Mirror Visual Feedback Research Articles

The effect of mirror therapy in patients with frozen shoulder.

This study was designed to compare mirror therapy and visual feedback with the control group in adhesive capsulitis patients. Thirty-six patients, divided into three groups as mirror therapy, visual feedback and control for 15 sessions of treatment. Evaluations were made before treatment, at 6th and 10th weeks. Bilateral glenohumeral exercise was performed at the end of each session with the affected extremity behind the mirror in the mirror group, with both upper extremities in front of the mirror in the visual feedback group, and without the mirror in the control group. There were statistically significant differences between the mirror therapy and visual feedback in terms of pain severity change, and the visual feedback was superior to the change in pain severity compared to the control. Visual feedback showed significant improvement in mean change from baseline to week 10 in shoulder pain and disability index scores compared to control (p = 0.012). There was no significant difference between the groups in terms of modified constant score, proprioception and shoulder range of motion. It was determined that the exercises performed by seeing the affected extremity in the mirror were more effective than mirror therapy and control group.

Priming Intermittent Theta Burst Stimulation for Hemiparetic Upper Limb After Stroke: A Randomized Controlled Trial.

Intermittent theta burst stimulation (iTBS) creates a state with increased excitability that permits treatment modalities to induce neuroplasticity and motor learning. Continuous theta burst stimulation before iTBS may induce metaplasticity and boost the facilitatory effect of iTBS. This study investigated the effects of priming iTBS (ie, applying continuous theta burst stimulation before iTBS) on poststroke hemiparetic upper limb recovery. In this randomized controlled trial, 42 patients with chronic stroke were recruited and randomly allocated to 10 sessions of either priming iTBS, nonpriming iTBS, or sham stimulation to the ipsilesional motor cortex, immediately before robot-assisted training. Outcomes included Fugl-Meyer Assessment-Upper Extremity, Action Research Arm Test and mean movement velocity during each robot-assisted training session. Twenty-one patients were enrolled for measuring the sensorimotor beta event-related desynchronization induced by either mirror visual feedback or movement. The Fugl-Meyer Assessment-Upper Extremity scores revealed a significant time-by-group interaction (P=0.011). Priming and nonpriming iTBS were both superior to sham stimulation in post hoc comparisons; however, the superiority was diminished at follow-up. Among patients with a higher functioning upper limb, priming iTBS yielded a significantly greater improvement in Fugl-Meyer Assessment-Upper Extremity scores than nonpriming iTBS (P=0.025) and sham stimulation (P=0.029) did. No significant interaction was found when analyzing the Action Research Arm Test and mean movement velocity. Priming iTBS enhanced the patients' mirror visual feedback-induced high beta sensorimotor event-related desynchronization over their ipsilesional hemisphere. Priming and nonpriming iTBS are both superior to sham stimulation in enhancing treatment gains from robot-assisted training, and patients with a higher functioning upper limb may experience more benefits from priming iTBS. Priming iTBS may facilitate poststroke motor learning by enhancing the permissiveness of the ipsilesional sensorimotor area to therapeutic sensory modalities, such as the mirror visual feedback. URL: https://www. gov; Unique identifier: NCT04034069.

Development and Testing of a Portable Virtual Reality-Based Mirror Visual Feedback System with Behavioral Measures Monitoring.

Virtual Reality (VR) is a technology that has been used to provide the Mirror Visual Feedback (MVF) illusion to patients with promising results. In the present work, the goal is to design, develop and test a portable VR-based MVF system that monitors behavioral information about the performance of a simple motor task. The developed application runs in a stand-alone VR system and allows the researcher to select the real and virtual hands used to perform the motor task. The system was evaluated with a group of twenty healthy volunteers (12 men and 8 women) with ages between 18 and 66 years. Participants had to repetitively perform a motor task in four different experimental conditions: two mirror conditions (performing real movements with the dominant and with the non-dominant hand) and two non-mirror conditions. A significant effect of the experimental condition on embodiment score (p < 0.001), response time (p < 0.001), performance time (p < 0.001), trajectory length (p < 0.004) and trajectory maximum horizontal deviation (p < 0.001) was observed. Furthermore, a significant effect of the experimental moment (initial, middle and final parts of the training) on the performance time was observed (p < 0.001). These results show that the monitored parameters provide relevant information to evaluate the participant’s task performance in different experimental conditions.

