Aoyama Toshiyuki, Kanazawa Atsushi, Kohno Yutaka, Watanabe Shinya, Tomita Kazuhide, Kimura Takehide, Endo Yusuke, Kaneko Fuminari
Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Ami, Japan.
Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ami, Japan.
Prog Rehabil Med. 2020 Oct 28;5:20200025. doi: 10.2490/prm.20200025. eCollection 2020.
Sensory ataxia is a disorder of movement coordination caused by sensory deficits, especially in kinesthetic perception. Visual stimulus-induced kinesthetic illusion (KINVIS) is a method used to provide vivid kinesthetic perception without peripheral sensory input by using a video showing pre-recorded limb movements while the actual limb remains stationary. We examined the effects of KINVIS intervention in a patient with sensory ataxia.
The patient was a 59-year-old man with a severe proprioceptive deficit caused by left thalamic hemorrhage. During KINVIS intervention, a computer screen displayed a pre-recorded mirror image video of the patient's unaffected hand performing flexion-extension movements as if it were attached to the patient's affected forearm. Kinematics during the flexion-extension movements of the paretic hand were recorded before and after 20-min interventions. Transcranial magnetic stimulation was applied to the affected and non-affected hemispheres. The amplitude of the motor-evoked potential (MEP) at rest was recorded for the muscles of both hands. After the intervention, the total trajectory length and the rectangular area bounding the trajectory of the index fingertip decreased. The MEP amplitude of the paretic hand increased, whereas the MEP amplitude of the non-paretic hand was unchanged.
The changes in kinematics after the intervention suggested that KINVIS therapy may be a useful new intervention for sensory ataxia, a condition for which few effective treatments are currently available. Studies in larger numbers of patients are needed to clarify the mechanisms underlying this therapeutic effect.
感觉性共济失调是一种由感觉缺陷引起的运动协调障碍，尤其是在本体感觉方面。视觉刺激诱发的本体感觉错觉（KINVIS）是一种通过播放预先录制的肢体运动视频，而实际肢体保持静止，从而在没有外周感觉输入的情况下提供生动本体感觉的方法。我们研究了KINVIS干预对一名感觉性共济失调患者的影响。
该患者为一名59岁男性，因左侧丘脑出血导致严重的本体感觉缺陷。在KINVIS干预过程中，电脑屏幕上显示患者未受影响手进行屈伸运动的预先录制的镜像视频，就好像它附着在患者受影响的前臂上。在20分钟干预前后记录患侧手屈伸运动时的运动学数据。对受影响和未受影响的半球进行经颅磁刺激。记录双手肌肉在静息状态下的运动诱发电位（MEP）幅度。干预后，食指指尖轨迹的总长度和轨迹所包围的矩形面积减小。患侧手的MEP幅度增加，而未患侧手的MEP幅度未改变。
干预后运动学的变化表明，KINVIS疗法可能是感觉性共济失调一种有用的新干预方法，目前针对这种疾病几乎没有有效的治疗方法。需要对更多患者进行研究，以阐明这种治疗效果的潜在机制。
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