Abstract
Stroke is a debilitating condition with major costs for patients and their care-givers. Here we present a novel virtual reality (VR) based cognitive neurorehabilitation system for improving the rehabilitation of stroke patients with arm and hand paresis. Using a custom, low-cost kinematic tracking system designed for clinical or home use, patients engage in task-oriented interactions with objects in a virtual environment. Our paradigm is based on the hypothesis that observed actions correlated with self-generated or intended actions activate the motor pathways by means of the so-called “mirror-system”. This cognitive approach engages cortical motor observation, planning and execution areas. Combined with intensive, task-oriented acute-phase training (1–6 weeks after stroke) when the factors for facilitating recovery are at their highest levels, we postulate that our approach will facilitate cortical plasticity and improve recovery of upper limb function. The tasks range from simple (hitting moving virtual objects) to complex (grasping and moving virtual objects). In the first-person VR environment the patient controls a displayed pair of upper limbs that follow the position and movements of his/her own arms and hands while performing the tasks. The therapist can adjust the contribution of the non-paretic hand in “assisting” the representation of the paretic hand to varying degrees in performing the tasks, simultaneously stimulating the action recognition systems and increasing patient motivation through graded task success. In this paper we present the neuroscientific background of the system, a technical description of its components, and results from testing on healthy subjects and stroke patients.
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References
H. Nakayama, H. S. Jorgensen, H. O. Raaschou, and T. S. Olsen, Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study, Arch. Phys. Med. Rehabil., vol. 75, pp. 394–398, 1994.
G. Kwakkel, B. Kollen, and E. Lindeman, Understanding the pattern of functional recovery after stroke: facts and theories, Restor. Neurol. Neurosci., vol. 22, pp. 281–299, 2004.
M. K. Holden, T. A. Dyer, L. Schwamm, and E. Bizzi, Virtual-Environment-Based Telerehabilitation in Patients with Stroke, Presence, vol. 14, pp. 214–233, 2005.
M. Holden, Virtual Environments for motor rehabilitation, CyberPsychology & Behavior, vol. 8, 2005.
S. Jezernik, G. Colombo, T. Keller, H. Frueh, and M. Morari, Robotic Orthosis Lokomat: A Rehabilitation and Research Tool, Neuromodulation, vol. 6, pp. 108–115, 2003.
H. Hummelsheim, M. L. Maier-Loth, and C. Eickhof, The functional value of electrical muscle stimulation for the rehabilitation of the hand in stroke patients, Scand J Rehabil Med, vol. 29, pp. 3–10, 1997.
S. Hesse, H. Schmidt, C. Werner, and A. Bardeleben, Upper and lower extremity robotic devices for rehabilitation and for studying motor control, vol. 16, pp. 705–710, 2003.
B. T. Volpe, M. Ferraro, H. I. Krebs, and N. Hogan, Robotics in the rehabilitation treatment of patients with stroke, vol. 4, pp. 270–276, 2002.
H. I. Krebs, M. Ferraro, S. P. Buerger, M. J. Newbery, A. Makiyama, M. Sandmann, D. Lynch, B. T. Volpe, and N. Hogan, Rehabilitation robotics: pilot trial of a spatial extension for MIT-Manus, vol. 1, pp. 5, 2004.
J. E. Deutsch, J. Latonio, G. C. Burdea, and R. Boian, Post-stroke rehabilitation with the Rutgers Ankle system: a case study, Presence, vol. 10, pp. 416–430, 2001.
T. Keller, M. R. Popovic, I. P. Pappas, and P. Y. Muller, Transcutaneous functional electrical stimulator “Compex Motion”, vol. 26, pp. 219–223, 2002.
M. R. Popovic and T. Keller, Compex Motion: Neuroprosthesis for grasping applications, in Enabling Technologies: Body Image and Body Function M. MacLachlan and P. Gallagher, Eds.: Elsevier Science Ltd., 2004, pp. 197–216.
L. Fadiga and L. Craighero, Electrophysiology of action representation, vol. 21, pp. 157–169, 2004.
G. Rizzolatti, R. Camarda, L. Fogassi, M. Gentilucci, G. Luppino, and M. Matelli, Functional organization of inferior area 6 in the macaque monkey II. Area F5 and the control of distal movements, Experimental Brain Research, vol. 71, pp. 491–507, 1988.
G. Buccino, F. Binkofski, G. R. Fink, L. Fadiga, L. Fogassi, V. Gallese, R. J. Seitz, K. Zilles, G. Rizzolatti, and H.-J. Freund, Action observation activates premotor and parietal areas in a somatotopic manner: an fMRI study, European Journal of Neuroscience, vol. 13, pp. 400–404, 2001.
G. Buccino, F. Binkofski, and L. Riggio, The mirror neuron system and action recognition, Brain and Language, vol. 89, pp. 370–376, 2004.
F. Binkofski, K. Amunts, K. M. Stephan, S. Posse, T. Schormann, H.-J. Freund, K. Zilles, and R. J. Seitz, Broca’s region subserves imagery of motion: A combined cytoarchitectonic and fMRI study, Human Brain Mapping, vol. 11, pp. 273–285, 2000.
K. Stefan, L. G. Cohen, J. Duque, R. Mazzocchio, P. Celnik, L. Sawaki, L. Ungerleider, and J. Classen, Formation of a Motor Memory by Action Observation, The Journal of Neuroscience, vol. 25, pp. 9339–9346, 2005.
V. S. Ramachandran and W. Hirstein, The perception of phantom limbs, Brain, vol. 121, pp. 1603–1630, 1998.
E. L. Altschuler, S. B. Wisdom, L. Stone, C. Foster, D. Galasko, D. M. E. Llewellyn, and V. S. Ramachandran, Rehabilitation of hemiparesis after stroke with a mirror, The Lancet, vol. 353, pp. 2035–2036, 1999.
G. Nelles, W. Jentzen, M. Jueptner, S. Muller, and H. C. Diener, Arm training induced brain plasticity in stroke studied with serial positron emission tomography., Neuroimage, vol. 13, pp. 1146–1154, 2001.
L. Fadiga, G. Buccino, L. Craighero, L. Fogassi, V. Gallese, and G. Pavesi, Corticospinal excitability is specifically modulated by motor imagery: a magnetic stimulation study, Neuropsychologia, vol. 37, pp. 147–158, 1999.
S. H. Johnson-Frey, F. R. Maloof, R. Newman-Norhund, C. Farrer, S. Inati, and S. T. Grafton, Actions or Hand-Object Interactions? Human Inferior Frontal Cortex and Action Observation, Neuron, vol. 39, pp. 1053–1058, 2003.
J. A. Stevens and M. E. Stoykov, Using motor imagery in the rehabilitation of hemiparesis, Arch. Phys. Med. Rehabil., vol. 84, pp. 1090–1092, 2003.
S. R. Barreca, P. W. Stratford, C. L. Lambert, L. M. Masters, and D. L. Streiner, Test-Retest Reliability, Validity, and Sensitivity of the Chedoke Arm and Hand Activity Inventory: A New Measure of Upper-Limb Function for Survivors of Stroke, Arch Phys Med Rehabil, vol. 86, pp. 1616–1622, 2005.
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© 2007 International Federation for Medical and Biological Engineering
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Eng, K. et al. (2007). Cognitive Virtual-Reality Based Stroke Rehabilitation. In: Magjarevic, R., Nagel, J.H. (eds) World Congress on Medical Physics and Biomedical Engineering 2006. IFMBE Proceedings, vol 14. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-36841-0_718
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DOI: https://doi.org/10.1007/978-3-540-36841-0_718
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