Abstract
Stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function, and connections is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. It has been shown that active cortical participation in a closed-loop brain machine interface (BMI) can induce neuroplasticity in cortical networks where the brain acts as a controller, e.g., during a visuomotor task. Here, the motor task can be assisted with neuromuscular electrical stimulation (NMES) where the BMI will act as a real-time decoder. However, the cortical control and induction of neuroplasticity in a closed-loop BMI is also dependent on the state of brain, e.g., visuospatial attention during visuomotor task performance. In fact, spatial neglect is a hidden disability that is a common complication of stroke and is associated with prolonged hospital stays, accidents, falls, safety problems, and chronic functional disability. This hypothesis and theory article presents a multi-level electrotherapy paradigm toward motor rehabilitation in virtual reality that postulates that while the brain acts as a controller in a closed-loop BMI to drive NMES, the state of brain can be can be altered toward improvement of visuomotor task performance with non-invasive brain stimulation (NIBS). This leads to a multi-level electrotherapy paradigm where a virtual reality-based adaptive response technology is proposed for post-stroke balance rehabilitation. In this article, we present a conceptual review of the related experimental findings.
Highlights
Stroke, defined as an episode of neurological dysfunction caused by focal cerebral, spinal, or retinal infarction, is a global health problem and fourth leading cause of disability worldwide (Strong et al, 2007; Sacco et al, 2013)
Post-stroke biopotentials often suffer from deficits, e.g., EMG suffers from delays in initiation/termination (Chae et al, 2002) as well as fatigue, and solely biopotentials based control of a Neuromuscular Electrical Stimulation (NMES)-assisted dynamic balance task is challenging where such activation delays may result in falls
According to the “feedforward models” for the visuomotor task, the predicted position of the cursor is compared with the actual position of the cursor with respect to the reaching goal and online-corrected if the parameters deviate due to noise
Summary
Stroke, defined as an episode of neurological dysfunction caused by focal cerebral, spinal, or retinal infarction, is a global health problem and fourth leading cause of disability worldwide (Strong et al, 2007; Sacco et al, 2013). Post-stroke impaired reciprocal inhibition between antagonistic muscles may be strengthened via increased presynaptic inhibition of group Ia-afferents under operant conditioning with visual feedback Post-stroke biopotentials often suffer from deficits, e.g., EMG suffers from delays in initiation/termination (Chae et al, 2002) as well as fatigue, and solely biopotentials based control of a NMES-assisted dynamic balance task is challenging where such activation delays may result in falls Such faults may be alleviated through sensor fusion with physical sensor signals (Dutta et al, 2011). NMES, Neuromuscular Electrical Stimulation; EMG, Electromyogram; EEG, Electroencephalogram; CoP, Center of Pressure; PC, Personal Computer
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