Abstract
BackgroundSeveral 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.ObjectivesWe 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.MethodsA 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.ResultsThe 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.ConclusionCorticospinal 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.
Highlights
Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation
In healthy subjects and stroke patients, the virtual mirror task with intermittent visual feedback significantly facilitated corticospinal excitability of Motor evoked potential (MEP) compared with continuous visual feedback
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
Summary
Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation. After a stroke, more than 50% of patients report continuous disability of upper extremity function: even after conventional treatment, and. New treatment methods for upper extremity rehabilitation, based on the motor learning theory, are being assessed. Representative treatment methods that have been emerging recently include the constraint-induced movement theory, robot-arm training, training using virtual reality (VR), mental practice, and mirror therapy [3]. Many studies have applied this therapy to hemiplegic patients, to investigate and validate its clinical effects based on the hypothesis that the visual illusion evoked by the mirror reflection of the unaffected arm, while blocking the visualization of the affected arm, would improve the motor abilities of these patients [6,7]. Some disadvantages of this method have been noticed, based on reduced clinical compliance for stroke patients
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