Lee Hsin-Min, Li Ping-Chia, Fan Shih-Chen
Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan, Republic of China.
Department of Occupational Therapy, I-Shou University, Kaohsiung, Taiwan, Republic of China.
J Neuroeng Rehabil. 2015 Jul 11;12:56. doi: 10.1186/s12984-015-0053-1.
Mirror visual feedback (MVF) generated in mirror therapy (MT) with a physical mirror promotes the recovery of hemiparetic limbs in patients with stroke, but is limited in that it cannot provide an asymmetric mode for bimanual coordination training. Here, we developed a novel MT system that can manipulate the MVF to resolve this issue. The aims of this pilot study were to examine the feasibility of delayed MVF on MT and to establish its effects on cortical activation in order to understand how it can be used for clinical applications in the future.
Three conditions (no MVF, MVF, and 2-s delayed MVF) presented via our digital MT system were evaluated for their time-course effects on cortical activity by event-related desynchronization (ERD) of mu rhythm electroencephalography (EEG) during button presses in 18 healthy adults. Phasic ERD areas, defined as the areas of the relative ERD curve that were below the reference level and within -2-0 s (P0), 0-2 s (P1), and 2-4 s (P2) of the button press, were used.
The overall (P0 to P2) and phasic ERD areas were higher when MVF was provided compared to when MVF was not provided for all EEG channels (C3, Cz, and C4). Phasic ERD areas in the P2 phase only increased during the delayed-MVF condition. Significant enhancement of cortical activation in the mirror neuron system and an increase in attention to the unseen limb may play major roles in the response to MVF during MT. In comparison to the no MVF condition, the higher phasic ERD areas that were observed during the P1 phase in the delayed-MVF condition indicate that the image of the still hand may have enhanced the cortical activation that occurred in response to the button press.
This study is the first to achieve delayed MVF for upper-limb MT. Our approach confirms previous findings regarding the effects of MVF on cortical activation and contributes additional evidence supporting the use of this method in the future for upper-limb motor training in patients with stroke.
在使用实体镜子的镜像疗法（MT）中产生的镜像视觉反馈（MVF）可促进中风患者偏瘫肢体的恢复，但局限性在于它无法为双手协调训练提供非对称模式。在此，我们开发了一种新型的MT系统，该系统可以操控MVF来解决这一问题。这项初步研究的目的是检验延迟MVF用于MT的可行性，并确定其对皮质激活的影响，以便了解其在未来如何用于临床应用。
通过我们的数字MT系统呈现三种条件（无MVF、MVF和延迟2秒的MVF），在18名健康成年人按键过程中，通过μ节律脑电图（EEG）的事件相关去同步化（ERD）评估它们对皮质活动的时程效应。使用了阶段性ERD区域，其定义为相对ERD曲线中低于参考水平且在按键后-2至0秒（P0）、0至2秒（P1）和2至4秒（P2）内的区域。
对于所有EEG通道（C3、Cz和C4），与不提供MVF时相比，提供MVF时总的（P0至P2）和阶段性ERD区域更高。仅在延迟MVF条件下，P2阶段的阶段性ERD区域增加。镜像神经元系统中皮质激活的显著增强以及对不可见肢体注意力的增加可能在MT期间对MVF的反应中起主要作用。与无MVF条件相比，在延迟MVF条件下P1阶段观察到的更高的阶段性ERD区域表明，静止手的图像可能增强了对按键做出反应时发生的皮质激活。
本研究首次实现了上肢MT的延迟MVF。我们的方法证实了先前关于MVF对皮质激活影响的研究结果，并为将来在中风患者上肢运动训练中使用该方法提供了更多支持证据。
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