Posts Tagged Neuroplasticity

[Editorial] Improving and Predicting Outcomes of Traumatic Brain Injury: Neuroplasticity, Imaging Modalities, and Perspective Therapy – Neural Plasticity

Each year, a new traumatic brain injury (TBI) event occurs in
an estimated 10 million people worldwide, particularly in
young adults. Not only is TBI the leading cause of longterm
disability and mortality worldwide, but it is also
expected to become the third largest cause of global disease
burden by 2020 [1, 2]. TBI is a challenging disease process,
both to treat and to investigate. TBI survivors often experience
substantial and lifelong cognitive, physical, and behavioral
impairments that require long-term access to health
care and disability services.
Over the past three decades, imaging modalities, such as
positron emission tomography (PET),functionalMRI (fMRI),
diffusion tensor imaging (DTI), and transcranial magnetic
stimulation (TMS), have played a pivotal role in predicting
TBI outcome and advancing TBI treatment [3].
Burgeoning evidences for neuroplasticity have shed light
on the potential therapeutic protocols focusing on synaptic
proteins, new network connections, inflammatory reactions,
and the recruitment of immune cells [4]. Future therapies,
including gene therapies or a combination of different pharmacologic
therapies and rehabilitative protocols, which may
benefit victims by targeting multiple mechanisms of recovery,
are of utmost interest and currently under heavy investigation
by devoting neuroscientists.
The articles contained in this special issue include 4
reviews and 2 original research papers: a quantitative study
focusing on predictors of recovery from TBI and a cohort
study on substance related disorder after TBI.

(i) TBI survivors suffer various functional and cognitive
sequelae that may impose serious medical and social
problems. J. Ma et al. reviewed the complicated
pathological mechanisms of diffuse axonal injury
(DAI) in an attempt to facilitate more accurate diagnosis
and hence improve the survival and life quality
of DAI patients.

(ii) Not many studies have discussed the role of synapses
after TBI. Z. Wen et al. provided a comprehensive
review on the role and mechanisms of synapses in
TBI and the correlation between key synaptic proteins
and neuroplasticity. The article also provides
insights on the role of synapses in the treatment
and prognosis of TBI.

(iii) Molecular studies concerning the microglia-induced
inflammation by M1 phenotype and antiinflammation
by M2 phenotype are a new strategy
for treatment of TBI. In the paper titled “The

Polarization States of Microglia in TBI: A New
Paradigm for Pharmacological Intervention,” H.
Xu et al. examined research on the polarization
of microglia and their roles in the inflammation
response and secondary brain injury after TBI. It is
hoped that decreasing M1 phenotype and increasing
M2 phenotype may shed light on the pharmacotherapy
of TBI.

(iv) Studies to locate the clinical predictors of recovery
from prolonged disorders of consciousness (PDC)
can be arduous. In the original research presented
by H. Abe et al., 14 TBI patients were investigated
using diffusion tensor imaging (DTI) for longterm
follow-ups of 1-2 years. The results disclosed
correlation between initial severity of PDC and
difference in axial diffusivity (AD) and the degree
of recovery from PDC (RPDC). Microstructural
white matter changes in this study implicate their
possible relationship with the degree of RPDC.

(v) Efforts to correct behavioral, cognitive, mood, and
executive impairment of TBI patients are costly.
The article “Rehabilitation Treatment and Progress
of Traumatic Brain Injury Dysfunction” by B. Dang
et al. compiles the current rehabilitation treatment
plans and outcomes of TBI in adults.

(vi) Whether TBI induces substance-related disorder
(SRD) is currently debatable. C.-H. Wu et al. carried
out a cohort study of 19 thousand TBI adults
with no history of mental disorders prior to brain
injury in the original paper titled “Traumatic Brain
Injury and Substance Related Disorder: A 10-Year
Nationwide Cohort Study in Taiwan.” Results show
that the overall incidence of SRD was 3.62-fold
higher in the TBI group and 9.01-fold in the severe
TBI group. The severity of TBI seems to have
strong correlation in the subsequent risks of SRD.

Download Full Text PDF

Advertisements

, , , ,

Leave a comment

[BOOK] Virtual Reality for Physical and Motor Rehabilitation – Google Books

Virtual Reality for Physical and Motor Rehabilitation

Front Cover

Patrice L. Tamar WeissEmily A. KeshnerMindy F. Levin
SpringerJul 24, 2014 – Medical – 232 pages

While virtual reality (VR) has influenced fields as varied as gaming, archaeology, and the visual arts, some of its most promising applications come from the health sector. Particularly encouraging are the many uses of VR in supporting the recovery of motor skills following accident or illness.

