A Case Series Clinical Trial of a Novel Approach Using Augmented Reality That Inspires Self-body Cognition in Patients With Stroke: Effects on Motor Function and Resting-State Brain Functional Connectivity.

Fuminari Kaneko,Keiichiro Shindo,Masaki Yoneta,Meigen Liu,Kazuto Akaboshi,Megumi Okawada

doi:10.3389/fnsys.2019.00076

Abstract

Barring a few studies, there are not enough established treatments to improve upper limb motor function in patients with severe impairments due to chronic stroke. This study aimed to clarify the effect of the kinesthetic perceptional illusion induced by visual stimulation (KINVIS) on upper limb motor function and the relationship between motor function and resting-state brain networks. Eleven patients with severe paralysis of upper limb motor function in the chronic phase (seven men and four women; age: 54.7 ± 10.8 years; 44.0 ± 29.0 months post-stroke) participated in the study. Patients underwent an intervention consisting of therapy using KINVIS and conventional therapeutic exercise (TherEX) for 10 days. Our originally developed KiNvis™ system was applied to induce KINVIS while watching the movement of the artificial hand. Clinical outcomes were examined to evaluate motor functions and resting-state brain functional connectivity (rsFC) by analyzing blood-oxygen-level-dependent (BOLD) signals measured using functional magnetic resonance imaging (fMRI). The outcomes of motor function (Fugle-Meyer Assessment, FMA) and spasticity (Modified Ashworth Scale, MAS) significantly improved after the intervention. The improvement in MAS scores for the fingers and the wrist flexors reached a minimum of clinically important differences. Before the intervention, strong and significant negative correlations between the motor functions and rsFC of the inferior parietal lobule (IPL) and premotor cortex (PMd) in the unaffected hemisphere was demonstrated. These strong correlations were disappeared after the intervention. A negative and strong correlation between the motor function and rsFC of the bilateral inferior parietal sulcus (IPS) significantly changed to strong and positive correlation after the intervention. These results may suggest that the combination approach of KINVIS therapy and TherEX improved motor functions and decreased spasticity in the paralyzed upper extremity after stroke in the chronic phase, possibly indicating the contribution of embodied-visual stimulation. The rsFC for the interhemispheric IPS and intrahemispheric IPL and PMd may be a possible regulatory factor for improving motor function and spasticity.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01274117.

Highlights

Upper extremity motor function after stroke recovers in only 50% of all survivors at 6 months post-stroke (Kwakkel et al, 2003)
This study primarily focused on exploring whether the resting-state brain functional connectivity (rsFC) and motor functions would be indicated or whether the intervention in the patients with stroke would influence these relationships
As we expected from our preliminary study (Kaneko et al, 2016a), the motor functions examined with Fugl-Meyer assessment (FMA) and Modified Ashworth Scale (MAS) improved after the therapeutic intervention period

Summary

Introduction

Upper extremity motor function after stroke recovers in only 50% of all survivors at 6 months post-stroke (Kwakkel et al, 2003). Mirror therapy (Dohle et al, 2009), mental practice (Page et al, 2007), and virtual reality therapy (Klamroth-Marganska et al, 2014) are shown to have beneficial effects with moderatequality evidence (Pollock et al, 2014) All these therapies have been implemented in patients with dexterity (Kwakkel et al, 2003; Langhorne and Legg, 2003; Wolf et al, 2006; Page et al, 2007; Dohle et al, 2009; Klamroth-Marganska et al, 2014; Pollock et al, 2014). A few influential results have been reported, other significant therapeutic approaches for patients with chronic stroke should be developed

Objectives

Results

Discussion

Conclusion