http://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-015-0039-z
- Belén Rubio BallesterEmail author,
- Jens Nirme,
- Esther Duarte,
- Ampar Cuxart,
- Susana Rodriguez,
- Paul Verschure and
- Armin Duff
Journal of NeuroEngineering and Rehabilitation201512:50
DOI: 10.1186/s12984-015-0039-z
© Rubio Ballester et al. 2015
Received: 5 February 2015
Accepted: 13 May 2015
Published: 9 June 2015
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.
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