Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine Seoul, Seoul, Korea.
J Neuroeng Rehabil. 2012 Oct 4;9:71. doi: 10.1186/1743-0003-9-71.
Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation. However, the underlying mechanisms for these therapeutic effects have not been previously described.
We attempted to delineate the changes in corticospinal excitability when individuals were asked to exercise their upper extremity using a real mirror and virtual mirror. Moreover, we attempted to delineate the role of visual modulation within the virtual environment that affected corticospinal excitability in healthy subjects and stroke patients.
A total of 18 healthy subjects and 18 hemiplegic patients were enrolled into the study. Motor evoked potential (MEP)s from transcranial magnetic stimulation were recorded in the flexor carpi radialis of the non-dominant or affected upper extremity using three different conditions: (A) relaxation; (B) real mirror; and (C) virtual mirror. Moreover, we compared the MEPs from the virtual mirror paradigm using continuous visual feedback or intermittent visual feedback.
The rates of amplitude increment and latency decrement of MEPs in both groups were higher during the virtual mirror task than during the real mirror. In healthy subjects and stroke patients, the virtual mirror task with intermittent visual feedback significantly facilitated corticospinal excitability of MEPs compared with continuous visual feedback.
Corticospinal excitability was facilitated to a greater extent in the virtual mirror paradigm than in the real mirror and in intermittent visual feedback than in the continuous visual feedback, in both groups. This provides neurophysiological evidence supporting the application of the virtual mirror paradigm using various visual modulation technologies to upper extremity rehabilitation in stroke patients.
几项针对脑卒中患者的实验研究表明，镜像疗法和各种虚拟现实程序有助于运动康复。然而，这些治疗效果的潜在机制尚未得到描述。
我们试图描述当个体被要求使用真实镜子和虚拟镜子来锻炼上肢时，皮质脊髓兴奋性的变化。此外，我们试图描述在虚拟环境中视觉调制的作用，它影响健康受试者和脑卒中患者的皮质脊髓兴奋性。
共有 18 名健康受试者和 18 名偏瘫患者被纳入研究。使用三种不同的条件（A.放松；B.真实镜子；C.虚拟镜子）从经颅磁刺激记录非优势或患侧上肢的桡侧腕屈肌的运动诱发电位（MEP）。此外，我们比较了使用连续视觉反馈或间歇视觉反馈的虚拟镜子范式的 MEP。
在两组中，虚拟镜子任务时 MEP 的振幅增加率和潜伏期缩短率均高于真实镜子任务。在健康受试者和脑卒中患者中，间歇视觉反馈的虚拟镜子任务比连续视觉反馈更显著地促进了 MEP 的皮质脊髓兴奋性。
在两组中，虚拟镜子范式比真实镜子和连续视觉反馈更能显著促进皮质脊髓兴奋性，间歇视觉反馈比连续视觉反馈更能显著促进皮质脊髓兴奋性。这为应用虚拟镜子范式结合各种视觉调制技术促进脑卒中患者上肢康复提供了神经生理学证据。
