Neural Reorganization Accompanying Upper Limb Motor Rehabilitation from Stroke with Virtual Reality-Based Gesture Therapy

Abstract

Prefrontal cortex and cerebellar activity are the driving forces of the recovery associated with Gesture Therapy. The relation between behavioral and brain changes suggests that those with stronger impairment benefit the most from this paradigm.

Gesture Therapy: An Upper Limb Virtual Reality-Based Motor Rehabilitation Platform

“…Among the main features of this platform are (i) its game set developed using game design criteria considered to be relevant for rehabilitation, (ii) its innovative controller, (iii) its monocular 3D tracking system, (iv) its capability to detect compensatory movements also from the vision system, and (v) its adaptation module which capitalizes on decision-theoretic models to fit the patient progress. Clinical trials carried out over an earlier version of the platform [4], [5] suggest that GT, might support motor recovery comparable to that of occupational therapy to stroke survivors but increasing motivation as measured by the Intrinsic Motivation Inventory as well as subjective comments from the patients. The feasibility pilot described in Sect IV using the platform version presented in Sect III provides preliminary evidence of the usefulness of the GT application with its latest developments.…”

“…First, the amount of therapy received in this feasibility study was short and insufficient to permit appreciation of differences. Note that this feasibility dose is lower than that administered in our clinical trials for earlier versions of the platform [4], [5]. Second, the game challenge adaptation mechanism with its current policy emphasizing coupled progress of speed and control, favours a slower but surer progress, and may be responsible for some of the drops in speed and increases in control.…”

“…The tasks are presented in the form of short serious games. Earlier trials [4], [5] suggest that Gesture Therapy provides measurable improvements in motor dexterity comparable to more classical occupational therapy but with an edge on motivation. Conceptually, the GT platform consists of five interacting modules:…”

“…Part of this paper overviews work previously published in conference paper format [2]- [5]. In addition, we further present here the new game set.…”

Upper limb rehabilitation with virtual environments: a review

“…Se observa la gran variedad en cuanto a la duración de las terapias, intensidad del tratamiento y en determinar si los efectos de la realidad virtual se mantienen a largo plazo, hay pocos estudios en los que se haga un seguimiento a largo plazo luego de aplicar la terapia de realidad virtual (26); por otro lado es importante determinar los efectos fisiológicos del porqué y cómo las terapias de realidad virtual pueden mejorar la capacidad motriz (72). Algunas investigaciones han demostrado que para que se produzca aprendizaje y reaprendizaje motor tienen que producirse cambios en la arquitectura neuronal; para ello, la terapia tiene que basarse en la realización de actividades funcionales, repetitivas, recompensadas, y realizadas en un período largo de tiempo (73,74).…”