Virtual Reality for Physical and Motor Rehabilitation reviews two decades of progress and anticipates advances to come. It offers current research on the capacity of VR to evaluate, address, and reduce motor skill limitations, and the use of VR to support motor and sensorimotor function, from the most basic to the most sophisticated skill levels. Expert scientists and clinicians explain how the brain organizes motor behavior, relate therapeutic objectives to client goals, and differentiate among VR platforms in engaging the production of movement and balance. On the practical side, contributors demonstrate that VR complements existing therapies across various conditions such as neurodegenerative diseases, traumatic brain injury, and stroke. Included among the topics:

  • Neuroplasticity and virtual reality.
  • Vision and perception in virtual reality.
  • Sensorimotor recalibration in virtual environments.
  • Rehabilitative applications using VR for residual impairments following stroke.
  • VR reveals mechanisms of balance and locomotor impairments.
  • Applications of VR technologies for childhood disabilities.

A resource of great immediate and future utility, Virtual Reality for Physical and Motor Rehabilitation distills a dynamic field to aid the work of neuropsychologists, rehabilitation specialists (including physical, speech, vocational, and occupational therapists), and neurologists.

Preview this book »

Source: Virtual Reality for Physical and Motor Rehabilitation – Google Books

, , , , ,

Leave a comment

[Abstract] EEG-guided robotic mirror therapy system for lower limb rehabilitation – IEEE Conference Publication

Abstract:

Lower extremity function recovery is one of the most important goals in stroke rehabilitation. Many paradigms and technologies have been introduced for the lower limb rehabilitation over the past decades, but their outcomes indicate a need to develop a complementary approach. One attempt to accomplish a better functional recovery is to combine bottom-up and top-down approaches by means of brain-computer interfaces (BCIs). In this study, a BCI-controlled robotic mirror therapy system is proposed for lower limb recovery following stroke. An experimental paradigm including four states is introduced to combine robotic training (bottom-up) and mirror therapy (top-down) approaches. A BCI system is presented to classify the electroencephalography (EEG) evidence. In addition, a probabilistic model is presented to assist patients in transition across the experiment states based on their intent. To demonstrate the feasibility of the system, both offline and online analyses are performed for five healthy subjects. The experiment results show a promising performance for the system, with average accuracy of 94% in offline and 75% in online sessions.

Source: EEG-guided robotic mirror therapy system for lower limb rehabilitation – IEEE Conference Publication

, , , , , , ,

Leave a comment

[WEB SITE] Brain Training: Improve Your Neuroplasticity in 9 Easy Steps

Can we improve our capacity for creativity, memory and analysis through brain training exercises? Do online brain training games really work? The simple answer to these questions is yes; we can improve the brain’s ability to function, and we can actually reshape the physical structure of our brains through neuroplasticity training exercises.

Happily in improving your brain’s ability to function, it is not necessary to pay for expensive online games, that ultimately add nothing to the quality of your life. These nine training tips are free to engage in, will improve your brain’s function, and entice you to live life to its fullest!

How We Can Increase Brain Function As We Age

A study of randomly chosen individuals age 57-71 showed improved brain function after just 12 hours of strategic brain training exercises. Using MRIs of the participants brains both before and after, researchers saw upwards of an 8% improvement in blood flow and other indices that indicate improved brain function.

Improved brain function included improved ability to strategize, remember and draw big-picture conclusions from lengthy texts of information.

Remarkably, in a follow up study using MRIs again on the participants, researchers found that the benefits derived from the single training session were still in place one year later. Enhanced synaptic plasticity means that we can think faster, listen better, respond to situations faster and concentrate with greater focus. Creativity is enhanced as well.

MRI of the Brain

By Nevit Dilmen (Own work)(http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
By Nevit Dilmen (Own work)(http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

[…]

more —> Brain Training: Improve Your Neuroplasticity in 9 Easy Steps | HealDove

, ,

Leave a comment

[Editorial] Motor Priming for Motor Recovery: Neural Mechanisms and Clinical Perspectives – Neurology

