Mechanism of Kinect-based virtual reality training for motor functional recovery of upper limbs after subacute stroke

Xiao Bao, Yurong Mao, Qiang Lin, Yunhai Qiu, Shaozhen Chen, Le Li, Ryan S Cates, Shufeng Zhou, Dongfeng Huang, Xiao Bao, Yurong Mao, Qiang Lin, Yunhai Qiu, Shaozhen Chen, Le Li, Ryan S Cates, Shufeng Zhou, Dongfeng Huang

Abstract

The Kinect-based virtual reality system for the Xbox 360 enables users to control and interact with the game console without the need to touch a game controller, and provides rehabilitation training for stroke patients with lower limb dysfunctions. However, the underlying mechanism remains unclear. In this study, 18 healthy subjects and five patients after subacute stroke were included. The five patients were scanned using functional MRI prior to training, 3 weeks after training and at a 12-week follow-up, and then compared with healthy subjects. The Fugl-Meyer Assessment and Wolf Motor Function Test scores of the hemiplegic upper limbs of stroke patients were significantly increased 3 weeks after training and at the 12-week follow-up. Functional MRI results showed that contralateral primary sensorimotor cortex was activated after Kinect-based virtual reality training in the stroke patients compared with the healthy subjects. Contralateral primary sensorimotor cortex, the bilateral supplementary motor area and the ipsilateral cerebellum were also activated during hand-clenching in all 18 healthy subjects. Our findings indicate that Kinect-based virtual reality training could promote the recovery of upper limb motor function in subacute stroke patients, and brain reorganization by Kinect-based virtual reality training may be linked to the contralateral sensorimotor cortex.

Keywords: Kinect-based virtual reality training; brain activation; cerebral cortex; functional MRI; grants-supported paper; neural plasticity; neural regeneration; neurological rehabilitation; neuroregeneration; region of interest; rehabilitation training; stroke; upper limb; virtual reality.

Conflict of interest statement

Conflicts of interest: None declared.

Figures

Figure 1
Figure 1
Brain regions activated during fist-clenching with left or right hand in 18 healthy subjects using functional MRI. (A) Averaged functional MRI activation maps of fist-clenching with left hand. Right side of the image corresponds to the left side of the brain. (B) Averaged functional MRI activation maps of fist-clenching with right hand. The activated brain regions during fist-clenching include contralateral sensorimotor cortex, bilateral supplementary motor areas and ipsilateral cerebellum.
Figure 2
Figure 2
Effect of Kinect-based virtual reality training on regions of interest in primary sensorimotor cortex of five stroke patients. Images are the average brain activation map (A) for patient 5 during fist-clenching with right hand before (B) and 3 weeks after training (C) and 12 weeks follow-up (D). Primary sensorimotor cortex cluster sizes of patient 5 gradually decreased.

