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Combined Transcranial Direct Current Stimulation and Virtual Reality-Based Paradigm for Upper Limb Rehabilitation in Individuals with Restricted Movements. A Feasibility Study with a Chronic Stroke Survivor with Severe Hemiparesis

Journal of Medical Systems volume 42, Article number: 87 (2018) Cite this article

Abstract

Impairments of the upper limb function are a major cause of disability and rehabilitation. Most of the available therapeutic options are based on active exercises and on motor and attentional inclusion of the affected arm in task oriented movements. However, active movements may not be possible after severe impairment of the upper limbs. Different techniques, such as mirror therapy, motor imagery, and non-invasive brain stimulation have been shown to elicit cortical activity in absence of movements, which could be used to preserve the available neural circuits and promote motor learning. We present a virtual reality-based paradigm for upper limb rehabilitation that allows for interaction of individuals with restricted movements from active responses triggered when they attempt to perform a movement. The experimental system also provides multisensory stimulation in the visual, auditory, and tactile channels, and transcranial direct current stimulation coherent to the observed movements. A feasibility study with a chronic stroke survivor with severe hemiparesis who seemed to reach a rehabilitation plateau after two years of its inclusion in a physical therapy program showed clinically meaningful improvement of the upper limb function after the experimental intervention and maintenance of gains in both the body function and activity. The experimental intervention also was reported to be usable and motivating. Although very preliminary, these results could highlight the potential of this intervention to promote functional recovery in severe impairments of the upper limb.

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Funding

This study was funded in part by Ministerio de Economía y Competitividad of Spain (Project TIN2014–61975-EXP and Grant BES-2014-068218) and by Universitat Politècnica de València (Grant PAID-10-14 and Grant PAID-10-16).

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Affiliations

  1. Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales VITHAS-NISA, Fundación Hospitales NISA, Río Tajo 1, 46022, Valencia, Spain

    María Antonia Fuentes, Carolina Colomer, Enrique Noé & Roberto Llorens

  2. Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, Camino de Vera s/n, 46011, Valencia, Spain

    Adrián Borrego, Jorge Latorre, Mariano Alcañiz & Roberto Llorens

  3. VisualMed Systems Group, University of Salamanca, Patio Escuelas 1, 37008, Salamanca, Spain

    María José Sánchez-Ledesma

Authors
  1. María Antonia Fuentes
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  2. Adrián Borrego
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  3. Jorge Latorre
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  4. Carolina Colomer
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  5. Mariano Alcañiz
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  6. María José Sánchez-Ledesma
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  7. Enrique Noé
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  8. Roberto Llorens
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Corresponding author

Correspondence to María José Sánchez-Ledesma.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

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This article is part of the Topical Collection on Patient Facing Systems

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Fuentes, M.A., Borrego, A., Latorre, J. et al. Combined Transcranial Direct Current Stimulation and Virtual Reality-Based Paradigm for Upper Limb Rehabilitation in Individuals with Restricted Movements. A Feasibility Study with a Chronic Stroke Survivor with Severe Hemiparesis. J Med Syst 42, 87 (2018). https://doi.org/10.1007/s10916-018-0949-y

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  • DOI: https://doi.org/10.1007/s10916-018-0949-y

Keywords

  • Virtual reality
  • tDCS
  • Eye-tracking
  • Surface electromyography
  • Upper limb paresis
  • Monoparesis, stroke