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Journal of NeuroEngineering and Rehabilitation
Published in: Journal of NeuroEngineering and Rehabilitation 1/2012

Open Access 01-12-2012 | Research

Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm

Authors: Youn Joo Kang, Hae Kyung Park, Hyun Jung Kim, Taeo Lim, Jeonghun Ku, Sangwoo Cho, Sun I Kim, Eun Sook Park

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2012

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Abstract

Background

Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation. However, the underlying mechanisms for these therapeutic effects have not been previously described.

Objectives

We attempted to delineate the changes in corticospinal excitability when individuals were asked to exercise their upper extremity using a real mirror and virtual mirror. Moreover, we attempted to delineate the role of visual modulation within the virtual environment that affected corticospinal excitability in healthy subjects and stroke patients.

Methods

A total of 18 healthy subjects and 18 hemiplegic patients were enrolled into the study. Motor evoked potential (MEP)s from transcranial magnetic stimulation were recorded in the flexor carpi radialis of the non-dominant or affected upper extremity using three different conditions: (A) relaxation; (B) real mirror; and (C) virtual mirror. Moreover, we compared the MEPs from the virtual mirror paradigm using continuous visual feedback or intermittent visual feedback.

Results

The rates of amplitude increment and latency decrement of MEPs in both groups were higher during the virtual mirror task than during the real mirror. In healthy subjects and stroke patients, the virtual mirror task with intermittent visual feedback significantly facilitated corticospinal excitability of MEPs compared with continuous visual feedback.

