
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Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015. OBJECTIVES Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists. SELECTION CRITERIA Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information. MAIN RESULTS We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard-care approach. PRIMARY OUTCOME results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) -0.05 to 0.20, 22 studies, 1038 participants, low-quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low-quality evidence). SECONDARY OUTCOMES when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty-three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild. AUTHORS' CONCLUSIONS We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.
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Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | - Belinda Lange
- Flinders UniversitySchool of Health Sciences, Discipline of PhysiotherapyAdelaideAustralia
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
| | - Judith E Deutsch
- Rutgers UniversityDepartment of Rehabilitation and Movement ScienceNewarkNew JerseyUSA
| | - Gustavo Saposnik
- University of TorontoDepartment of Medicine (Neurology), St Michael's HospitalTorontoCanadaM5C 1R6
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareLevel 1, C Block, Repatriation General Hospital, Daws Road, Daw ParkAdelaideSouth AustraliaAustralia5041
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20
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Archer DB, Kang N, Misra G, Marble S, Patten C, Coombes SA. Visual feedback alters force control and functional activity in the visuomotor network after stroke. NEUROIMAGE-CLINICAL 2017; 17:505-517. [PMID: 29201639 PMCID: PMC5700823 DOI: 10.1016/j.nicl.2017.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 11/09/2017] [Accepted: 11/13/2017] [Indexed: 11/27/2022]
Abstract
Modulating visual feedback may be a viable option to improve motor function after stroke, but the neurophysiological basis for this improvement is not clear. Visual gain can be manipulated by increasing or decreasing the spatial amplitude of an error signal. Here, we combined a unilateral visually guided grip force task with functional MRI to understand how changes in the gain of visual feedback alter brain activity in the chronic phase after stroke. Analyses focused on brain activation when force was produced by the most impaired hand of the stroke group as compared to the non-dominant hand of the control group. Our experiment produced three novel results. First, gain-related improvements in force control were associated with an increase in activity in many regions within the visuomotor network in both the stroke and control groups. These regions include the extrastriate visual cortex, inferior parietal lobule, ventral premotor cortex, cerebellum, and supplementary motor area. Second, the stroke group showed gain-related increases in activity in additional regions of lobules VI and VIIb of the ipsilateral cerebellum. Third, relative to the control group, the stroke group showed increased activity in the ipsilateral primary motor cortex, and activity in this region did not vary as a function of visual feedback gain. The visuomotor network, cerebellum, and ipsilateral primary motor cortex have each been targeted in rehabilitation interventions after stroke. Our observations provide new insight into the role these regions play in processing visual gain during a precisely controlled visuomotor task in the chronic phase after stroke.
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Affiliation(s)
- Derek B Archer
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Nyeonju Kang
- Division of Sport Science, Incheon National University, Incheon, South Korea
| | - Gaurav Misra
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Shannon Marble
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Carolynn Patten
- Neural Control of Movement Lab, Department of Physical Therapy, University of Florida and Malcolm-Randall VA Medical Center, Gainesville, FL, United States
| | - Stephen A Coombes
- Laboratory for Rehabilitation Neuroscience, Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States.
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21
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Saleh S, Fluet G, Qiu Q, Merians A, Adamovich SV, Tunik E. Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke. Front Neurol 2017; 8:452. [PMID: 28928708 PMCID: PMC5591400 DOI: 10.3389/fneur.2017.00452] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 08/15/2017] [Indexed: 12/13/2022] Open
Abstract
Several approaches to rehabilitation of the hand following a stroke have emerged over the last two decades. These treatments, including repetitive task practice (RTP), robotically assisted rehabilitation and virtual rehabilitation activities, produce improvements in hand function but have yet to reinstate function to pre-stroke levels-which likely depends on developing the therapies to impact cortical reorganization in a manner that favors or supports recovery. Understanding cortical reorganization that underlies the above interventions is therefore critical to inform how such therapies can be utilized and improved and is the focus of the current investigation. Specifically, we compare neural reorganization elicited in stroke patients participating in two interventions: a hybrid of robot-assisted virtual reality (RAVR) rehabilitation training and a program of RTP training. Ten chronic stroke subjects participated in eight 3-h sessions of RAVR therapy. Another group of nine stroke subjects participated in eight sessions of matched RTP therapy. Functional magnetic resonance imaging (fMRI) data were acquired during paretic hand movement, before and after training. We compared the difference between groups and sessions (before and after training) in terms of BOLD intensity, laterality index of activation in sensorimotor areas, and the effective connectivity between ipsilesional motor cortex (iMC), contralesional motor cortex, ipsilesional primary somatosensory cortex (iS1), ipsilesional ventral premotor area (iPMv), and ipsilesional supplementary motor area. Last, we analyzed the relationship between changes in fMRI data and functional improvement measured by the Jebsen Taylor Hand Function Test (JTHFT), in an attempt to identify how neurophysiological changes are related to motor improvement. Subjects in both groups demonstrated motor recovery after training, but fMRI data revealed RAVR-specific changes in neural reorganization patterns. First, BOLD signal in multiple regions of interest was reduced and re-lateralized to the ipsilesional side. Second, these changes correlated with improvement in JTHFT scores. Our findings suggest that RAVR training may lead to different neurophysiological changes when compared with traditional therapy. This effect may be attributed to the influence that augmented visual and haptic feedback during RAVR training exerts over higher-order somatosensory and visuomotor areas.
