Virtual reality-based treatment for regaining upper extremity function induces cortex grey matter changes in persons with acquired brain injury

Abstract

Background Individuals with acquired brain injuries (ABI) are in need of neurorehabilitation and neurorepair. Virtual anatomical interactivity (VAI) presents a digital game-like format in which ABI survivors with upper limb paresis use an unaffected limb to control a standard input device and a commonplace computer mouse to control virtual limb movements and tasks in a virtual world. Methods In a prospective cohort study, 35 ambulatory survivors of ABI (25/71% stroke, 10/29% traumatic brain injury) were enrolled. The subjects were divided into three groups: group A received VAI therapy only, group B received VAI and physical/occupational therapy (P/OT), and group C received P/OT only. Motor skills were evaluated by muscle strength (hand key pinch strength, grasp, and three-jaw chuck pinch) and active range of motion (AROM) of the shoulder, elbow, and wrist. Changes were analyzed by ANOVA, ANCOVA, and one-tailed Pearson correlation analysis. MRI data was acquired for group A, and volumetric changes in grey matter were analyzed using voxel-based morphometry (VBM) and correlated with quantified motor skills. Results AROM of the shoulder, elbow, and wrist improved in all three groups. VBM revealed grey matter increases in five brain areas: the tail of the hippocampus, the left caudate, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex. A positive correlation between the grey matter volumes in three cortical regions (motor and premotor and supplementary motor areas) and motor test results (power and AROM) was detected. Conclusions Our findings suggest that the VAI rehabilitation program significantly improved motor function and skills in the affected upper extremities of subjects with acquired brain injuries. Significant increases in grey matter volume in the motor and premotor regions of affected hemisphere and correlations of motor skills and volume in nonaffected brain regions were present, suggesting marked changes in structural brain plasticity. Trial registration The trial “Limitations of motor brain activity – use of virtual reality for simulation of therapeutic interventions” has been registered under reference number ISRCTN11757651.

Leap Motion Controller Video Game-Based Therapy for Upper Extremity Motor Recovery in Patients with Central Nervous System Diseases. A Systematic Review with Meta-Analysis

“…The repetitive tasks of the different games could favor brain plasticity. Different studies have suggested that non-immersive VR therapy produces improvements in UE motor function in patients with stroke and increases gray matter volume in the motor and premotor regions of the affected hemisphere and could be correlated with an improvement in motor skills in undamaged brain areas, suggesting plasticity changes related to imagining, planning, and performing motor tasks [ 93 ]. In recent studies, other non-immersive VR devices, such as Doctor Kinetic [ 94 ] and the Nintendo ® Wii gaming system [ 95 ], have proven effective in improving UE motor function in stroke patients, demonstrating that they are a good tool to be used in neurorehabilitation, although they are not superior to CT when used alone [ 96 , 97 ].…”

Virtual Reality for Neurorehabilitation and Cognitive Enhancement

“…The main therapeutic effect of VR on upper limb motor activity is to increase the active range of motion (AROM) of the shoulder, elbow, and wrist [ 121 , 122 ]. Significant gray matter increases were detected by MRI with voxel-based morphometry in five brain areas: the tail of the hippocampus, the left caudate nucleus, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex [ 122 ]. Furthermore, the gray matter volumes of motor, premotor, and supplementary motor cortices correlated positively with the power and AROM measured in motor tests [ 122 ].…”

“…Significant gray matter increases were detected by MRI with voxel-based morphometry in five brain areas: the tail of the hippocampus, the left caudate nucleus, the rostral cingulate zone, the depth of the central sulcus, and the visual cortex [ 122 ]. Furthermore, the gray matter volumes of motor, premotor, and supplementary motor cortices correlated positively with the power and AROM measured in motor tests [ 122 ]. Interestingly, EEG recordings showed significantly increased EEG concentration (indicated by strong beta waves) in the frontopolar 2 (FP2) and frontal 4 (F4) areas, and enhanced brain activity (indicated by higher average wave frequency) in the frontopolar 1 (FP1) and frontal 3 (F3) areas in an upper-extremity training group using VR [ 123 ].…”

Patients with chronic mild or moderate traumatic brain injury have abnormal longitudinal brain volume enlargement more than atrophy

“…Regarding possible compensatory hypertrophy, there have been many studies showing that when brain regions perform more tasks, they enlarge. [47][48][49][50][51][52][53][54][55][56][57][58][59][60] There are a few possible causes or subcategories of the hypothesized compensatory hypertrophy that are discussed below, including: 1) injured brain regions becomes more active and enlarge; 2) uninjured brain regions connected to the injured brain regions become more active and enlarge; and 3) the injured regions atrophied in the post-injury acute phase and later enlarged as recovery occurred.…”

“…This is supported by studies of patients with brain disorders showing that increased brain activity leads to brain enlargement. 47,55,59,60 Subhypothesis 2: uninjured brain regions account for the enlargement. This is indirectly supported by studies of people without brain disorders showing that increased brain activity leads to brain enlargement.…”