Conclusion

Corticospinal excitability was facilitated to a greater extent in the virtual mirror paradigm than in the real mirror and in intermittent visual feedback than in the continuous visual feedback, in both groups. This provides neurophysiological evidence supporting the application of the virtual mirror paradigm using various visual modulation technologies to upper extremity rehabilitation in stroke patients.
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Literature
1.
2.
Page SJ, Sisto S, Johnston MV, Levine P, Hughes M: Modified constraint-induced therapy in subacute stroke: a case report. Arch Phys Med Rehabil 2002, 83: 286-290. 10.1053/apmr.2002.28007CrossRefPubMed
3.
Krakauer JW: Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol 2006, 19: 84-90. 10.1097/01.wco.0000200544.29915.ccCrossRefPubMed
4.
Oujamaa L, Relave I, Froger J, Mottet D, Pelissier JY: Rehabilitation of arm function after stroke. Literature review. Ann Phys Rehabil Med 2009, 52: 269-293.CrossRefPubMed
5.
Ramachandran VS, Rogers-Ramachandran D: Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci 1996, 263: 377-386. 10.1098/rspb.1996.0058CrossRefPubMed
6.
Dohle C, Pullen J, Nakaten A, Kust J, Rietz C, Karbe H: Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair 2009, 23: 209-217.CrossRefPubMed
7.
Yavuzer G, Selles R, Sezer N, Sutbeyaz S, Bussmann JB, Koseoglu F, Atay MB, Stam HJ: Mirror therapy improves hand function in subacute stroke: a randomized controlled trial. Arch Phys Med Rehabil 2008, 89: 393-398. 10.1016/j.apmr.2007.08.162CrossRefPubMed
8.
Lucca LF: Virtual reality and motor rehabilitation of the upper limb after stroke: a generation of progress? J Rehabil Med 2009, 41: 1003-1100. 10.2340/16501977-0405CrossRefPubMed
9.
Saposnik G, Teasell R, Mamdani M, Hall J, McIlroy W, Cheung D, Thorpe KE, Cohen LG, Bayley M: Effectiveness of virtual reality using Wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle. Stroke 2010, 41: 1477-1484. 10.1161/STROKEAHA.110.584979CrossRefPubMed
10.
Calautti C, Naccarato M, Jones PS, Sharma N, Day DD, Carpenter AT, Bullmore ET, Warburton EA, Baron JC: The relationship between motor deficit and hemisphere activation balance after stroke: a 3 T fMRI study. NeuroImage 2007, 34: 322-331. 10.1016/j.neuroimage.2006.08.026CrossRefPubMed
11.
Talelli P, Greenwood RJ, Rothwell JC: Arm function after stroke: neurophysiological correlates and recovery mechanisms assessed by transcranial magnetic stimulation. Clin Neurophysiol 2006, 117: 1641-1659. 10.1016/j.clinph.2006.01.016CrossRefPubMed
12.
13.
Hallett M: Transcranial magnetic stimulation and the human brain. Nature 2000, 406: 147-150. 10.1038/35018000CrossRefPubMed
14.
Leonard G, Tremblay F: Corticomotor facilitation associated with observation, imagery and imitation of hand actions: a comparative study in young and old adults. Exp Brain Res 2007, 177: 167-175. 10.1007/s00221-006-0657-6CrossRefPubMed
15.
Wassermann EM: Variation in the response to transcranial magnetic brain stimulation in the general population. Clin Neurophysiol 2002, 113: 1165-1171. 10.1016/S1388-2457(02)00144-XCrossRefPubMed
16.
Rossini PM, Barker AT, Berardelli A, Caramia MD, Caruso G, Cracco RQ, Dimitrijevic MR, Hallett M, Katayama Y, Lucking CH, et al.: Non-invasive electrical and magnetic stimulation of the brain, spinal cord and roots: basic principles and procedures for routine clinical application. Report of an IFCN committee. Electroencephalogr Clin Neurophysiol 1994, 91: 79-92. 10.1016/0013-4694(94)90029-9CrossRefPubMed
17.
Fukumura K, Sugawara K, Tanabe S, Ushiba J, Tomita Y: Influence of mirror therapy on human motor cortex. Int J Neurosci 2007, 117: 1039-1048. 10.1080/00207450600936841CrossRefPubMed
18.
Nielsen JF: Logarithmic distribution of amplitudes of compound muscle action potentials evoked by transcranial magnetic stimulation. J Clin Neurophysiol 1996, 13: 423-434. 10.1097/00004691-199609000-00005CrossRefPubMed
19.
Perani D, Fazio F, Borghese NA, Tettamanti M, Ferrari S, Decety J, Gilardi MC: Different brain correlates for watching real and virtual hand actions. NeuroImage 2001, 14: 749-758. 10.1006/nimg.2001.0872CrossRefPubMed
20.
Tai YF, Scherfler C, Brooks DJ, Sawamoto N, Castiello U: The human premotor cortex is 'mirror' only for biological actions. Current biology: CB 2004, 14: 117-120. 10.1016/j.cub.2004.01.005CrossRefPubMed
21.
Gazzola V, Rizzolatti G, Wicker B, Keysers C: The anthropomorphic brain: the mirror neuron system responds to human and robotic actions. NeuroImage 2007, 35: 1674-1684. 10.1016/j.neuroimage.2007.02.003CrossRefPubMed
22.
Donne CM, Enticott PG, Rinehart NJ, Fitzgerald PB: A transcranial magnetic stimulation study of corticospinal excitability during the observation of meaningless, goal-directed, and social behaviour. Neurosci Lett 2011, 489: 57-61. 10.1016/j.neulet.2010.11.067CrossRefPubMed
23.
Enticott PG, Kennedy HA, Bradshaw JL, Rinehart NJ, Fitzgerald PB: Motor corticospinal excitability during the observation of interactive hand gestures. Brain Res Bull 2011, 85: 89-95. 10.1016/j.brainresbull.2011.03.018CrossRefPubMed
24.
Stedman A, Davey NJ, Ellaway PH: Facilitation of human first dorsal interosseous muscle responses to transcranial magnetic stimulation during voluntary contraction of the contralateral homonymous muscle. Muscle Nerve 1998, 21: 1033-1039. 10.1002/(SICI)1097-4598(199808)21:8<1033::AID-MUS7>3.0.CO;2-9CrossRefPubMed
25.
Strafella AP, Paus T: Modulation of cortical excitability during action observation: a transcranial magnetic stimulation study. Neuroreport 2000, 11: 2289-2292. 10.1097/00001756-200007140-00044CrossRefPubMed
26.
Winstein CJ, Grafton ST, Pohl PS: Motor task difficulty and brain activity: investigation of goal-directed reciprocal aiming using positron emission tomography. J Neurophysiol 1997, 77: 1581-1594.PubMed
27.
Smyth C, Summers JJ, Garry MI: Differences in motor learning success are associated with differences in M1 excitability. Hum Mov Sci 2010, 29: 618-630. 10.1016/j.humov.2010.02.006CrossRefPubMed
28.
Shams L, Seitz AR: Benefits of multisensory learning. Trends Cogn Sci 2008, 12: 411-417. 10.1016/j.tics.2008.07.006CrossRefPubMed
29.
Grafton ST, Schmitt P, Van Horn J, Diedrichsen J: Neural substrates of visuomotor learning based on improved feedback control and prediction. NeuroImage 2008, 39: 1383-1395. 10.1016/j.neuroimage.2007.09.062PubMedCentralCrossRefPubMed
30.
Ku J, Lee JH, Han K, Kim SI, Kang YJ, Park ES: Validity and reliability of cognitive assessment using virtual environment technology in patients with stroke. Am J Phys Med Rehab 2009, 88: 702-710. 10.1097/PHM.0b013e3181aa427dCrossRef
31.
Kim JH, Jang SH, Kim CS, Jung JH, You JH: Use of virtual reality to enhance balance and ambulation in chronic stroke: a double-blind, randomized controlled study. Am J Phys Med Rehab 2009, 88: 693-701. 10.1097/PHM.0b013e3181b33350CrossRef
Metadata
Title
Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm
Authors
Youn Joo Kang
Hae Kyung Park
Hyun Jung Kim
Taeo Lim
Jeonghun Ku
Sangwoo Cho
Sun I Kim
Eun Sook Park
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Journal of NeuroEngineering and Rehabilitation / Issue 1/2012
Electronic ISSN: 1743-0003
DOI
https://doi.org/10.1186/1743-0003-9-71

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