Editorial on the Research Topic

Motor Priming for Motor Recovery: Neural Mechanisms and Clinical Perspectives

The Oxford dictionary defines the term priming as “a substance that prepares something for use or action.” In this special issue, we define motor priming as a technique, experience, or activity targeting the motor cortex resulting in subsequent changes in motor behavior. Inadequate functional recovery after neural damage is a persisting burden for many, and this insufficiency highlights the need for new neurorehabilitation paradigms that facilitate the capacity of the brain to learn and recover. The concept of motor priming has gained importance in the last decade. Numerous motor priming paradigms have emerged to demonstrate success to improve functional recovery after injury. Some of the successful priming paradigms that have shown to alter motor behavior and are easily implementable in clinical practice include non-invasive brain stimulation, movement priming, motor imagery, and sensory priming. The full clinical impact of these priming paradigms has not yet been realized due to limited evidence regarding neural mechanisms, safety and effectiveness, dosage, individualization of parameters, identification of the appropriate therapies that need to be provided in combination with the priming technique, and the vital time window to maximize the effectiveness of priming. In this special issue, four manuscripts address critical questions that will enhance our understanding of motor priming paradigms and attempt to bridge the gap between neurophysiology and clinical implementation.

In their study, “Non-Invasive Brain Stimulation to Enhance Upper Limb Motor Practice Poststroke: A Model for Selection of Cortical Site,” Harris-Love and Harrington elegantly address the extremely important issue of individualizing brain stimulation for upper limb stroke recovery. Many brain stimulation techniques show high interindividual variability and low reliability as the “one-size-for-all” does not fit the vast heterogeneity in recovery observed in stroke survivors. In this article, the authors propose a novel framework that personalizes the application of non-invasive brain stimulation based on understanding of the structural anatomy, neural connectivity, and task attributes. They further provide experimental support for this idea with data from severely impaired stroke survivors that validate the proposed framework.

The issue of heterogeneity poststroke is also addressed by Lefebvre and Liew in “Anatomical Parameters of tDCS to modulate the motor system after stroke: A review.” These authors discuss the variability in research using tDCS for the poststroke population. According to the authors, the most likely sources of variability include the heterogeneity of poststroke populations and the experimental paradigms. Individually based variability of results could be related to various factors including: (1) molecular factors such as baseline measures of GABA, levels of dopamine receptor activity, and propensity of brain-derived neurotropic factor expression; (2) time poststroke, (3) lesion location; (4) type of stroke; and (5) level of poststroke motor impairment. Variability related to experimental paradigms include the timing of the stimulation (pre- or post-training), the experimental task, and whether the protocol emphasizes motor performance (a temporary change in motor ability) or motor learning based (more permanent change in motor ability). Finally, the numerous possibilities of electrode placement, neural targets, and the different setups (monocephalic versus bi-hemispheric) add further complexity. For future work with the poststroke population, the authors suggest that tDCS experimental paradigms explore individualized neural targets determined by neuronavigation.

In another exciting study in this issue, Estes et al. tackle the timely topic of spinal reflex excitability modulated by motor priming in individuals with spinal cord injury. The authors choose to test four non-pharmacological interventions: stretching, continuous passive motion, transcranial direct current stimulation, and transcutaneous spinal cord stimulation to reduce spasticity. Three out of four techniques were associated with reduction in spasticity immediately after treatment, to an extent comparable to pharmacological approaches. These priming approaches provide a low-cost and low-risk alternative to anti-spasticity medications.

In another clinical study in individuals with spinal cord injury, Gomes-Osman et al. examined effects of two different approaches to priming. Participants were randomized to either peripheral nerve stimulation (PNS) plus functional task practice, PNS alone, or conventional exercise therapy. The findings were unexpected. There was no change in somatosensory function or power grip strength in any of the groups. Interestingly, all of the interventions produced changes in precision grip of the weaker hand following training. However, only PNS plus functional task practice improved precision grip in both hands. The authors found that baseline corticospinal excitability were significantly correlated to changes in precision grip strength of the weaker hand. The lack of change in grip strength in any of the groups was surprising. Previous evidence suggests, however, that the corticomotor system is more strongly activated during precision grip as compared to power grip, and the authors suggest that interventions targeting the corticomotor system (i.e., various priming methods) may more strongly effect precision grip.

Overall, this special issue brings together an array of original research articles and reviews that further enhance our understanding of motor priming for motor recovery with an emphasis on neural mechanisms and clinical implementation. We hope that the studies presented encourage future studies on motor priming paradigms to optimize the potential for functional recovery in the neurologically disadvantaged population, and further our understanding of neuroplasticity after injury.

Author Contributions

SM and MS have made a substantial, direct, and intellectual contribution to the work and approved it for publication.

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Funding

SM is supported by funding from the National Institutes of Health (R01HD075777).