Synergistic Immediate Cortical Activation on Mirror Visual Feedback Combined With a Soft Robotic Bilateral Hand Rehabilitation System: A Functional Near Infrared Spectroscopy Study.

BackgroundMirror visual feedback (MVF) has been widely used in neurological rehabilitation. Due to the potential gain effect of the MVF combination therapy, the related mechanisms still need be further analyzed.MethodsOur self-controlled study recruited 20 healthy subjects (age 22.150 ± 2.661 years) were asked to perform four different visual feedback tasks with simultaneous functional near infrared spectroscopy (fNIRS) monitoring. The right hand of the subjects was set as the active hand (performing active movement), and the left hand was set as the observation hand (static or performing passive movement under soft robotic bilateral hand rehabilitation system). The four VF tasks were designed as RVF Task (real visual feedback task), MVF task (mirror visual feedback task), BRM task (bilateral robotic movement task), and MVF + BRM task (Mirror visual feedback combined with bilateral robotic movement task).ResultsThe beta value of the right pre-motor cortex (PMC) of MVF task was significantly higher than the RVF task (RVF task: -0.015 ± 0.029, MVF task: 0.011 ± 0.033, P = 0.033). The beta value right primary sensorimotor cortex (SM1) in MVF + BRM task was significantly higher than MVF task (MVF task: 0.006 ± 0.040, MVF + BRM task: 0.037 ± 0.036, P = 0.016).ConclusionOur study used the synchronous fNIRS to compare the immediate hemodynamics cortical activation of four visual feedback tasks in healthy subjects. The results showed the synergistic gain effect on cortical activation from MVF combined with a soft robotic bilateral hand rehabilitation system for the first time, which could be used to guide the clinical application and the future studies.

Improvements of Physical Activity Performance and Motivation in Adult Men through Augmented Reality Approach: A Randomized Controlled Trial.

The COVID-19 pandemic had a global impact, increasing the prevalence of physical inactivity, which is mostly due to the lockdown and social distancing measures adopted during the pandemic. Hence, this study aimed to compare the efficacy of augmented reality-based training on physical activity performance and motivation in healthy adults to mirror visual feedback training and conventional physical therapy. This study used the randomized control trial pretest-posttest research design. Forty-eight healthy men aged 18–35 years who were engaged in recreational physical activities were enrolled and randomly divided into four groups: augmented reality-based training reality (ART), mirror visual feedback training (MVFT), therapist-based training (TBT), and control group. The total training program was held for four weeks. The isokinetic dynamometer, sit-and-reach test, Y balance test, and the intrinsic motivation inventory-22 were used to measure the outcomes before and after the intervention. Paired sample t-test was used to compare the changes before and after the intervention within groups, while the one-way ANOVA was used for the comparison between the groups. Results of the study showed that, after four weeks of intervention, balance, muscle strength, and muscle endurance in all groups significantly improved except for the control group. The ART group showed the highest increase in muscle strength, muscle endurance, and balance compared to the other groups. The motivation level increased in all three feedback groups and was observed in the following order: ART group > MVFT group > TBT group > control group. This study highlighted the most effective method that may be applied for home training during and after this period of the pandemic. The findings revealed that training while receiving real-time feedback via AR devices improves both physical performance and motivation. Augmented reality-based training can be used as an effective training option for improving physical activity and motivation and can be suggested for home training programs.

Associated Mirror Therapy Enhances Motor Recovery of the Upper Extremity and Daily Function after Stroke: A Randomized Control Study.

