Proactive Motor Functional Recovery Following Immersive Virtual Reality–Based Limb Mirroring Therapy in Patients with Subacute Stroke

Mekbib, Destaw B; Zhao, Zhiyong; Wang, Jianbao; Xu, Bin; Zhang, Li; Cheng, Ruiding; Fang, Shan; Shao, Yuling; Yang, Wei; Han, Jian; Jiang, Hongjie; Zhu, Junming; Ye, Xiangming; Zhang, Jianmin; Xu, Dongrong

doi:10.1007/s13311-020-00882-x

Cited by 51 publications

(59 citation statements)

References 47 publications

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“…24,25,[42][43][44] The recovery of impaired sensorimotor functions following intensive rehabilitative intervention may be associated with improved arm motor function. 23,59 Following this speculation, our newly developed VR system appears to be capable of promoting functional reorganization of the motor system that has been directly or indirectly affected by stroke.…”

Section: Discussionmentioning

confidence: 94%

A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke

Mekbib

Debeli

Zhang

et al. 2021

Annals of the New York Academy of Sciences

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Given the rising incidence of stroke, several technology-driven methods for rehabilitation have recently been developed. Virtual reality (VR) is a promising therapeutic technology among them. We recently developed a neuroscientifically grounded VR system to aid recovery of motor function poststroke. The developed system provides unilateral and bilateral upper extremity (UE) training in a fully immersive virtual environment that may stimulate and activate mirror neurons (MNs) in the brain necessary for UE rehabilitation. Twenty-three participants were randomized to a VR group (n = 12) to receive VR intervention (8 h within 2 weeks) plus 8-h occupational therapy (OT) or a control group (n = 11) to receive time-matched OT alone. Treatment effects on motor recovery and cortical reorganization were investigated using the Barthel Index (BI), Fugl-Meyer Upper Extremity (FM-UE), and resting-state fMRI. Both groups significantly improved BI (P < 0.05), reflecting the recovery of UE motor function. The VR group revealed significant improvements on FM-UE scores (P < 0.05) than the control group. Neural activity increased after the intervention, particularly in the brain areas implicating MNs, such as in the primary motor cortex. Overall, results suggested that using a neuroscientifically grounded VR system might offer additional benefits for UE rehabilitation in patients receiving OT.

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Section: Discussionmentioning

confidence: 94%

A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke

Mekbib

Debeli

Zhang

et al. 2021

Annals of the New York Academy of Sciences

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“…In the case of VR interventions in stroke patients with affected ULs, leap motions are usually used in order to track the user's movements. Three of the included trials in our review used this method in their treatment protocol to regain the motor function of affected limbs in patients with subacute stroke ( 44 , 51 , 57 ). However, the remaining studies used the terms “virtual reality intervention” and “game-based intervention” interchangeably.…”

Section: Discussionmentioning

confidence: 99%

“…Based on these limitations, we recommend conducting more robust, well-designed trials of larger sample sizes and longer follow-up periods to reach more definitive conclusions. Fourth, outcomes were assessed directly after the application of the VR interventions with a short follow-up period, ranging from 2 to 12 weeks ( 44 , 56 ). Therefore, we are not confident that the improvement in motor function following the implementation of VR protocols is long-lasting.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Virtual Reality in the Rehabilitation of Motor Function of Patients With Subacute Stroke: A Meta-Analysis

Peng¹,

Yin²,

Cao³

2021

Front. Neurol.