Source: Frontiers | Editorial: Motor Priming for Motor Recovery: Neural Mechanisms and Clinical Perspectives | Neurology

, , , , , , , , , , ,

Leave a comment

[Abstract] A pilot study on the optimal speeds for passive wrist movements by a rehabilitation robot of stroke patients: A functional NIRS study  

Abstract:

The optimal conditions inducing proper brain activation during performance of rehabilitation robots should be examined to enhance the efficiency of robot rehabilitation based on the concept of brain plasticity. In this study, we attempted to investigate differences in cortical activation according to the speeds of passive wrist movements performed by a rehabilitation robot for stroke patients. 9 stroke patients with right hemiparesis participated in this study. Passive movements of the affected wrist were performed by the rehabilitation robot at three different speeds: 0.25 Hz; slow, 0.5Hz; moderate and 0.75 Hz; fast. We used functional near-infrared spectroscopy to measure the brain activity during the passive movements performed by a robot. Group-average activation map and the relative changes in oxy-hemoglobin (ΔOxyHb) in two regions of interest: the primary sensory-motor cortex (SM1); premotor area (PMA) and region of all channels were measured. In the result of group-averaged activation map, the contralateral SM1, PMA and somatosensory association cortex (SAC) showed the greatest significant activation according to the movements at 0.75 Hz, while there is no significantly activated area at 0.5 Hz. Regarding ΔOxyHb, no significant diiference was observed among three speeds regardless of region. In conclusion, the contralateral SM1, PMA and SAC showed the greatest activation by a fast speed (0.75 Hz) rather than slow (0.25 Hz) and moderate (0. 5 Hz) speed. Our results suggest an optimal speed for execution of the wrist rehabilitation robot. Therefore, we believe that our findings might point to several promising applications for future research regarding useful and empirically-based robot rehabilitation therapy.

Source: A pilot study on the optimal speeds for passive wrist movements by a rehabilitation robot of stroke patients: A functional NIRS study – IEEE Xplore Document

, , , , , , , , , , ,

Leave a comment

[Abstract] Virtual reality and non-invasive brain stimulation in stroke: How effective is their combination for upper limb motor improvement?

Abstract:

Upper limb (UL) hemiparesis is frequently a disabling consequence of stroke. The ability to improve UL functioning is associated with motor relearning and experience dependent neuroplasticity. Interventions such as non-invasive brain stimulation (NIBS) and task-practice in virtual environments (VEs) can influence motor relearning as well as adaptive plasticity. However, the effectiveness of a combination of NIBS and task-practice in VEs on UL motor improvement has not been systematically examined. The objective of this review was to examine the evidence regarding the effectiveness of combining NIBS with task-practice in VEs on UL motor impairment and activity levels. A systematic review of the published literature was conducted using standard methodology. Study quality was assessed using the PEDro scale and Down’s and Black checklist. Four studies examining the effects of a combination of NIBS (involving transcranial direct current stimulation; tDCS and repetitive transcranial magnetic stimulation; rTMS) were retrieved. Of these, three studies were randomized controlled trials (RCTs) and one was a cross-sectional study. There was 1a level evidence that the combination of NIBS and task-practice in a VE was beneficial in the sub-acute stage. A combination of training in a VE with rTMS as well as tDCS was beneficial for motor improvements in the UL in sub-acute stage of stroke (1b level). The combination was not found to be superior compared to task practice in VEs alone in the chronic stage (1b level). The results suggest that people with stroke may be capable of improving levels of motor impairment and activity in the sub-acute stage if their rehabilitation program involves a combination on NIBS and VE training. Emergent questions regarding the use of more sensitive outcomes, different types of stimulation parameters, locations and training environments still need to be addressed.

Source: Virtual reality and non-invasive brain stimulation in stroke: How effective is their combination for upper limb motor improvement? – IEEE Xplore Document

, , , , , , , , , , , ,

Leave a comment

[Abstract] Preliminary results of testing the recoveriX system on stroke patients 

Abstract

Motor imagery based brain-computer interfaces (BCI) extract the movement intentions of subjects in real-time and can be used to control a cursor or medical devices. In the last years, the control of functional electrical stimulation (FES) devices drew researchers’ attention for the post-stroke rehabilitation field. In here, a patient can use the movement imagery to artificially induce movements of the paretic arms through FES in real-time.

Five patients who had a stroke that affected the motor system participated in the current study, and were trained across 10 to 24 sessions lasting about 40 min each with the recoveriX® system. The patients had to imagine 80 left and 80 right hand movements. The electroencephalogram (EEG) data was analyzed with Common Spatial Patterns (CSP) and linear discriminant analysis (LDA) and a feedback was provided in form of a cursor on a computer screen. If the correct imagination was classified, the FES device was also activated to induce the right or left hand movement.

