Domiciliary VR-based therapy for functional recovery and cortical reorganization: randomized controlled trial in participants at the chronic stage post stroke

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• dc.contributor.author Rubio Ballester, Belénca
• dc.contributor.author Nirme, Jensca
• dc.contributor.author Camacho, Ireneca
• dc.contributor.author Duarte Oller, Estherca
• dc.contributor.author Rodriguez, Susanaca
• dc.contributor.author Cuxart, Amparca
• dc.contributor.author Duff, Arminca
• dc.contributor.author Verschure, Paul F. M. J.ca
• dc.date.accessioned 2018-06-07T07:53:37Z
• dc.date.available 2018-06-07T07:53:37Z
• dc.date.issued 2017
• dc.description.sponsorship BACKGROUND: Most stroke survivors continue to experience motor impairments even after hospital discharge. Virtual reality-based techniques have shown potential for rehabilitative training of these motor impairments. Here we assess the impact of at-home VR-based motor training on functional motor recovery, corticospinal excitability and cortical reorganization. OBJECTIVE: The aim of this study was to identify the effects of home-based VR-based motor rehabilitation on (1) cortical reorganization, (2) corticospinal tract, and (3) functional recovery after stroke in comparison to home-based occupational therapy. METHODS: We conducted a parallel-group, controlled trial to compare the effectiveness of domiciliary VR-based therapy with occupational therapy in inducing motor recovery of the upper extremities. A total of 35 participants with chronic stroke underwent 3 weeks of home-based treatment. A group of subjects was trained using a VR-based system for motor rehabilitation, while the control group followed a conventional therapy. Motor function was evaluated at baseline, after the intervention, and at 12-weeks follow-up. In a subgroup of subjects, we used Navigated Brain Stimulation (NBS) procedures to measure the effect of the interventions on corticospinal excitability and cortical reorganization. RESULTS: Results from the system's recordings and clinical evaluation showed significantly greater functional recovery for the experimental group when compared with the control group (1.53, SD 2.4 in Chedoke Arm and Hand Activity Inventory). However, functional improvements did not reach clinical significance. After the therapy, physiological measures obtained from a subgroup of subjects revealed an increased corticospinal excitability for distal muscles driven by the pathological hemisphere, that is, abductor pollicis brevis. We also observed a displacement of the centroid of the cortical map for each tested muscle in the damaged hemisphere, which strongly correlated with improvements in clinical scales. CONCLUSIONS: These findings suggest that, in chronic stages, remote delivery of customized VR-based motor training promotes functional gains that are accompanied by neuroplastic changes. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number NCT02699398 (Archived by ClinicalTrials.gov at https://clinicaltrials.gov/ct2/show/NCT02699398?term=NCT02699398&rank=1).
• dc.description.sponsorship We would like to thank all subjects who participated in this study. We also would like to gratefully acknowledge Estefanía Montiel for her assistance in recruiting and evaluating the participants. This work was supported by the MINECO “Retos Investigacion tos Investigacion I + D + I” Plan Nacional project SANAR (Gobierno de España), and the European Research Council under grant agreement 341196 CDAC and FP7-ICT- 270212 project eSMC.
• dc.format.mimetype application/pdf
• dc.identifier.citation Ballester BR, Nirme J, Camacho I, Duarte E, Rodríguez S, Cuxart A. et al. Domiciliary VR-based therapy for functional recovery and cortical reorganization: randomized controlled trial in participants at the chronic stage post stroke. JMIR Serious Games. 2017 Aug 7;5(3):e15. DOI: 10.2196/games.6773
• dc.identifier.doi http://dx.doi.org/10.2196/games.6773
• dc.identifier.issn 2291-9279
• dc.identifier.uri http://hdl.handle.net/10230/34848
• dc.language.iso eng
• dc.publisher JMIR Publicationsca
• dc.relation.ispartof JMIR Serious Games. 2017 Aug 7;5(3):e15
• dc.relation.projectID info:eu-repo/grantAgreement/EC/FP7/270212
• dc.rights © 2017 Belén Rubio Ballester et al. Originally published in JMIR Serious Games (http://games.jmir.org), 07.08.2017. This is an open-access article distributed under the terms of a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Serious Games, is properly cited. The complete bibliographic information, a link to the original publication on http://games.jmir.org, as well as this copyright and license information must be included
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri https://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Computer applications software
• dc.subject.keyword Hemiparesis
• dc.subject.keyword Movement disorder
• dc.subject.keyword Physical therapy
• dc.subject.keyword Recovery of function
• dc.subject.keyword Neuroplasticity
• dc.subject.keyword stroke
• dc.subject.keyword Transcranial magnetic stimulation
• dc.subject.other Infart
• dc.subject.other Programari d'aplicació
• dc.subject.other Neuroplasticitat
• dc.title Domiciliary VR-based therapy for functional recovery and cortical reorganization: randomized controlled trial in participants at the chronic stage post strokeca
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion