Figure - available from: Frontiers in Neurology
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The camera-based mirror visual feedback setup used in the study. (A) Providing mirror visual feedback. (B) Sham-mirror visual feedback.
Source publication
Purpose: Robot-assisted training has been widely used in neurorehabilitation, but its effect on facilitating recovery after stroke remains controversial. One possible reason might be lacking consideration of the role of embodiment in robotic systems. Mirror visual feedback is an ideal method to approach embodiment. Thus, we hypothesized that mirror...
Citations
... Analyses revealed interventions using the VR system used a game called "Super Punch" along with VR goggles and controllers elicited the largest gains improvement in EG compared to CG in grip strength, averaging 8.1 kg [79]. This significantly exceeded more modest gains of 0.68 kg with robotic devices and 0.6 kg with alternate controllers [55,64,65,74]. Younger cohorts with a mean age of 55 years exhibited greater enhancements, improving by 1.8 kg [55,74,79] more than older subgroups averaging 64 years [50,59,64,80,81]. ...
... Younger cohorts with a mean age of 55 years exhibited greater enhancements, improving by 1.8 kg [55,74,79] more than older subgroups averaging 64 years [50,59,64,80,81]. Rehabilitation regimens lower than four weeks were associated with substantially higher effects, boosting grip strength by 3.4 kg [50,65,79] than just 0.9 kg for longer 6-24-week protocols [55,59,74,80,81,83]. ...
... It provides an ordinal rating of the amount of assistance, in terms of physical support and time, required to execute various mobility and self-care tasks. Thirteen RCTs comprising 492 patients compared VR rehabilitation to conventional occupational therapy for enhancing post-stroke upper limb function using the BI as an evaluative outcome [39,41,44,52,57,61,65,70,71,74,77,80,87]. Considerable between-study heterogeneity was present (I 2 = 84%). ...
Background
Stroke frequently gives rise to incapacitating motor impairments in the upper limb. Virtual reality (VR) rehabilitation has exhibited potential for augmenting upper extremity recovery; nonetheless, the optimal techniques for such interventions remain a topic of uncertainty. The present systematic review and meta-analysis were undertaken to comprehensively compare VR-based rehabilitation with conventional occupational therapy across a spectrum of immersion levels and outcome domains.
Methods
A systematic search was conducted in PubMed, IEEE, Scopus, Web of Science, and PsycNET databases to identify randomized controlled trials about upper limb rehabilitation in stroke patients utilizing VR interventions. The search encompassed studies published in the English language up to March 2023. The identified studies were stratified into different categories based on the degree of immersion employed: non-immersive, semi-immersive, and fully-immersive settings. Subsequent meta-analyses were executed to assess the impact of VR interventions on various outcome measures.
Results
Of the 11,834 studies screened, 55 studies with 2142 patients met the predefined inclusion criteria. VR conferred benefits over conventional therapy for upper limb motor function, functional independence, Quality of life, Spasticity, and dexterity. Fully immersive VR showed the greatest gains in gross motor function, while non-immersive approaches enhanced fine dexterity. Interventions exceeding six weeks elicited superior results, and initiating VR within six months post-stroke optimized outcomes.
Conclusions
This systematic review and meta-analysis demonstrates that adjunctive VR-based rehabilitation enhances upper limb motor recovery across multiple functional domains compared to conventional occupational therapy alone after stroke. Optimal paradigms likely integrate VR’s immersive capacity with conventional techniques.
Trial registration
This systematic review and meta-analysis retrospectively registered in the OSF registry under the identifier [https://doi.org/10.17605/OSF.IO/YK2RJ].
... On the other hand, imaging evaluation can also help us understand the mechanisms by which mirror therapy [21][22][23]. For example, during MT, stroke patients showed increased functional magnetic resonance imaging (fMRI) activities across widely distributed brain regions [24,25]. ...
Background and purpose
Research to date has lacked definitive evidence to determine whether mirror therapy promotes the recovery of upper extremity function after stroke. Considering that previous studies did not stratify patients based on structural retention, this may be one of the reasons for the negative results obtained in many trials. The goal evaluates the efficacy of TBMT (utilizing an innovatively designed mirror) versus standard occupational therapy for stroke patient’s upper limb functionality.
Methods and analysis
This single-center randomized controlled trial will involve 50 patients with stroke. All patients will be randomly assigned to either the task-based mirror therapy or the control group. The interventions will be performed 5 days per week for 4 weeks. The primary outcomes will be the mean change in scores on both the FMA-UE and modified Barthel Index (MBI) from baseline to 4 weeks intervention and at 12 weeks follow-up between the two groups and within groups. The other outcomes will include the Action Research Arm Test (ARAT), the Nine Hole Peg Test (9HPT), the Functional Independence Measure, and MRI.
Discussion
This trial will not only to establish that task-based mirror therapy (TBMT) could improve the recovery of hand function after stroke but also to explore the underlying mechanisms. We expect that this finding will clarify the brain activation and brain network mechanisms underlying the improvement of hand function with task-oriented mirror therapy and lead to new ideas for stroke hand function rehabilitation.