References

    1. Dai CY, Huang YH, Chou LW, et al. Effects of primary caregiver participation in vestibular rehabilitation for unilateral neglect patients with right hemispheric stroke: a randomized controlled trial. Neuropsychiatr Dis Treat. 2013;9:477–484.
    1. Kleindorfer D, Broderick J, Khoury J, et al. The unchanging incidence and case-fatality of stroke in the 1990s: a population-based study. Stroke. 2006;37(10):2473–2478.
    1. Patel MD, Tilling K, Lawrence E, et al. Relationships between long-term stroke disability, handicap and health-related quality of life. Age Ageing. 2006;35(3):273–279.
    1. French B, Thomas LH, Leathley MJ, et al. Repetitive task training for improving functional ability after stroke. Cochrane Database Syst Rev. 2007;4:CD006073.
    1. Guerrero C, Uribe-Quevedo A. Kinect-based posture tracking for correcting positions during exercise. Stud Health Technol Inform. 2013;184:158–160.
    1. Banerjee T, Keller JM, Skubic M, et al. Resident identification using Kinect depth image data and fuzzy clustering techniques. Conf Proc IEEE Eng Med Biol Soc 2012. 2012:5102–5105.
    1. Page SJ, Levine P, Leonard AC, et al. Modified constraint-induced therapy in acute stroke: a randomized controlled pilot study. Neurorehabil Neural Repair. 2005;19(1):27–32.
    1. Thielman G, Bonsall P. Rehabilitation of the upper extremity after stroke: a case series evaluating reotherapy and an auditory sensor feedback for trunk control. Stroke Res Treat 2012. 2012 348631.
    1. Kim YM, Chun MH, Yun GJ, et al. The effect of virtual reality training on unilateral spatial neglect in stroke patients. Ann Rehabil Med. 2011;35(3):309–315.
    1. Laver KE, George S, Thomas S, et al. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2011;9:CD008349.
    1. Housman SJ, Scott KM, Reinkensmeyer DJ. A randomized controlled trial of gravity-supported, computer-enhanced arm exercise for individuals with severe hemiparesis. Neurorehabil Neural Repair. 2009;23(5):505–514.
    1. Piron L, Turolla A, Agostini M, et al. Motor learning principles for rehabilitation: a pilot randomized controlled study in poststroke patients. Neurorehabil Neural Repair. 2010;24(6):501–508.
    1. Saposnik G, Teasell R, Mamdani M, et al. Effectiveness of virtual reality using wii gaming technology in stroke rehabilitation: a pilot randomized clinical trial and proof of principle. Stroke. 2010;41(7):1477–1484.
    1. Lange B, Chang CY, Suma E, et al. Development and evaluation of low cost game-based balance rehabilitation tool using the microsoft Kinect sensor. Conf Proc IEEE Eng Med Biol Soc 2011. 2011:1831–1834.
    1. Calautti C, Baron JC. Functional neuroimaging studies of motor recovery after stroke in adults: a review. Stroke. 2003;34(6):1553–1566.
    1. Cramer SC, Bastings EP. Mapping clinically relevant plasticity after stroke. Neuropharmacology. 2000;39(5):842–851.
    1. Dijkhuizen RM, van der Marel K, Otte WM, et al. Functional mri and diffusion tensor imaging of brain reorganization after experimental stroke. Transl Stroke Res. 2012;3(1):36–43.
    1. Chang YJ, Chen SF, Huang JD, et al. A Kinect-based system for physical rehabilitation: a pilot study for young adults with motor disabilities. Res Dev Disabil. 2011;32(6):2566–2570.
    1. State Council of the People's Republic of China. Administrative Regulations on Medical Institution. 1994 Sep 01;
    1. Calautti C, Naccarato M. The relationship between motor deficit and hemisphere activation balance after stroke: A 3T fMRI study. Neuroimage. 2007;34(1):322–331.
    1. Konczak J, Pierscianek D. Recovery of upper limb function after cerebellar stroke: lesion symptom mapping and arm kinematics. Stroke. 2010;41(10):2191–200.
    1. Szameitat AJ, Shen S, Conforto A, et al. Cortical activation during executed, imagined, observed, and passive wrist movements in healthy volunteers and stroke patients. Neuroimage. 2012;62(11):266–280.
    1. Lefebvre S, Dricot L, Gradkowski W, et al. Brain activations underlying different patterns of performance improvement during early motor skill learning. Neuroimage. 2012;62(1):290–299.
    1. Rehme AK, Fink GR, von Cramon DY, et al. The role of the contralesional motor cortex for motor recovery in the early days after stroke assessed with longitudinal FMRI. Cereb Cortex. 2011;21(4):756–768.
    1. Loubinoux I, Dechaumont-Palacin S, Castel-Lacanal E, et al. Prognostic value of FMRI in recovery of hand function in subcortical stroke patients. Cereb Cortex. 2007;17(12):2980–2987.
    1. Rehme AK, Eickhoff SB, Wang LE, et al. Dynamic causal modeling of cortical activity from the acute to the chronic stage after stroke. Neuroimage. 2011;55(1):1147–1158.
    1. Loibl M, Beutling W, Kaza E, et al. Non-effective increase of FMRI-activation for motor performance in elder individuals. Behav Brain Res. 2011;223(2):280–286.
    1. Solodkin A, Hlustik P, Noll DC, et al. Lateralization of motor circuits and handedness during finger movements. Eur J Neurol. 2001;8(5):425–434.
    1. Hlustik P, Solodkin A, Gullapalli RP, et al. Functional lateralization of the human premotor cortex during sequential movements. Brain Cogn. 2002;9(1):54–62.
    1. Dong Y, Winstein CJ, Albistegui-DuBois R, et al. Evolution of fMRI activation in the perilesional primary motor cortex and cerebellum with rehabilitation training-related motor gains after stroke: a pilot study. Neurorehabil Neural Repair. 2007;21(5):412–428.
    1. Tombari D, Loubinoux I, Pariente J, et al. A longitudinal fMRI study: in recovering and then in clinically stable sub-cortical stroke patients. Neuroimage. 2004;23(3):827–839.
    1. Ward NS, Brown MM, Thompson AJ, et al. Neural correlates of outcome after stroke: a cross-sectional FMRI study. Brain. 2003;126(Pt 6):1430–1448.
    1. Mintzopoulos D, Astrakas LG. Connectivity alterations assessed by combining fMRI andMR-compatible hand robots in chronic stroke. Neuroimage. 2009;47(Suppl 2):T90–T97.
    1. Nair DG, Hutchinson S. Imaging correlates of motor recovery from cerebral infarction and their physiological significance in well-recovered patients. Neuroimage. 2007;34(1):253–263.
    1. Cook DJ, Crandall A, Singla G, et al. Indoor way finding based on wireless sensor networks for individuals with multiple special needs. Cybern Syst. 2010;41:317–333.
    1. Chang YJ, Peng SM, Wang TY, et al. Autonomous indoor way finding for individuals with cognitive impairments. J Neuroeng Rehabil. 2010;7:45.
    1. Chang YJ, Wang TY. Comparing picture and video prompting in autonomous indoor wayfinding for individuals with cognitive impairments. Personal and Ubiquitous Computing. 2010;14:737–747.
    1. Shih CH, Chang ML, Shih CT, et al. A new limb movement detector enabling people with multiple disabilities to control environmental stimulation through limb swing with a gyration air mouse. Res Dev Disabil. 2010;31(4):875–880.
    1. Lachapelle Y, Wehmeyer ML, Haelewyck MC, et al. The relationship between quality of life and self-determination: an international study. J Intellect Disabil Res. 2005;49(Pt 10):740–744.
    1. Wessels R, Dijcks B, Soede M, et al. Non-use of provided assistive technology devices: a literature overview. Technol Disabil. 2003;15:231–238.
    1. Felce D, Perry J. Quality of life: its definition and measurement. Res Dev Disabil. 1995;16(1):51–74.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe