Neural Patterns of Reorganization after Intensive Robot-Assisted Virtual Reality Therapy and Repetitive Task Practice in Patients with Chronic Stroke

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.

Agency and Performance of Reach-to-Grasp With Modified Control of a Virtual Hand: Implications for Rehabilitation

“…Virtual reality (VR) is an attractive platform to develop customized methods for user-device integration and agencybased rehabilitation. For the user, VR is proven to enhance cognitive engagement in performing repetitive physical therapy movements (Sveistrup, 2004;Saleh et al, 2017). VR is readily programmable (Todorov et al, 2012) to customize visual projections of user actions and their consequences in functional task performance.…”

The Activation of the Mirror Neuron System during Action Observation and Action Execution with Mirror Visual Feedback in Stroke: A Systematic Review

“…A substantial number of advanced rehabilitation strategies have been applied in upper limb stroke rehabilitation, such as robot-assisted therapy [ 2 ], constraint-induced movement training (CIMT) [ 3 ], and virtual reality- (VR-) based rehabilitation [ 4 ], which are aimed at helping stroke survivors relearn motor skills through intensive training. These rehabilitation strategies have been reported to improve patients' motor functions by inducing experience-dependent neuroplasticity in their damaged hemispheres [ 5 – 7 ]. However, the neuroplasticity resulting from intensive-based interventions may be limited if the residual motor functions of the patients are also extremely limited.…”

Intensity- and Duration-Adaptive Functional Electrical Stimulation Using Fuzzy Logic Control and a Linear Model for Dropfoot Correction

“…A typical cause of dropfoot is muscle weakness, which results in a limited ability to lift the foot voluntarily and an increased risk of falls (2–4). Great effort is made toward the recovery of walking ability for poststroke patients with dropfoot, such as ankle–foot orthoses (5), physical therapy (6), and rehabilitation robot (7). …”