Trial registration
URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2300068855. Registered on March 1, 2023
... These results suggest that combination therapy has potential for improving moderate to severe upper limb dysfunction after stroke. In the past some studies simply superimposed MVF and other interventions in order [such as MVF combined with acupuncture (Yin et al., 2020), robotassisted therapy (Thakkar et al., 2020;Rong et al., 2021)], and failed to form MVF synchronized with other peripheral interventions to achieve central-peripheral-central closed-loop measures. Additionally, although some studies (such as MVF synchronous electromyographic biofeedback, EMG-induced electrical stimulation) have achieved closed-loop intervention formally, the muscle electrical stimulation given by the electrode could not accurately induce hand movement resulting in a significant difference between the passive movement of the affected side and the mirror movement leading to the poor effect of the closed-loop regulation mode. ...
Background
Mirror 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.
Methods
Our 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).
Results
The 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).
Conclusion
Our 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.
Robot-assisted therapy and mirror therapy are both effective in promoting upper limb function after stroke and combining these two interventions might yield greater therapeutic effects. We aimed to examine whether using mirror therapy as a priming strategy would augment therapeutic effects of robot-assisted therapy. Thirty-seven chronic stroke survivors (24 male/13 female; age = 49.8 ± 13.7 years) were randomized to receive mirror therapy or sham mirror therapy prior to robot-assisted therapy. All participants received 18 intervention sessions (60 min/session, 3 sessions/week). Outcome measures were evaluated at baseline and after the 18-session intervention. Motor function was assessed using Fugl-Meyer Assessment and Wolf Motor Function Test. Daily function was assessed using Nottingham Extended Activities of Daily Living Scale. Self-efficacy was assessed using Stroke Self-Efficacy Questionnaires and Daily Living Self-Efficacy Scale. Data was analyzed using mixed model analysis of variance. Both groups demonstrated statistically significant improvements in measures of motor function and daily function, but no significant between-group differences were found. Participants who received mirror therapy prior to robot-assisted therapy showed greater improvements in measures of self-efficacy, compared with those who received sham mirror therapy. Our findings suggest that sequentially combined mirror therapy with robot-assisted therapy could be advantageous for enhancing self-efficacy post-stroke.
Trial registration: ClinicalTrials.gov Identifier: NCT03917511. Registered on 17/04/2019, https://clinicaltrials.gov/ct2/show/ NCT03917511.
Movement function rehabilitation of patients with craniocerebral injuries is an important issue facing neurorehabilitation science. The use of brain–computer interface technology in rehabilitation training systems can allow patients to actively participate in the rehabilitation training process and use the brain’s neuroplasticity to enhance the effects from rehabilitation training. At present, the brain–computer interface-based rehabilitation training system still has problems such as insufficient active participation of patients, resulting in slowed motor neural circuit repair or low action execution accuracy. In response to the above problems, this paper designed an active and passive upper limb rehabilitation training system based on a hybrid brain–computer interface of steady-state visual evoked potentials (SSVEP) and movement-related cortical potentials (MRCPs). The system includes six parts: task setting and training guidance module, EEG signal acquisition module, EEG signal preprocessing and recognition module, rehabilitation training module, training completion evaluation module, and communication module. The system drives the rehabilitation robot to complete the training actions by identifying the participant’s SSVEP and evaluates the completion of the rehabilitation training based on the patient’s movement intention recognition results. In this study, 12 participants were recruited. In the online test, the system achieved an average action execution accuracy of 99.3%. The movement intention detection based on MRCPs reached an average accuracy of 82.7%. The participants’ average completion rate was 0.91. The experimental results show that the system can achieve a high rate of execution accuracy. In addition, it can evaluate the active participation level of patients in rehabilitation training based on the movement intention detection results, accelerate the reconstruction of motor neural circuits, improve the effects of training, and provide more effective ways of thinking for the study of upper limb rehabilitation training systems for patients with craniocerebral injuries.
Central and peripheral interventions for brain injury rehabilitation have been widely employed. However, as patients’ requirements and expectations for stroke rehabilitation have gradually increased, the limitations of simple central intervention or peripheral intervention in the rehabilitation application of stroke patients’ function have gradually emerged. Studies have suggested that central intervention promotes the activation of functional brain regions and improves neural plasticity, whereas peripheral intervention enhances the positive feedback and input of sensory and motor control modes to the central nervous system, thereby promoting the remodeling of brain function. Based on the model of a central–peripheral–central (CPC) closed loop, the integration of center and peripheral interventions was effectively completed to form “closed-loop” information feedback, which could be applied to specific brain areas or function-related brain regions of patients. Notably, the closed loop can also be extended to central and peripheral immune systems as well as central and peripheral organs such as the brain–gut axis and lung–brain axis. In this review article, the model of CPC closed-loop rehabilitation and the potential neuroimmunological mechanisms of a closed-loop approach will be discussed. Further, we highlight critical questions about the neuroimmunological aspects of the closed-loop technique that merit future research attention.