Bimanual cooperation plays a vital role in functions of the upper extremity and daily activities. Based on the principle of bilateral movement, mirror therapy could provide bimanual cooperation training. However, conventional mirror therapy could not achieve the isolation of the mirror. A novel paradigm mirror therapy called associated mirror therapy (AMT) was proposed to achieve bimanual cooperation task-based mirror visual feedback isolating from the mirror. The study was aimed at exploring the feasibility and effectiveness of AMT on stroke patients. We conducted a single-blind, randomized controlled trial. Thirty-six eligible patients were equally assigned into the experimental group (EG) receiving AMT and the control group (CG) receiving bimanual training without mirroring for five days/week, lasting four weeks. The Fugl-Meyer Assessment Upper Limb subscale (FMA-UL) for upper extremity motor impairment was used as the primary outcome. The secondary outcomes were the Box and Block Test (BBT) and Functional Independence Measure (FIM) for motor and daily function. All patients participated in trials throughout without adverse events or side effects. The scores of FMA-UL and FIM improved significantly in both groups following the intervention. Compared to CG, the scores of FMA-UL and FIM were improved more significantly in EG after the intervention. The BBT scores were improved significantly for EG following the intervention, but no differences were found in the BBT scores of CG after the intervention. However, no differences in BBT scores were observed between the two groups. In summary, our study suggested that AMT was a feasible and practical approach to enhance the motor recovery of paretic arms and daily function in stroke patients. Furthermore, AMT may improve manual dexterity for poststroke rehabilitation.

Modulation of Functional Connectivity in Response to Mirror Visual Feedback in Stroke Survivors: An MEG Study.

Background. Several brain regions are activated in response to mirror visual feedback (MVF). However, less is known about how these brain areas and their connectivity are modulated in stroke patients. This study aimed to explore the effects of MVF on brain functional connectivity in stroke patients. Materials and Methods. We enrolled 15 stroke patients who executed Bilateral-No mirror, Bilateral-Mirror, and Unilateral-Mirror conditions. The coherence values among five brain regions of interest in four different frequency bands were calculated from magnetoencephalographic signals. We examined the differences in functional connectivity of each two brain areas between the Bilateral-No mirror and Bilateral-Mirror conditions and between the Bilateral-Mirror and Unilateral-Mirror conditions. Results. The functional connectivity analyses revealed significantly stronger connectivity between the posterior cingulate cortex and primary motor cortex in the beta band (adjusted p = 0.04) and possibly stronger connectivity between the precuneus and primary visual cortex in the theta band (adjusted p = 0.08) in the Bilateral-Mirror condition than those in the Bilateral-No mirror condition. However, the comparisons between the Bilateral-Mirror and Unilateral-Mirror conditions revealed no significant differences in cortical coherence in all frequency bands. Conclusions. Providing MVF to stroke patients may modulate the lesioned primary motor cortex through visuospatial and attentional cortical networks.

Effectiveness of Facial Neuromuscular Retraining with and without Mirror Visual Feedback in Patients with Bell's Palsy

Effectiveness of Facial Neuromuscular Retraining with and without Mirror Visual Feedback in Patients with Bell's Palsy

Mirror Visual Feedback Induces M1 Excitability by Disengaging Functional Connections of Perceptuo-Motor-Attentional Processes during Asynchronous Bimanual Movement: A Magnetoencephalographic Study.

Mirror visual feedback (MVF) has been shown to increase the excitability of the primary motor cortex (M1) during asynchronous bimanual movement. However, the functional networks underlying this process remain unclear. We recruited 16 healthy volunteers to perform asynchronous bimanual movement, that is, their left hand performed partial range of movement while their right hand performed normal full range of movement. Their ongoing brain activities were recorded by whole-head magnetoencephalography during the movement. Participants were required to keep both hands stationary in the control condition. In the other two conditions, participants were required to perform asynchronous bimanual movement with MVF (Asy_M) and without MVF (Asy_w/oM). Greater M1 excitability was found under Asy_M than under Asy_w/oM. More importantly, when receiving MVF, the visual cortex reduced its functional connection to brain regions associated with perceptuo-motor-attentional process (i.e., M1, superior temporal gyrus, and dorsolateral prefrontal cortex). This is the first study to demonstrate a global functional network of MVF during asynchronous bimanual movement, providing a foundation for future research to examine the neural mechanisms of mirror illusion in motor control.