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Affiliation(s)
- Soha Saleh
- Human Performance and Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Gerard Fluet
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, United States
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, United States
| | - Alma Merians
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, United States
| | - Sergei V. Adamovich
- Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, United States
- Department of Biomedical Engineering, NJIT, Newark, NJ, United States
| | - Eugene Tunik
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, MA, United States
- Department of Bioengineering, Northeastern University, Boston, MA, United States
- Department of Biology, Northeastern University, Boston, MA, United States
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22
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Virtual Reality and Serious Games in Neurorehabilitation of Children and Adults: Prevention, Plasticity, and Participation. Pediatr Phys Ther 2017; 29 Suppl 3:S23-S36. [PMID: 28654475 PMCID: PMC5488703 DOI: 10.1097/pep.0000000000000387] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Use of virtual reality (VR) and serious games (SGs) interventions within rehabilitation as motivating tools for task specific training for individuals with neurological conditions are fast-developing. Within this perspective paper we use the framework of the IV STEP conference to summarize the literature on VR and SG for children and adults by three topics: Prevention; Outcomes: Body-Function-Structure, Activity and Participation; and Plasticity. Overall the literature in this area offers support for use of VR and SGs to improve body functions and to some extent activity domain outcomes. Critical analysis of clients' goals and selective evaluation of VR and SGs are necessary to appropriately take advantage of these tools within intervention. Further research on prevention, participation, and plasticity is warranted. We offer suggestions for bridging the gap between research and practice integrating VR and SGs into physical therapist education and practice.
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23
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Sayegh PF, Gorbet DJ, Hawkins KM, Hoffman KL, Sergio LE. The Contribution of Different Cortical Regions to the Control of Spatially Decoupled Eye-Hand Coordination. J Cogn Neurosci 2017; 29:1194-1211. [PMID: 28253075 DOI: 10.1162/jocn_a_01111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our brain's ability to flexibly control the communication between the eyes and the hand allows for our successful interaction with the objects located within our environment. This flexibility has been observed in the pattern of neural responses within key regions of the frontoparietal reach network. More specifically, our group has shown how single-unit and oscillatory activity within the dorsal premotor cortex (PMd) and the superior parietal lobule (SPL) change contingent on the level of visuomotor compatibility between the eyes and hand. Reaches that involve a coupling between the eyes and hand toward a common spatial target display a pattern of neural responses that differ from reaches that require eye-hand decoupling. Although previous work examined the altered spiking and oscillatory activity that occurs during different types of eye-hand compatibilities, they did not address how each of these measures of neurological activity interacts with one another. Thus, in an effort to fully characterize the relationship between oscillatory and single-unit activity during different types of eye-hand coordination, we measured the spike-field coherence (SFC) within regions of macaque SPL and PMd. We observed stronger SFC within PMdr and superficial regions of SPL (areas 5/PEc) during decoupled reaches, whereas PMdc and regions within SPL surrounding medial intrapareital sulcus had stronger SFC during coupled reaches. These results were supported by meta-analysis on human fMRI data. Our results support the proposal of altered cortical control during complex eye-hand coordination and highlight the necessity to account for the different eye-hand compatibilities in motor control research.
