The role of virtual reality in improving motor performance as revealed by EEG: a randomized clinical trial

• Published in: Journal of neuroengineering and rehabilitation Vol. 14; no. 1; pp. 53 - 16
• Main Authors: Calabrò, Rocco Salvatore, Naro, Antonino, Russo, Margherita, Leo, Antonino, De Luca, Rosaria, Balletta, Tina, Buda, Antonio, La Rosa, Gianluca, Bramanti, Alessia, Bramanti, Placido
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07-06-2017; BioMed Central; BMC
• Subjects: Aged; Analysis; Balance; Band spectra; Biomechanical Phenomena; Brain; Brain Ischemia - rehabilitation; Cerebral Cortex - physiopathology; Clinical trials; Computer applications; Cortex; EEG; Electroencephalography; Entrainment; Ersp; Female; Gait; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - rehabilitation; Group dynamics; Humans; Intervention; Ischemia; Lokomat; Loreta; Male; Medical imaging; Memory; Middle Aged; Mirror neuron system; Mirror neurons; Mobility; Motivation; Motor skill learning; Motor task performance; Neurology; NMR; Nuclear magnetic resonance; Oscillations; Paresis; Paresis - rehabilitation; Patients; Pilot Projects; Psychological aspects; Psychomotor Performance; Recovery of Function; Rehabilitation; Rehabilitation robots; Robotics; Stroke; Stroke - psychology; Stroke Rehabilitation - instrumentation; Stroke Rehabilitation - methods; Training; Treatment Outcome; Virtual Reality; Lokomat; Loreta; Ersp; Mirror neuron system; Virtual reality
• ISSN: 1743-0003; 1743-0003
• DOI: 10.1186/s12984-017-0268-4

Many studies have demonstrated the usefulness of repetitive task practice by using robotic-assisted gait training (RAGT) devices, including Lokomat, for the treatment of lower limb paresis. Virtual reality (VR) has proved to be a valuable tool to improve neurorehabilitation training. The aim of our pilot randomized clinical trial was to understand the neurophysiological basis of motor function recovery induced by the association between RAGT (by using Lokomat device) and VR (an animated avatar in a 2D VR) by studying electroencephalographic (EEG) oscillations.
Twenty-four patients suffering from a first unilateral ischemic stroke in the chronic phase were randomized into two groups. One group performed 40 sessions of Lokomat with VR (RAGT + VR), whereas the other group underwent Lokomat without VR (RAGT-VR). The outcomes (clinical, kinematic, and EEG) were measured before and after the robotic intervention.
As compared to the RAGT-VR group, all the patients of the RAGT + VR group improved in the Rivermead Mobility Index and Tinetti Performance Oriented Mobility Assessment. Moreover, they showed stronger event-related spectral perturbations in the high-γ and β bands and larger fronto-central cortical activations in the affected hemisphere.
The robotic-based rehabilitation combined with VR in patients with chronic hemiparesis induced an improvement in gait and balance. EEG data suggest that the use of VR may entrain several brain areas (probably encompassing the mirror neuron system) involved in motor planning and learning, thus leading to an enhanced motor performance.
Retrospectively registered in Clinical Trials on 21-11-2016, n. NCT02971371 .