Learning and Practicing Dance Phrases with and without a Mirror: A Comparative Study

ABSTRACT Mirror visual feedback increases neural activity, enhances performance, and induces neuroplasticity; however, mixed results have been observed during the learning of motor skills. While mirrors are commonplace in Western dance education, further research is needed to determine how mirrors are used when learning dance phrases. This study measured the movement accuracy and timing performance of 20 experienced dancers, randomly placed into three groups, with mirrors present/absent during different learning phases while learning thirty-two counts of modern dance movements. Results showed group one (mirrors during demonstration and explanation only), had the best accuracy, while group two (mirrors only during practice) had the best timing. Group three (mirrors during the demonstration and practice phase) had the most errors in accuracy and the second-most timing errors. These data suggest there may be learning benefits from removing the mirror during either the demonstration or the practice phase.

Movement-Related Cortical Potentials in Embodied Virtual Mirror Visual Feedback

Background: Mirror therapy is thought to drive interhemispheric communication, resulting in a balanced activation. We hypothesized that embodied virtual mirror visual feedback (VR-MVF) presented on a computer screen may produce a similar activation. In this proof-of-concept study, we investigated differences in movement-related cortical potentials (MRCPs) in the electroencephalogram (EEG) from different visual feedback of user movements in 1 stroke patient and 13 age-matched adults.Methods: A 60-year-old right-handed (Edinburgh score >95) male ischemic stroke [left paramedian pontine, National Institutes of Health Stroke Scale (NIHSS) = 6] patient and 13 age-matched right-handed (Edinburgh score >80) healthy adults (58 ± 9 years; six female) participated in the study. We recorded 16-electrode electroencephalogram (EEG), while participants performed planar center-out movements in two embodied visual feedback conditions: (i) direct (movements translated to the avatar's ipsilateral side) and (ii) mirror (movements translated to the avatar's contralateral side) with left (direct left/mirror left) or right (direct right/mirror right) arms.Results: As hypothesized, we observed more balanced MRCP hemispheric negativity in the mirror right compared to the direct right condition [statistically significant at the FC4 electrode; 99.9% CI, (0.81, 13)]. MRCPs in the stroke participant showed reduced lateralized negativity in the direct left (non-paretic) situation compared to healthy participants. Interestingly, the potentials were stronger in the mirror left (non-paretic) compared to direct left case, with significantly more bilateral negativity at FC3 [95% CI (0.758 13.2)] and C2 [95% CI (0.04 9.52)].Conclusions: Embodied mirror visual feedback is likely to influence bilateral sensorimotor cortical subthreshold activity during movement preparation and execution observed in MRCPs in both healthy participants and a stroke patient.

Event-Related Desynchronization During Mirror Visual Feedback: A Comparison of Older Adults and People After Stroke.

Event-related desynchronization (ERD), as a proxy for mirror neuron activity, has been used as a neurophysiological marker for motor execution after mirror visual feedback (MVF). Using EEG, this study investigated ERD upon the immediate effects of single-session MVF in unimanual arm movements compared with the ERD effects occurring without a mirror, in two groups: stroke patients with left hemiplegia and their healthy counterparts. During EEG recordings, each group performed one session of mirror therapy training in three task conditions: with a mirror, with no mirror, and with a covered mirror. An asymmetry index was calculated from the subtraction of the event-related spectrum perturbations between the C3 and C4 electrodes located over the sensorimotor cortices contralateral and ipsilateral to the moved arm. Results of the effect of task versus group in contralateral and ipsilateral motor areas showed that there was a significant effect of task condition at the contralateral motor area in the high beta band (17–35 Hz) at C3. High beta ERD showed that the suppression was greater over the contralateral hemisphere than it was over the ipsilateral hemisphere in both study groups. The magnitude of low beta (12–16 Hz) ERD in patients with stroke was more suppressed in contralesional C3 under the no mirror compared to that of the covered mirror and similarly more suppressed in ipsilesional C4 ERD under the no mirror compared to that of the mirror condition. The correlation analysis revealed that the magnitude of ERSP power correlated significantly with arm severity in the low and high beta bands in patients with stroke, and a higher asymmetry index in the low beta band was associated with higher arm functioning under the no-mirror condition. There was a shift in sensorimotor ERD toward the contralateral hemisphere as induced by MVF accompanying unimanual movement in both stroke patients and healthy controls. The use of ERD in the low beta band as a neurophysiological marker to indicate the relationships between the amount of MVF-induced ERD attenuation and motor severity, and the outcome indicator for improving stroke patients’ neuroplasticity in clinical trials using MVF are warranted to be explored in the future.