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Affiliation(s)
| | - Diana J Gorbet
- 1 York University, Toronto, Ontario, Canada.,2 Canadian Action and Perception Network, Toronto, Ontario, Canada
| | | | - Kari L Hoffman
- 1 York University, Toronto, Ontario, Canada.,2 Canadian Action and Perception Network, Toronto, Ontario, Canada
| | - Lauren E Sergio
- 1 York University, Toronto, Ontario, Canada.,2 Canadian Action and Perception Network, Toronto, Ontario, Canada
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Emergence of virtual reality as a tool for upper limb rehabilitation: incorporation of motor control and motor learning principles. Phys Ther 2015; 95:415-25. [PMID: 25212522 PMCID: PMC4348716 DOI: 10.2522/ptj.20130579] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The primary focus of rehabilitation for individuals with loss of upper limb movement as a result of acquired brain injury is the relearning of specific motor skills and daily tasks. This relearning is essential because the loss of upper limb movement often results in a reduced quality of life. Although rehabilitation strives to take advantage of neuroplastic processes during recovery, results of traditional approaches to upper limb rehabilitation have not entirely met this goal. In contrast, enriched training tasks, simulated with a wide range of low- to high-end virtual reality-based simulations, can be used to provide meaningful, repetitive practice together with salient feedback, thereby maximizing neuroplastic processes via motor learning and motor recovery. Such enriched virtual environments have the potential to optimize motor learning by manipulating practice conditions that explicitly engage motivational, cognitive, motor control, and sensory feedback-based learning mechanisms. The objectives of this article are to review motor control and motor learning principles, to discuss how they can be exploited by virtual reality training environments, and to provide evidence concerning current applications for upper limb motor recovery. The limitations of the current technologies with respect to their effectiveness and transfer of learning to daily life tasks also are discussed.
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Abstract
BACKGROUND Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation. In particular, commercial gaming consoles have been rapidly adopted in clinical settings. This is an update of a Cochrane Review published in 2011. PRIMARY OBJECTIVE To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity. SECONDARY OBJECTIVE To determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance activity, global motor function, cognitive function, activity limitation, participation restriction and quality of life, voxels or regions of interest identified via imaging, and adverse events. Additionally, we aimed to comment on the feasibility of virtual reality for use with stroke patients by reporting on patient eligibility criteria and recruitment. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (October 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 11), MEDLINE (1950 to November 2013), EMBASE (1980 to November 2013) and seven additional databases. We also searched trials registries and reference lists. SELECTION CRITERIA Randomised and quasi-randomised trials of virtual reality ("an advanced form of human-computer interface that allows the user to 'interact' with and become 'immersed' in a computer-generated environment in a naturalistic fashion") in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance function and activity, and global motor function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data and assessed risk of bias. A third review author moderated disagreements when required. The authors contacted investigators to obtain missing information. MAIN RESULTS We included 37 trials that involved 1019 participants. Study sample sizes were generally small and interventions varied. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains 'low' or 'very low' quality when rated using the GRADE system. Control groups received no intervention or therapy based on a standard care approach. Intervention approaches in the included studies were predominantly designed to improve motor function rather than cognitive function or activity performance. The majority of participants were relatively young and more than one year post stroke. PRIMARY OUTCOME results were statistically significant for upper limb function (standardised mean difference (SMD) 0.28, 95% confidence intervals (CI) 0.08 to 0.49 based on 12 studies with 397 participants). SECONDARY OUTCOMES there were no statistically significant effects for grip strength, gait speed or global motor function. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.43, 95% CI 0.18 to 0.69 based on eight studies with 253 participants); however, we were unable to pool results for cognitive function, participation restriction, quality of life or imaging studies. There were few adverse events reported across studies and those reported were relatively mild. Studies that reported on eligibility rates showed that only 26% of participants screened were recruited. AUTHORS' CONCLUSIONS We found evidence that the use of virtual reality and interactive video gaming may be beneficial in improving upper limb function and ADL function when used as an adjunct to usual care (to increase overall therapy time) or when compared with the same dose of conventional therapy. There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on grip strength, gait speed or global motor function. It is unclear at present which characteristics of virtual reality are most important and it is unknown whether effects are sustained in the longer term.
