The visual amplification of goal-oriented movements counteracts acquired non-use in hemiparetic stroke patients.

Rubio Ballester, Belén; Nirme, Jens; Duarte Oller, Esther; Cuxart, Ampar; Rodriguez, Susana; Verschure, Paul F. M. J.; Duff, Armin

doi:http://dx.doi.org/10.1186/s12984-015-0039-z

The visual amplification of goal-oriented movements counteracts acquired non-use in hemiparetic stroke patients.

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Citation

Rubio Ballester B, Nirme J, Duarte E, Cuxart A, Rodriguez S5, Verschure P. et al. The visual amplification of goal-oriented movements counteracts acquired non-use in hemiparetic stroke patients. J Neuroeng Rehabil. 2015 Jun 9;12:50. doi: 10.1186/s12984-015-0039-z.

Abstract

BACKGROUND: Stroke-induced impairments result from both primary and secondary causes, i.e. damage to the brain and the acquired non-use of the impaired limbs. Indeed, stroke patients often under-utilize their paretic limb despite sufficient residual motor function. We hypothesize that acquired non-use can be overcome by reinforcement-based training strategies. METHODS: Hemiparetic stroke patients (n = 20, 11 males, 9 right-sided hemiparesis) were asked to reach targets appearing in either the real world or in a virtual environment. Sessions were divided into 3 phases: baseline, intervention and washout. During the intervention the movement of the virtual representation of the patients' paretic limb was amplified towards the target. RESULTS: We found that the probability of using the paretic limb during washout was significantly higher in comparison to baseline. Patients showed generalization of these results by displaying a more substantial workspace in real world task. These gains correlated with changes in effector selection patterns. CONCLUSIONS: The amplification of the movement of the paretic limb in a virtual environment promotes the use of the paretic limb in stroke patients. Our findings indicate that reinforcement-based therapies may be an effective approach for counteracting learned non-use and may modulate motor performance in the real world.