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

I'm quite sure this is damned important to your recovery. If it is not in your hospital in a week, call your hospital president and ask why their stroke department is so f*cking incompetent. The beatings will continue until your hospital is updating stroke protocols on a weekly basis. This is really the responsibility of the presidents of the ASA and NSA to ride herd on stroke hospitals to make sure they are up-to-date on all the latest and are running research to prove the next breakthrough.
Your replies:
Matt Lopez, president of the NSA
 Dr. Mariel Jessup, president of the ASA

http://www.jneuroengrehab.com/content/12/1/50 

Belén Rubio Ballester^1*, Jens Nirme¹, Esther Duarte², Ampar Cuxart³, Susana Rodriguez³, Paul Verschure¹⁴ and Armin Duff¹

• * Corresponding author: Belén R Ballester belen.rubio@upf.edu

Author Affiliations

¹ Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Center of Autonomous Systems and Neurorobotics, Pompeu Fabra, Roc Boronat, Barcelona, Spain
² Servei de Medicina Física I Rehabilitació, Hospitals del Mar I l’Esperanç, Institut Hospital del Mar d’Investigacions Médiques, Barcelona, Spain
³ Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall dHebron, Barcelona, Spain
⁴ ICREA, Institució Catalana de Recerca i Estudis Avançats, Passeig Lluís Companys, Barcelona, Spain

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Journal of NeuroEngineering and Rehabilitation 2015, 12:50  doi:10.1186/s12984-015-0039-z
The electronic version of this article is the complete one and can be found online at: http://www.jneuroengrehab.com/content/12/1/50

Received:	5 February 2015
Accepted:	13 May 2015
Published:	9 June 2015

© 2015 Rubio Ballester et al.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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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.