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Affiliation(s)
- Kate E Laver
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
| | - Stacey George
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
| | - Susie Thomas
- University of South Australia (City East)International Centre for Allied Health Evidence (iCAHE)GPO Box 2471AdelaideAustralia5000
| | - Judith E Deutsch
- Rutgers UniversityDepartment of Rehabilitation and Movement ScienceNewarkUSA
| | - Maria Crotty
- Flinders UniversityDepartment of Rehabilitation and Aged CareRepatriation General HospitalsDaws Road, Daw ParkAdelaideAustralia5041
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Gatica-Rojas V, Méndez-Rebolledo G. Virtual reality interface devices in the reorganization of neural networks in the brain of patients with neurological diseases. Neural Regen Res 2014; 9:888-96. [PMID: 25206907 PMCID: PMC4146258 DOI: 10.4103/1673-5374.131612] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 11/04/2022] Open
Abstract
Two key characteristics of all virtual reality applications are interaction and immersion. Systemic interaction is achieved through a variety of multisensory channels (hearing, sight, touch, and smell), permitting the user to interact with the virtual world in real time. Immersion is the degree to which a person can feel wrapped in the virtual world through a defined interface. Virtual reality interface devices such as the Nintendo® Wii and its peripheral nunchuks-balance board, head mounted displays and joystick allow interaction and immersion in unreal environments created from computer software. Virtual environments are highly interactive, generating great activation of visual, vestibular and proprioceptive systems during the execution of a video game. In addition, they are entertaining and safe for the user. Recently, incorporating therapeutic purposes in virtual reality interface devices has allowed them to be used for the rehabilitation of neurological patients, e.g., balance training in older adults and dynamic stability in healthy participants. The improvements observed in neurological diseases (chronic stroke and cerebral palsy) have been shown by changes in the reorganization of neural networks in patients' brain, along with better hand function and other skills, contributing to their quality of life. The data generated by such studies could substantially contribute to physical rehabilitation strategies.
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Affiliation(s)
- Valeska Gatica-Rojas
- Laboratory of Human Motor Control, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Guillermo Méndez-Rebolledo
- Laboratory of Human Motor Control, School of Kinesiology, Faculty of Health Sciences, University of Talca, Talca, Chile
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Merians AS, Fluet G, Tunik E, Qiu Q, Saleh S, Adamovich S. Movement rehabilitation in virtual reality from then to now: how are we doing? INTERNATIONAL JOURNAL ON DISABILITY AND HUMAN DEVELOPMENT : IJDHD 2014; 13:311-317. [PMID: 29057195 PMCID: PMC5648340 DOI: 10.1515/ijdhd-2014-0321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
During the past decade, there has been a continuous exploration of how virtual environments can be used to facilitate motor recovery and relearning after neurological impairment. There are two goals for using virtual environments: to improve patients' rehabilitation outcomes beyond our current capabilities or to supplement labor-intensive and time consuming therapies with technology-based interventions. After over a decade of investigation, it seems appropriate to determine whether we are succeeding in meeting such goals.
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Affiliation(s)
- Alma S. Merians
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, 65 Bergen Street, Newark, NJ 07107, USA
| | - Gerard Fluet
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, Newark, NJ, USA
| | - Eugene Tunik
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, Newark, NJ, USA
| | - Q. Qiu
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, Newark, NJ, USA
| | - Soha Saleh
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, Newark, NJ, USA
| | - Sergei Adamovich
- Department of Rehabilitation and Movement Sciences, University of Medicine
and Dentistry of New Jersey, Newark, NJ, USA; and New Jersey Institute of Technology,
Department of Biomedical Engineering, Newark, NJ, USA
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Saleh S, Adamovich SV, Tunik E. Mirrored feedback in chronic stroke: recruitment and effective connectivity of ipsilesional sensorimotor networks. Neurorehabil Neural Repair 2013; 28:344-54. [PMID: 24370569 DOI: 10.1177/1545968313513074] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mirrored feedback has potential as a therapeutic intervention to restore hand function after stroke. However, the functional (effective) connectivity of neural networks involved in processing mirrored feedback after stroke is not known. OBJECTIVE To determine if regions recruited by mirrored feedback topographically overlap with those involved in control of the paretic hand and to identify the effective connectivity of activated nodes within the mirrored feedback network. METHODS Fifteen patients with chronic stroke performed a finger flexion task with their unaffected hand during event-related functional magnetic resonance imaging (fMRI). Real-time hand kinematics was recorded during fMRI and used to actuate hand models presented in virtual reality (VR). Visual feedback of the unaffected hand motion was manipulated pseudorandomly by either actuating the VR hand corresponding to the moving unaffected side (veridical feedback) or the affected side (mirrored feedback). In 2 control conditions, the VR hands were replaced with moving nonanthropomorphic shapes. RESULTS Mirrored feedback was associated with significant activation of regions within and outside the ipsilesional sensorimotor cortex, overlapping with areas engaged when patients performed the task with their affected hand. Effective connectivity analysis showed a significantly interconnected ipsilesional somatosensory and motor cortex in the mirrored feedback condition. CONCLUSIONS Mirrored feedback recruits ipsilesional brain areas relevant for control of the affected hand. These data provide a neurophysiological basis by which mirrored feedback may be beneficial as a therapy for restoring function after stroke.
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Affiliation(s)
- Soha Saleh
- 1Department of Rehabilitation and Movement Science, Rutgers University, Newark, NJ, USA
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