In at least one session, all patients were able to achieve a maximum accuracy above 96%. Moreover, all patients exhibited improvements in motor function. On one hand, the high accuracies achieved within the study show that the patients are highly motivated to participate into a study to improve their lost motor functions. On the other hand, this study reflects the efficacy of combining motor imagination, visual feedback and real hand movement that activates tactile and proprioceptive systems.

Source: O174 Preliminary results of testing the recoveriX system on stroke patients – Clinical Neurophysiology

, , , , , , , , , , , ,

Leave a comment

[Abstract] Effect of reciprocal pedaling exercise on cortical reorganization and gait in stroke patients

Abstract

Objectives

Functional impairment of the lower limb is a major complication in stroke patients. The involvement of the cortex in pedaling has critical clinical implications to control of cyclical motor functions in patients with damaged cortical structures or cortical pathways.The study aimed at determining the effect of reciprocal pedaling exercise (RPE) on the gait and cortical reorganization in the stroke patients.

Methods

Forty patients suffering from stroke with hemiparesis will be included in this study. They were divided to Group I treated by training for lower limb muscles of the affected side. While Group II were treated by the same program as group I in addition to RPE. Quantitative EEG (QEEG) was carried for all patients before and after the treatment programs. The midline frontal, central and parietal regions (Fz, Cz and Pz) were studied for evidence of plasticity induced by RPE.

Results

Neuroplasticity was noticed among patients of group II in the midline frontal region (Fz) and to a lesser extent the midline central region (Cz).

Discussion

The rhythmic and reciprocal nature of cycling motion permits patients to generate timely symmetrical and reciprocal powers from both limbs required for locomotion.

Conclusions

Leg cycling exercise, and thus RPE, is a rehabilitation program that improves the function of ambulation in stroke patients.

Significance

Post stroke physical therapy can utilize RPE for better rehabilitation.

Source: S186 Effect of reciprocal pedaling exercise on cortical reorganization and gait in stroke patients – Clinical Neurophysiology

, , , , , ,

Leave a comment

[ARTICLE] Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke – Full Text

ABSTRACT

Background: Most stroke survivors continue to experience motor impairments even after hospital discharge. Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments. Here we assess the impact of at-home VR-based motor training on functional motor recovery, corticospinal excitability and cortical reorganization.

Objective: The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on (1) cortical reorganization, (2) corticospinal tract, and (3) functional recovery after stroke in comparison to home-based occupational therapy.

Methods: We conducted a parallel-group, controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities. A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment. A group of subjects was trained using a VR-based system for motor rehabilitation, while the control group followed a conventional therapy. Motor function was evaluated at baseline, after the intervention, and at 12-weeks follow-up. In a subgroup of subjects, we used Navigated Brain Stimulation (NBS) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization.

Results: Results from the system’s recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group (1.53, SD 2.4 in Chedoke Arm and Hand Activity Inventory). However, functional improvements did not reach clinical significance. After the therapy, physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere, that is, abductor pollicis brevis. We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere, which strongly correlated with improvements in clinical scales.

Conclusions: These findings suggest that, in chronic stages, remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes.

Introduction

After initial hospitalization, many stroke patients return home relatively soon despite still suffering from impairments that require continuous rehabilitation [1]. Therefore, ¼ to ¾ of patients display persistent functional limitations for a period of 3 to 6 months after stroke [2]. Although clinicians may prescribe a home exercise regimen, reports indicate that only one-third of patients actually accomplish it [3]. Consequently, substantial gains in health-related quality of life during inpatient stroke rehabilitation may be followed by equally substantial declines in the 6 months after discharge [4]. Multiple studies have shown, however, that supported discharge combined with at home rehabilitation services does not compromise clinical inpatient outcomes [57] and may enhance recovery in subacute stroke patients [8]. Hence, it is essential that new approaches are deployed that help to manage chronic conditions associated with stroke, including domiciliary interventions [9] and the augmentation of current rehabilitation approaches in order to enhance their efficiency. There should be increased provision of home-based rehabilitation services for community-based adults following stroke, taking cost-effectiveness, and a quick family and social reintegration into account [10].

