Abstract

Finger flexor spasticity, which is commonly observed among patients with stroke, disrupts finger extension movement, consequently influencing not only upper limb function in daily life but also the outcomes of upper limb therapeutic exercise. Kinesthetic illusion induced by visual stimulation (KINVIS) has been proposed as a potential treatment for spasticity in patients with stroke. However, it remains unclear whether KINVIS intervention alone could improve finger flexor spasticity and finger extension movements without other intervention modalities. Therefore, the current study investigated the effects of a single KINVIS session on finger flexor spasticity, including its underlying neurophysiological mechanisms, and finger extension movements. To this end, 14 patients who experienced their first episode of stroke participated in this study. A computer screen placed over the patient’s forearm displayed a pre-recorded mirror image video of the patient’s non-paretic hand performing flexion–extension movements during KINVIS. The position and size of the artificial hand were adjusted appropriately to create a perception that the artificial hand was the patient’s own. Before and after the 20-min intervention, Modified Ashworth Scale (MAS) scores and active range of finger extension movements of the paretic hand were determined. Accordingly, MAS scores and active metacarpophalangeal joint extension range of motion improved significantly after the intervention. Moreover, additional experimentation was performed using F-waves on eight patients whose spasticity was reduced by KINVIS to determine whether the same intervention also decreased spinal excitability. Our results showed no change in F-wave amplitude and persistence after the intervention. These results demonstrate the potential clinical significance of KINVIS as a novel intervention for improving finger flexor spasticity and extension movements, one of the most significant impairments among patients with stroke. The decrease in finger flexor spasticity following KINVIS may be attributed to neurophysiological changes not detectable by the F-wave, such as changes in presynaptic inhibition of Ia afferents. Further studies are certainly needed to determine the long-term effects of KINVIS on finger spasticity, as well as the neurophysiological mechanisms explaining the reduction in spasticity.

Highlights

  • Stroke, one of the most prevalent neurological diseases worldwide, causes long-term motor impairment

  • A preliminary study examining the effects of kinesthetic illusion induced by visual stimulation (KINVIS) among post-stroke patients reported that the single intervention session increased beta band event-related desynchronization obtained from sensorimotor cortex during motor imagery (Okawada et al, 2020), as well as improved paretic upper limb motor function (Kaneko et al, 2016a)

  • A study of 11 stroke patients who underwent 10 days of rehabilitation that included KINVIS reported a significant reduction in the spasticity of the finger and wrist flexor muscles and improved upper limb motor function after the intervention (Kaneko et al, 2019)

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Summary

Introduction

One of the most prevalent neurological diseases worldwide, causes long-term motor impairment. Impaired finger extension movement due to spasticity has been assumed to potentially interfere with motor function improvement by increasing the difficultly of therapeutic exercise. Developing new rehabilitation techniques to reduce finger flexor spasticity may increase the efficiency of therapeutic exercise by improving finger extension movements, thereby contributing to improved performance of ADLs. Mirror therapy has been one of the proposed treatments for upper limb paralysis after stroke (Altschuler et al, 1999). A study of 11 stroke patients who underwent 10 days of rehabilitation that included KINVIS reported a significant reduction in the spasticity of the finger and wrist flexor muscles and improved upper limb motor function after the intervention (Kaneko et al, 2019). We investigated the relationship between changes in spasticity and active range of finger extension, as well as whether subjective illusory sensation and body ownership of the virtual hand presented in the video affected changes in spasticity and active range of finger extension

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