Effects of virtual reality-based motor rehabilitation: a systematic review of fMRI studies

Abstract

Background: The use of virtual reality (VR) as a rehabilitation tool has been shown to induce motor and cognitive improvements in different populations. Functional magnetic resonance imaging (fMRI) has been used to investigate neuroplasticity resulting from these treatments. We hypothesize that VR rehabilitation induces functional improvement and brain changes that can be detected by fMRI. Objective: To systematically review the effects of VR intervention on the cortical reorganization measured by fMRI and associated with functional improvement. Methods: We performed a systematic review of studies published between 2005 and 2021. Papers were retrieved from six databases using the following keywords: “motor rehabilitation”, “fMRI” and “virtual reality”. Case studies, pre-post studies, cross-sectional studies, and randomized controlled trials published were included. Manuscripts were assessed by The NIH Study Quality Assessment Tools to determine their quality. Results: Twenty-three articles met our eligibility criteria: 18 about VR rehabilitation in stroke and five on other clinical conditions (older adults, cerebral palsy, and Parkinson's disease). Changes in neural patterns of activation and reorganization were revealed in both the ipsilesional and the contralesional hemispheres. Results were located mainly in the primary motor cortex, sensorimotor cortex and supplementary motor area in post-stroke patients in the acute, subacute, and chronic rehabilitation phases, and were associated with functional improvement after VR intervention. Similar effects were observed in older adults and in patients with other neurological diseases with improved performance. Conclusion: Most stroke-related studies showed either restoration to normal or increase of activation patterns or relateralization at/to the ipsilesional hemisphere, with some also reporting a decrease in activity or extent of activation after VR therapy. In general, VR intervention demonstrated evidence of efficacy both in neurological rehabilitation and in performance improvement of older adults, accompanied by fMRI evidence of brain reorganization.

Assisted technology in Parkinson's disease gait: what's up?

“…42 Some studies used VR to interact three-dimensional virtual environment. 4,25,[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] We also found studies using Robotic-assisted gait training for PD. 24,29,[59][60][61][62] We analyzed several types of AP and categorized them into commercial and non-commercial devices available for research, rehabilitation, or home-based care.…”

“…Studies observed that VR rehabilitation may improve neuroplasticity and change brain neural patterns by activation and reorganization mainly of the primary motor cortex, sensorimotor cortex, and supplementary motor area. 48 In addition, functional magnetic resonance imaging showed that PD patients who underwent VR training increased activity in the precuneus region, which is linked to visuospatial integration, memory, and self-awareness, and this network is active during activities involving memory encoding and retrieval. 47 Cognition plays an important role in postural control and may interfere with gait and posture assessment and treatment.…”

Virtual reality-induced motor function of the upper extremity and brain activation in stroke: study protocol for a randomized controlled trial

“…Neurological imaging tended to obtain information from multiple modalities and integrate them and combined with different advantages of modal imaging technology so as to obtain more comprehensive, rich, accurate, and reliable brain information, and this method also provides a new monitoring method for the description of the cognitive neural dynamic process ( 45 ). VR-associated neurophysiological changes can be assessed by non-invasive and portable neuroimaging techniques including fMRI ( 46 ) and/or EEG ( 47 ) to determine changes in cerebral hemodynamic responses or oscillating brain waves, respectively. In particular, the use of fMRI as a measure of cerebral hemodynamic response to the neurological rehabilitation process has received attention.…”

Altered effective connectivity in the emotional network induced by immersive virtual reality rehabilitation for post-stroke depression

“…The basic neuroscience behind VR-based treatment has mainly been linked to functional brain remodeling ( Feitosa et al, 2022 ). The present study also set the imaging ROIs in the emotional networks, as reported previously, to explore the functional remodeling induced by VR supporting emotion recovery.…”