One of the latest approaches in rehabilitation science is based on the use of robotics and virtual reality (VR), which allow remote delivery of customized treatment by combining dedicated interface devices with automatized training scenarios [1012]. Several studies have tested the acceptability of VR-based setups as an intervention and evaluation tool for rehabilitation [1315]. One example of this technology is the, so called, Rehabilitation Gaming System (RGS) [16], which has been shown to be effective in the rehabilitation of the upper extremities in the acute and the chronic phases of stroke [13]. However, so far little work exists on the quantitative assessment of the clinical impact of VR based approaches and their effects on neural reorganization that can directly inform the design of these systems and their application in the domiciliary context. The main objective of this paper is to further explore the potential and limitations of VR technologies in domiciliary settings. Specifically, we examine the efficacy of a VR-based therapy when used at home for (1) assessing functional improvement, (2) facilitating functional recovery of the upper-limbs, and (3) inducing cortical reorganization. This is the first study testing the effects of VR-based therapy on cortical reorganization and corticospinal integrity using NBS.

Methods

Design

We conducted a parallel-group, controlled trial in order to compare the effectiveness of domiciliary VR-based therapy versus domiciliary occupational therapy (OT) in inducing functional recovery and cortical reorganization in chronic stroke patients.

Participants

Participants were first approached by an occupational therapist from the rehabilitation units of Hospital Esperanza and Hospital Vall d’Hebron from Barcelona to determine their interest in participating in a research project. Recruited participants met the following inclusion criteria: (1) mild-to-moderate upper-limbs hemiparesis (Proximal MRC>2) secondary to a first-ever stroke (>12 months post-stroke), (2) age between 45 and 85 years old, (3) absence of any major cognitive impairment (Mini-Mental State Evaluation, MMSE>22), and (4) previous experience with RGS in the clinic. The ethics committee of clinical research of the Parc de Salut Mar and Vall d’Hebron Research Institute approved the experimental guidelines. Thirty-nine participants at the chronic stage post-stroke were recruited for the study by two occupational therapists, between October 2011 and January 2012, and were assigned to a RGS (n=20) or a control group (n=19) using stratified permuted block randomization methods for balancing the participants’ demographics and clinical scores at baseline (Table 1). One participant in the RGS group refused to participate. Prior to the experiment, participants signed informed consent forms. This trial was not registered at or before the onset of participants’ enrollment because it is a pilot study that evaluates the feasibility of a prototype device. However, this study was registered retrospectively in ClinicalTrials.gov and has the identifier NCT02699398.

Instrumentation

Description of the Rehabilitation Gaming System

The RGS integrates a paradigm of goal-directed action execution and motor imagery [17], allowing the user to control a virtual body (avatar) through an image capture device (Figure 1). For this study, we developed training and evaluation scenarios within the RGS framework. In the Spheroids training scenario (Figure 1), the user has to perform bilateral reaching movements to intercept and grasp a maximum number of spheres moving towards him [16]. RGS captures only joint flexion and extension and filters out the participant’s trunk movements, therefore preventing the execution of compensatory body movements [18]. This task was defined by three difficulty parameters, each of them associated with a specific performance descriptor: (1) different trajectories of the spheres require different ranges of joint motion for elbow and shoulder, (2) the size of the spheres require different hand and grasp precision and perceptual abilities, and (3) the velocity of the spheres require different movement speeds and timing. All these parameters, also including the range of finger flexion and extension required to grasp and release spheroids, were dynamically modulated by the RGS Adaptive Difficulty Controller [19] to maintain the performance ratio (ie, successful trials over the total trials) above 0.6 and below 0.8, optimizing effort and reinforcement during training [20]. […]

Figure 1. Experimental setup and protocol: (A) Movements of the user’s upper limbs are captured and mapped onto an avatar displayed on a screen in first person perspective so that the user sees the movements of the virtual upper extremities. A pair of data gloves equipped with bend sensors captures finger flexion. (B) The Spheroids is divided into three subtasks: hit, grasp, and place. A white separator line divides the workspace in a paretic and non-paretic zone only allowing for ipsilateral movements.(C) The experimental protocol. Evaluation periods (Eval.) indicate clinical evaluations using standard clinical scales and Navigated Brain Stimulation procedures (NBS). These evaluations took place before the first session (W0), after the last session of the treatment (day 15, W3), and at follow-up (week 12, W12).

Continue —>  JSG-Domiciliary VR-Based Therapy for Functional Recovery and Cortical Reorganization: Randomized Controlled Trial in Participants at the Chronic Stage Post Stroke | Ballester | JMIR Serious Games

, , , , , , , , , , ,

Leave a comment

%d bloggers like this: