Cerebral Reorganization in Subacute Stroke Survivors after Virtual Reality-Based Training: A Preliminary Study

Abstract

Background Functional magnetic resonance imaging (fMRI) is a promising method for quantifying brain recovery and investigating the intervention-induced changes in corticomotor excitability after stroke. This study aimed to evaluate cortical reorganization subsequent to virtual reality-enhanced treadmill (VRET) training in subacute stroke survivors. Methods Eight participants with ischemic stroke underwent VRET for 5 sections per week and for 3 weeks. fMRI was conducted to quantify the activity of selected brain regions when the subject performed ankle dorsiflexion. Gait speed and clinical scales were also measured before and after intervention. Results Increased activation in the primary sensorimotor cortex of the lesioned hemisphere and supplementary motor areas of both sides for the paretic foot (p < 0.01) was observed postintervention. Statistically significant improvements were observed in gait velocity (p < 0.05). The change in voxel counts in the primary sensorimotor cortex of the lesioned hemisphere is significantly correlated with improvement of 10 m walk time after VRET (r = −0.719). Conclusions We observed improved walking and increased activation in cortical regions of stroke survivors after VRET training. Moreover, the cortical recruitment was associated with better walking function. Our study suggests that cortical networks could be a site of plasticity, and their recruitment may be one mechanism of training-induced recovery of gait function in stroke. This trial is registered with ChiCTR-IOC-15006064.

Effects of Virtual Reality-Based Rehabilitation on Burned Hands: A Prospective, Randomized, Single-Blind Study

“…Moreover, many reports regarding neurorehabilitation have suggested that for functional recovery in the upper and lower extremities, repetitive intervention using VR is helpful and induces neuroplasticity [14,[30][31][32]. Saleh et al observed the different mechanisms between robot-assisted VR training and conventional functional rehabilitation in patients with chronic stroke using functional magnetic resonance imaging (MRI).…”

Optimization of fMRI methods to determine laterality of cortical activation during ankle movements of children with unilateral cerebral palsy

“…Testing began using a blocked design frequently reported in ankle dorsiflexion fMRI investigations (de Bode et al, 2007; Dobkin et al, 2004; Enzinger et al, 2009; Enzinger et al, 2008; Phillips et al, 2007; Xiao et al, 2017) involving 30 seconds (s) of rest followed by 20 s of continuous dorsiflexion. This sequence was repeated 5 times for a total run time of 5:22 minutes (min).…”

“…Considering distal control is a target of training in UCP, ankle dorsiflexion is an ideal task for investigation of training‐induced plasticity. The fMRI task has been tested in healthy adults (MacIntosh et al, 2004; Sahyoun et al, 2004), and people with stroke (Dobkin et al, 2004; Enzinger et al, 2009; Enzinger et al, 2008; Xiao et al, 2017). When piloted in a group of six children with UCP, two had excessive head movement during the fMRI (Phillips et al, 2007) indicating that test procedures warrant further refinement.…”

The Emergent Role of Virtual Reality in the Treatment of Neuropsychiatric Disease

“…With an adapted setup, both young patients and senior patients could see their rehabilitation sessions benefiting from a new vision and therefore see a new capacity added to the means accessible to them in order to get better. By targeting specific brain areas and specific training, VR could be used as a cortical reorganization inducer, and trigger new healing neurological and critical pathways in mental health disorders or trauma induced stress and anxiety such as Post-Traumatic Stress Disorder (Maples-Keller et al, 2017 ; Tielman et al, 2017 ), to adaptive rehabilitation following stroke induced neurological impairments (Xiao et al, 2017 ; Yasuda et al, 2017 ).…”