Electrophysiological Correlates of Virtual-Reality Applications in the Rehabilitation Setting: New Perspectives for Stroke Patients

Francesco Arcuri,Antonio Cerasa,Camillo Porcaro,Paolo Tonin,Irene Ciancarelli

doi:10.3390/electronics10070836

Abstract

Here we reviewed the last evidence on the application of electroencephalography (EEG) as a non-invasive and portable neuroimaging method useful to extract hallmarks of neuroplasticity induced by virtual reality (VR) rehabilitation approaches in stroke patients. In the neurorehabilitation context, VR training has been used extensively to hamper the effects of motor treatments on the stroke’s brain. The concept underlying VR therapy is to improve brain plasticity by engaging users in multisensory training. In this narrative review, we present the key concepts of VR protocols applied to the rehabilitation of stroke patients and critically discuss challenges of EEG signal when applied as endophenotype to extract neurophysiological markers. When VR technology was applied to magnify the effects of treatments on motor recovery, significant EEG-related neural improvements were detected in the primary motor circuit either in terms of power spectral density or as time-frequency domains.

Highlights

As a non-invasive and portable neuroimaging method useful to extract hallmarks of neuroplasticity induced by virtual reality (VR) rehabilitation approaches in stroke patients
The International Classification of Functioning, Disability, and Health (ICF) [2] produced a transition from an exclusive neurophysiological focus to an inclusive rehabilitation perspective [3], based on the classification of three levels of human functions: (1) body level, (2) whole person, and (3) person in a social context [4]. This approach ensures the improvement of quality of life (QOF) and the performance of Advanced technology is increasingly being applied in neurorehabilitation to potentiate conventional treatments, reduce neurological disability, and improve global functions
EEG has overcome many of the functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS) limitations, becoming the best candidate for monitoring stroke patients in a VR setting

Summary

Advanced Neurorehabilitation Systems for Recovering Patients with Stroke

The great challenge of the survivors of stroke is to address the long-term consequences as sensory, motor, cognitive, and visual impairments These neurological deficits are the main rehabilitation targets since these reduce the ability of individuals to perform activities of daily living (ADL) [1]. It is worth noting that the learning of new motor tasks depends on the feedback originated from the performance This concept has grounded the rationale of VR application [16]. To stimulate and encourage VR applications as an alternative and/or complementary treatment in a rehabilitation setting, Tieri et al [23] highlight the importance of VEs as a valid instrument to enhance implicit learning during robot-assisted rehabilitation and to increase the level of compliance in neurological patients [24], while the exploitation of the augmented feedback during motor/cognitive tasks can facilitate the reacquisition of motor abilities [16]. It should be considered that the employment of VR applications may have a positive influence on the Healthy System in terms of optimization of professional resources [16]

Looking for Endophenotypes of Recovery

EEG Reveals Neurophysiological Correlates of Neurorehabilitation with VR

Findings

Conclusions