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Stroke is a major cause of death and disability in adults. Conventional therapy (CT) has limited effectiveness, and therefore, various virtual reality (VR) rehabilitation programs have been designed. However, their efficacy in regaining motor function in patients with subacute stroke is questionable. Therefore, we conducted this meta-analysis to determine the efficacy of VR, compared to CT, in restoring motor function in this patient population. Up to October 10, 2020, nine electronic databases were searched for relevant articles reporting the effectiveness of VR in regaining motor function in patients with subacute stroke. This search was updated on March 7, 2021, with no additional added articles. The control group included CT, physical therapy, occupational therapy, or a combination of them. Effectiveness is defined as the positive change from baseline values to the last follow-up point. The Cochrane's revised risk-of-bias tool was used to determine the quality of included trials. A metaregression analysis was conducted to determine the effect of “time since last stroke” on reported outcomes. Publication bias and sensitivity analyses were also carried out. A total of 19 studies (17 randomized controlled trials, 1 cohort study, and 1 crossover trial) were included in the qualitative analysis, whereas 16 trials were meta-analyzed. A great improvement in motor function was noted in the VR group, when compared to preintervention values [standardized mean difference (SMD) = 1.14; 95% confidence interval (CI) = 0.77–1.52; I2 = 82%; P < 0.001]. When compared to CT, VR resulted in mild improvement in motor function (SMD = 0.47; 95% CI = 0.22–0.72; I2 = 75%; P < 0.001). However, upon trim-and-fill adjustment, this finding was deemed insignificant (SMD = 0.08; 95% CI = −0.16 to 0.33; I2 = 82.6%; P < 0.001). Ten studies had low risk, five had some concerns, three had high risk, and one had a moderate risk of bias. VR programs can be used jointly with CT for the rehabilitation of the motor function of patients with subacute stroke. However, more studies are still warranted to determine the effectiveness of these interventions in retaining the cognitive function and physical performance of such patients.

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“…Previous studies have found a beneficial role of motor-related areas on the recovery of motor function following stroke [ 7 , 51 , 52 ]. Additionally, the connectivity related to these motor-related areas was improved and tended toward connectivity values of healthy participants after clinical intervention [ 11 , 53 , 54 ]. Regarding the bilateral SMA, previous studies have shown that these regions are mainly involved in motor planning and motor execution during voluntary movement [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

The disrupted topological properties of structural networks showed recovery in ischemic stroke patients: a longitudinal design study

et al. 2021

BMC Neurosci

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Introduction Stroke is one of the leading causes of substantial disability worldwide. Previous studies have shown brain functional and structural alterations in adults with stroke. However, few studies have examined the longitudinal reorganization in whole-brain structural networks in stroke. Methods Here, we applied graph theoretical analysis to investigate the longitudinal topological organization of white matter networks in 20 ischemic stroke patients with a one-month interval between two timepoints. Two sets of clinical scores, Fugl-Meyer motor assessment (FMA) and neurological deficit scores (NDS), were assessed for all patients on the day the image data were collected. Results The stroke patients exhibited significant increases in FMA scores and significant reductions in DNS between the two timepoints. All groups exhibited small-world organization (σ > 1) in the brain structural network, including a high clustering coefficient (γ > 1) and a low normalized characteristic path length (λ ≈ 1). However, compared to healthy controls, stroke patients showed significant decrease in nodal characteristics at the first timepoint, primarily in the right supplementary motor area, right middle temporal gyrus, right inferior parietal lobe, right postcentral gyrus and left posterior cingulate gyrus. Longitudinal results demonstrated that altered nodal characteristics were partially restored one month later. Additionally, significant correlations between the nodal characteristics of the right supplementary motor area and the clinical scale scores (FMA and NDS) were observed in stroke patients. Similar behavioral-neuroimaging correlations were found in the right inferior parietal lobe. Conclusion Altered topological properties may be an effect of stroke, which can be modulated during recovery. The longitudinal results and the neuroimaging-behavioral relationship may provide information for understanding brain recovery from stroke. Future studies should detect whether observed changes in structural topological properties can predict the recovery of daily cognitive function in stroke.

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Proactive Motor Functional Recovery Following Immersive Virtual Reality–Based Limb Mirroring Therapy in Patients with Subacute Stroke

Cited by 51 publications

References 47 publications

A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke

A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke

Effectiveness of Virtual Reality in the Rehabilitation of Motor Function of Patients With Subacute Stroke: A Meta-Analysis

The disrupted topological properties of structural networks showed recovery in ischemic stroke patients: a longitudinal design study

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