Shaping corticospinal pathways in virtual reality: effects of task complexity and sensory feedback during mirror therapy in neurologically intact individuals.

IF 5.2 2区 医学 Q1 ENGINEERING, BIOMEDICAL Journal of NeuroEngineering and Rehabilitation Pub Date : 2024-09-04 DOI:10.1186/s12984-024-01454-2
Trevor A Norris, Thomas E Augenstein, Kazandra M Rodriguez, Edward S Claflin, Chandramouli Krishnan
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Abstract

Background: Restoration of limb function for individuals with unilateral weakness typically requires volitional muscle control, which is often not present for individuals with severe impairment. Mirror therapy-interventions using a mirror box to reflect the less-impaired limb onto the more-impaired limb-can facilitate corticospinal excitability, leading to enhanced recovery in severely impaired clinical populations. However, the mirror box applies limitations on mirror therapy, namely that all movements appear bilateral and are confined to a small area, impeding integration of complex activities and multisensory feedback (e.g., visuo-tactile stimulation). These limitations can be addressed with virtual reality, but the resulting effect on corticospinal excitability is unclear.

Objective: Examine how virtual reality-based unilateral mirroring, complex activities during mirroring, and visuo-tactile stimulation prior to mirroring affect corticospinal excitability.

Materials and methods: Participants with no known neurological conditions (n = 17) donned a virtual reality system (NeuRRoVR) that displayed a first-person perspective of a virtual avatar that matched their motions. Transcranial magnetic stimulation-induced motor evoked potentials in the nondominant hand muscles were used to evaluate corticospinal excitability in four conditions: resting, mirroring, mirroring with prior visuo-tactile stimulation (mirroring + TACT), and control. During mirroring, the movements of each participant's dominant limb were reflected onto the nondominant limb of the virtual avatar, and the avatar's dominant limb was kept immobile (i.e., unilateral mirroring). The mirroring + TACT condition was the same as the mirroring condition, except that mirroring was preceded by visuo-tactile stimulation of the nondominant limb. During the control condition, unilateral mirroring was disabled. During all conditions, participants performed simple (flex/extend fingers) and complex (stack virtual blocks) activities.

Results: We found that unilateral mirroring increased corticospinal excitability compared to no mirroring (p < 0.001), complex activities increased excitability compared to simple activities during mirroring (p < 0.001), and visuo-tactile stimulation prior to mirroring decreased excitability (p = 0.032). We also found that these features did not interact with each other.

Discussions: The findings of this study shed light onto the neurological mechanisms of mirror therapy and demonstrate the unique ways in which virtual reality can augment mirror therapy. The findings have important implications for rehabilitation for design of virtual reality systems for clinical populations.

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在虚拟现实中塑造皮质脊髓通路:任务复杂性和感官反馈对神经系统完好者镜像疗法的影响。
背景:单侧肢体无力者恢复肢体功能通常需要意志肌肉控制,而严重受损者往往不具备这种能力。镜像疗法--使用镜像箱将受损较轻的肢体反射到受损较重的肢体上,可促进皮质脊髓的兴奋性,从而提高严重受损临床人群的恢复能力。不过,镜箱对镜像疗法有一定的限制,即所有动作都是双侧的,而且仅限于一小块区域,妨碍了复杂活动和多感官反馈(如视觉触觉刺激)的整合。虚拟现实可以解决这些限制,但对皮质脊髓兴奋性的影响尚不清楚:研究基于虚拟现实的单侧镜像、镜像过程中的复杂活动以及镜像前的视觉触觉刺激如何影响皮质脊髓兴奋性:没有已知神经系统疾病的参与者(n = 17)戴上虚拟现实系统(NeuRRoVR),该系统会以第一人称视角显示与其动作相匹配的虚拟化身。经颅磁刺激诱导的非支配手部肌肉运动诱发电位用于评估皮质脊髓在四种情况下的兴奋性:静止、镜像、镜像前视觉触觉刺激(镜像 + TACT)和对照。在镜像过程中,每位受试者优势肢体的运动被反射到虚拟化身的非优势肢体上,而虚拟化身的优势肢体保持不动(即单侧镜像)。镜像 + TACT 条件与镜像条件相同,只是在镜像之前先对非优势肢体进行视觉触觉刺激。在对照组条件下,单侧镜像被禁用。在所有条件下,参与者进行简单(弯曲/伸展手指)和复杂(堆叠虚拟积木)的活动:结果:我们发现,与无镜像相比,单侧镜像增加了皮质脊髓兴奋性(p 讨论):本研究结果揭示了镜像疗法的神经机制,并展示了虚拟现实技术增强镜像疗法的独特方式。研究结果对临床人群的虚拟现实系统康复设计具有重要意义。
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来源期刊
Journal of NeuroEngineering and Rehabilitation
Journal of NeuroEngineering and Rehabilitation 工程技术-工程:生物医学
CiteScore
9.60
自引率
3.90%
发文量
122
审稿时长
24 months
期刊介绍: Journal of NeuroEngineering and Rehabilitation considers manuscripts on all aspects of research that result from cross-fertilization of the fields of neuroscience, biomedical engineering, and physical medicine & rehabilitation.
期刊最新文献
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