Upper extremity rehabilitation of stroke: Facilitation of corticospinal excitability using virtual mirror paradigm
- Author(s)
- Youn Joo Kang; Hae Kyung Park; Hyun Jung Kim; Taeo Lim; Jeonghun Ku; Sangwoo Cho; Sun I Kim; Eun Sook Park
- Keimyung Author(s)
- Ku, Jeong Hun
- Department
- Dept. of Biomedical Engineering (의용공학과)
- Journal Title
- Journal of NeuroEngineering and Rehabilitation
- Issued Date
- 2012
- Volume
- 9
- Issue
- 1
- Keyword
- Stroke; Corticospinal excitability; Transcranial magnetic stimulation; Virtual reality, Feedback
- Abstract
- Background: Several 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.
Objectives: We 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.
Methods: A 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.
Results: The 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.
Conclusion: 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. This provides
neurophysiological evidence supporting the application of the virtual mirror paradigm using various visual
modulation technologies to upper extremity rehabilitation in stroke patients.
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