Kinesthetic illusion induced by visual stimulation influences sensorimotor event-related desynchronization in stroke patients with severe upper-limb paralysis: A pilot study

Abstract

Background: Repetition of motor imagery improves the motor function of patients with stroke. However, patients who develop severe upper-limb paralysis after chronic stroke often have an impaired ability to induce motor imagery. We have developed a method to passively induce kinesthetic perception using visual stimulation (kinesthetic illusion induced by visual stimulation [KINVIS]). Objective: This pilot study further investigated the effectiveness of KINVIS in improving the induction of kinesthetic motor imagery in patients with severe upper-limb paralysis after stroke. Methods: Twenty participants (11 with right hemiplegia and 9 with left hemiplegia; mean time from onset [±standard deviation], 67.0±57.2 months) with severe upper-limb paralysis who could not extend their paretic fingers were included in this study. The ability to induce motor imagery was evaluated using the event-related desynchronization (ERD) recorded during motor imagery before and after the application of KINVIS for 20 min. The alpha- and beta-band ERDs around the premotor, primary sensorimotor, and posterior parietal cortices of the affected and unaffected hemispheres were evaluated during kinesthetic motor imagery of finger extension and before and after the intervention. Results: Beta-band ERD recorded from the affected hemisphere around the sensorimotor area showed a significant increase after the intervention, while the other ERDs remained unchanged. Conclusions: In patients with chronic stroke who were unable to extend their paretic fingers for a prolonged period of time, the application of KINVIS, which evokes kinesthetic perception, improved their ability to induce motor imagery. Our findings suggest that although KINVIS is a passive intervention, its short-term application can induce changes related to the motor output system.

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

“…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.…”

“…Studies in healthy volunteers have shown that motorrelated cortical area activation and corticomotor excitability increase during and after KINVIS (Kaneko et al, 2007(Kaneko et al, , 2015(Kaneko et al, , 2016b(Kaneko et al, , 2019Aoyama et al, 2012;Shibata and Kaneko, 2019). A preliminary study examining the effects of KINVIS among post-stroke patients reported that the single intervention session increased beta band event-related desynchronization obtained from sensorimotor cortex during motor imagery (Okawada et al, 2020), as well as improved paretic upper limb motor function (Kaneko et al, 2016a). Moreover, a study of 11 stroke patients who underwent 10 days of rehabilitation that included KINVIS reported a significant reduction in the spasticity of the finger and wrist flexor muscles and improved upper limb motor function after the intervention (Kaneko et al, 2019).…”

Event-Related EEG Desynchronization Reveals Enhanced Motor Imagery From the Third Person Perspective by Manipulating Sense of Body Ownership With Virtual Reality for Stroke Patients

“…We focused our analysis on the primary motor areas (M1), the activation of which was roughly detected by the EEG from channels C3/C4. This approach is a common choice for assessing the effectiveness of MI involving hand movements in healthy [25], [55] and stroke patients [56]. The C3/C4 channels were used to evaluate MI involving more complex upper limb tasks, such as wiping a table [57] and elbow rotation, among others [22].…”

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).…”