Assessing the Feasibility of an Open-Source Virtual Reality Mirror Visual Feedback Module for Complex Regional Pain Syndrome: Pilot Usability Study.

BackgroundComplex regional pain syndrome (CRPS) is a rare and severe chronic pain condition, with effective treatment options not established for many patients. The underlying pathophysiology remains unclear, but there is a growing appreciation for the role of central mechanisms which have formed the basis for brain-based therapies such as transcranial magnetic stimulation and mirror visual feedback (MVF). MVF has been deployed in the treatment of CRPS using both conventional mirrors and virtual reality (VR).ObjectiveThe aim of this study was to further investigate the use of VR in the treatment of patients with unilateral upper limb CRPS. VR has the potential advantage of more flexible and more motivating tasks, as well as the option of tracking patient improvement through the use of movement data.MethodsWe describe the development, acceptability, feasibility, and usability of an open-source VR program MVF module designed to be used with consumer VR systems for the treatment of CRPS. The development team was an interdisciplinary group of physical therapists, pain researchers, and VR researchers. Patients recruited from a pain clinic completed 3-5 visits each to trial the system and assessed their experiences in pre- and post-treatment questionnaires.ResultsAll 9 (100%) participants were able to use the system for 3, 4, or 5 trials each. None of the participants quit any trial due to cybersickness. All 9 (100%) participants reported interest in using the module in the future. Participants’ reported average pain scores in the affected limb were not significantly different from baseline during treatment or after treatment (P=.16). We did not find a statistically significant effect on participants’ self-reported average pain scores.ConclusionsWe propose that this module could be a useful starting point for modification and testing for other researchers. We share modifications to make this module usable with standalone headsets and finger tracking. Next steps include adapting this module for at-home use, or for use with participants with lower limb pain.

Ipsilateral and contralateral responses following unimanual fatigue with and without illusionary mirror visual feedback.

Illusionary mirror visual feedback alters interhemispheric communication and influences cross-limb interactions. Combining forceful unimanual contractions with the mirror illusion is a convenient way to provoke robust alterations within ipsilateral motor networks. It is unknown, however, if the mirror illusion affects cross-limb fatigability. We examine this concept by comparing the ipsilateral and contralateral handgrip force and electromyographic (EMG) responses following unimanual fatigue with and without illusionary mirror visual feedback. Participants underwent three experimental sessions (mirror, no-mirror, and control), performing a unimanual fatigue protocol with and without illusionary mirror visual feedback. Maximal handgrip force and EMG activity were measured before and after each session for both hands during maximal unimanual and bimanual contractions. The associated EMG activity from the inactive forearm during unimanual contraction was also examined. The novel findings demonstrate greater relative fatigability during bimanual versus unimanual contraction following unimanual fatigue (-31.8% vs. -23.4%, P < 0.01) and the mirror illusion attenuates this difference (-30.3% vs. -26.3%, P = 0.169). The results show no evidence for a cross-over effect of fatigue with (+0.62%, -2.72%) or without (+0.26%, -2.49%) the mirror illusion during unimanual or bimanual contraction. The mirror illusion resulted in significantly lower levels of associated EMG activity in the contralateral forearm. There were no sex differences for any of the measures of fatigability. These results demonstrate that the mirror illusion influences contraction-dependent fatigue during maximal handgrip contractions. Alterations in facilitatory and inhibitory transcallosal drive likely explain these findings.NEW & NOTEWORTHY Illusionary mirror visual feedback is a promising clinical tool for motor rehabilitation, yet many features of its influence on motor output are unknown. We show that maximal bimanual force output is compromised to a greater extent than unimanual force output following unimanual fatigue, yet illusionary mirror visual feedback attenuates this difference. The mirror illusion also reduces the unintended EMG activity of the inactive, contralateral forearm during unimanual contraction.

The effects of sensory re-education on hand function recovery after peripheral nerve repair: A systematic review.

Peripheral nerve injury can result in both sensory and motor deficits, and these impairments can last for a long period after nerve repair. To systematically review the effects of sensory re-education (SR) on facilitating hand function recovery after peripheral nerve repair. This systematic review was limited to articles published from 1970 to 20 December 2020. Electronic searching was performed in CINAHL, Embase, PubMed, Web of Science, and Medline databases to include trials investigating the effects of SR training on hand function recovery after peripheral nerve repair and included only those studies with controlled comparisons. Sixteen articles were included in final data synthesis. We found that only four studies could be rated as having good quality and noted obvious methodological limitations in the remaining studies. The current evidence showed that early SR with mirror visual feedback and the combinational use of classic SR and topical temporary anesthetic seemed to have long- and short-term effects, respectively on improving the sensibility and reducing the disabilities of the hand. The evidence to support the effects of conventional classical SR on improving hand functions was not strong. Further well-designed trials are needed to evaluate the effects of different SR techniques on hand function after nerve repair over short- and long-term periods.

Differential effects of minified and magnified mirror visual feedback on the underlying misperception of hand size

Perception of the size of body parts, for instance the hand, has been shown to be distorted in healthy participants, with over- and underestimations of width and length, respectively. Illusory manipulations of body shape and size have highlighted the flexibility of the body representation and have also been found to update immediate perceptions of body size and surrounding objects. Here, we examined whether underlying misperceptions of hand width and length can be modified through exposure to illusory changes in hand size using a mirror visual feedback (MVF) paradigm. While questionnaire responses indicated subjective susceptibility to both magnified and minified manipulations, objective hand size estimates only showed significant differences following exposure to minifying mirrors. These variations might reflect differences in the way that stored representations are accessed or updated in response to size manipulations. Secondly, the findings further reinforce differences between subjective and objective outcomes of illusions on subsequent body perception.

The Effects of Priming Intermittent Theta Burst Stimulation on Movement-Related and Mirror Visual Feedback-Induced Sensorimotor Desynchronization.

The potential benefits of priming intermittent theta burst stimulation (iTBS) with continuous theta burst stimulation (cTBS) have not been examined in regard to sensorimotor oscillatory activities recorded in electroencephalography (EEG). The objective of this study was to investigate the modulatory effect of priming iTBS (cTBS followed by iTBS) delivered to the motor cortex on movement-related and mirror visual feedback (MVF)-induced sensorimotor event-related desynchronization (ERD), compared with iTBS alone, on healthy adults. Twenty participants were randomly allocated into Group 1: priming iTBS—cTBS followed by iTBS, and Group 2: non-priming iTBS—sham cTBS followed by iTBS. The stimulation was delivered to the right primary motor cortex daily for 4 consecutive days. EEG was measured before and after 4 sessions of stimulation. Movement-related ERD was evaluated during left-index finger tapping and MVF-induced sensorimotor ERD was evaluated by comparing the difference between right-index finger tapping with and without MVF. After stimulation, both protocols increased movement-related ERD and MVF-induced sensorimotor ERD in high mu and low beta bands, indicated by significant time effects. A significant interaction effect favoring Group 1 in enhancing movement-related ERD was observed in the high mu band [F(1,18) = 4.47, p = 0.049], compared with Group 2. Our experiment suggests that among healthy adults priming iTBS with cTBS delivered to the motor cortex yields similar effects with iTBS alone on enhancing ERD induced by MVF-based observation, while movement-related ERD was more enhanced in the priming iTBS condition, specifically in the high mu band.

Immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the unilateral spatial neglect model.

[Purpose] This study aimed to clarify the immediate effect of adding mirror visual feedback to lateral weight-shifting training on the standing balance control of the left unilateral spatial neglect model. [Participants and Methods] We included 64 healthy participants to create left unilateral spatial neglect models and divided them into four subgroups. Each subgroup received opposite lateral weight-shifting training with or without mirror visual feedback. We then evaluated the static and dynamic standing balance by measuring the center of pressure point alterations in the medial-lateral and anterior-posterior planes. We further evaluated the center of pressure length and bilateral load ratio. [Results] The center of pressure was significantly stable upon performing the eyes-open static standing balance test in the left weight-shifting training subgroup with mirror visual feedback. When participants performed the left dynamic standing balance test, the center of pressure moved significantly rightward and became significantly stable in the right weight-shifting training subgroup with mirror visual feedback. The left load ratio significantly decreased in the right weight-shifting training of subgroups that either did or did not receive mirror visual feedback upon performing the left dynamic standing balance test. [Conclusion] We concluded that adding mirror visual feedback to lateral weight-shifting training affected some measurements of standing balance control of the left unilateral spatial neglect model.

Embodied Virtual Reality Mirror Visual Feedback for an Adult with Cerebral Palsy

Virtual reality-assisted physical therapy and mirror visual feedback (MVF) are promising treatments for children with cerebral palsy (CP). However, thus far, neither interventions’ use has been reported in adults with CP. The following case report examines the safety and feasibility of using customized virtual reality (VR) interventions to deliver MVF to an adult with hemiplegic CP and right sided pain, weakness, and dystonias. A weekly intervention was delivered in an ambulatory care setting over one year. Self-reported pain, motor function, anxiety, disability, quality of life and depression were monitored weekly. The treatment was acceptable and well tolerated with no instances of cybersickness. The intervention showed immediate and consistent pain relief during treatment, similar to those reported in other studies, with the percentage of pain relief during sessions ranging from 6.25% to 38.5%. Motor function, including range of motion, control, and dexterity, were improved per patient report. However, the duration of pain relief lasted only 2–4 days between sessions. The authors believe that the present findings may inspire others treating adults and children with CP to explore the use of MVF and VR to enhance rehabilitation with an emphasis on adapting technologies for home use. Further implications of these findings for the future are discussed.

Mirror Visual Feedback Combining Vibrotactile Stimulation Promotes Embodiment Perception: An Electroencephalogram (EEG) Pilot Study.

As one determinant of the efficacy of mirror visual feedback (MVF) in neurorehabilitation, the embodiment perception needs to be sustainable and enhanced. This study explored integrating vibrotactile stimulation into MVF to promote the embodiment perception and provide evidence of the potential mechanism of MVF. In the experiment, the participants were instructed to keep their dominant hand still (static side), while open and close their non-dominant hand (active side) and concentrate on the image of the hand movement in the mirror. They were asked to tap the pedal with the foot of the active side once the embodiment perception is generated. A vibrotactile stimulator was attached on the hand of the active side, and three conditions were investigated: no vibration (NV), continuous vibration (CV), and intermittent vibration (IV). The effects were analyzed on both objective data, including latency time (LT) and electroencephalogram (EEG) signals, and subjective data, including embodiment questionnaire (EQ). Results of LT and EQ suggested a stronger subjective sense of embodiment under the condition of CV and IV, comparing with NV. No significant difference was found between CV and IV. EEG analysis showed that in the hemisphere of the static side, the desynchronization of CV and IV around the central-frontal region (C3 and F3) in the alpha band (8–13 Hz) was significantly prominent compared to NV, and in the hemisphere of the active side, the desynchronization of three conditions was similar. The network analysis of EEG data indicated that there was no significant difference in the efficiency of neural communication under the three conditions. These results demonstrated that MVF combined with vibrotactile stimulation could strengthen the embodiment perception with increases in motor cortical activation, which indicated an evidence-based protocol of MVF to facilitate the recovery of patients with stroke.