Feasibility Case Study for Treating a Patient with Sensory Ataxia Following a Stroke with Kinesthetic Illusion Induced by Visual Stimulation

Abstract

Background: 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. Case: 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. Discussion: 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.

Influence of Visual Stimulation-Induced Passive Reproduction of Motor Images in the Brain on Motor Paralysis After Stroke

“…This result implies that changes in these variables were independent of each other. A case report of a patient with stroke showed increased extensor digitorum activity after a single session of KINVIS ( Aoyama et al, 2020 ). Therefore, change in hand extensor muscle activity may be a candidate factor affecting the improvement in active range of finger extension apart from hand flexor muscle spasticity.…”

“…All patients underwent a single 20-min session of KINVIS ( Aoyama et al, 2020 ; Okawada et al, 2020 ). The patients were seated in a comfortable chair with their paretic forearm on the table.…”

“…The patients were seated in a comfortable chair with their paretic forearm on the table. Prior to the intervention, the patients were filmed executing the finger flexion–extension movement (3-s flexion and 3-s extension) with the non-paretic hand ( Aoyama et al, 2020 ). During KINVIS intervention (KiNvis Therapy System TM ; Inter Reha, Tokyo, Japan), the patients were instructed to remain completely relaxed while observing a computer screen projecting a mirror image of the patient’s non-paretic hand placed over their paretic hand ( Figure 1 ).…”

“…After KINVIS intervention, patients were asked to rate the sense of body ownership and illusory sensation during intervention using a 7-point Likert scale (–3, strongly disagree; 0, neither agree nor disagree; + 3, strongly agree) ( Kaneko et al, 2019 ; Aoyama et al, 2020 ).…”

Model-Based Analyses for the Causal Relationship Between Post-stroke Impairments and Functional Brain Connectivity Regarding the Effects of Kinesthetic Illusion Therapy Combined With Conventional Exercise

“…However, these therapies require patients to perform voluntary movements or motor imagery, and severe cases with strong difficulties in such performances are often excluded. Therefore, an effective therapy for severe cases is required, for which a novel therapy utilizing kinesthetic illusion of segmental body part induced by visual stimulation (KINVIS) was proposed (Kaneko et al, 2016a(Kaneko et al, , 2019Aoyama et al, 2020;Okawada et al, 2020).…”