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Brain activity during virtual and real dart throwing tasks in patients with stroke: A pilot study

Filipe S. Melo1*, Jacilda O. Passos2, Deyvson P. Brito2, Pedro Passos1, Aline S. Fernandes2, Tânia Campos2 and João Barreiros1
  • 1 Faculdade de Motricidade Humana, Sport and Health Sciences Department, Portugal
  • 2 Universidade Federal Rio Grande do Norte, Brazil

Stroke is a neurological problem that may cause severe sensorimotor, cognitive and functional impairments. Motor recovery of upper limb dysfunction in patients with stroke is an important goal for neurorehabilitation depending on the functional reorganization of the Central Nervous System (CNS)1. Virtual Reality (VR) is considered a promising tool for functional Neurorehabilitation, providing intensive repetition of complex tasks, positive and dynamic individual-task interaction, and may also remove limiting factors related with physical constraints2. Previous studies using virtual reality in motor rehabilitation aim to rate VR consoles efficiency and effectiveness3. The use of VR as an intervention technique in rehabilitation raises the question about the similarity of sensory-motor perception between real and virtual environments4. The literature considers that the level of accuracy of a motor task performed in different environments can be assessed by brain activity analysis, and/or movement kinematic analysis5. Due to the movement similarity between real and virtual environments (e.g., videogame tasks), it was hypothesized that virtual environments could be useful in neurorehabilitation. This research aimed to compare brain activity and arm movement during virtual and real dart throwing tasks between stroke patients and healthy subjects. The participants, all dexterous, were two patients (one with right brain injury and the other with left brain injury, aged 41 and 69 years) and two healthy individuals (aged 38 and 60 years). The research was submitted to the Ethics in Research Committee, and all the participants signed an Informed Consent form. In order to quantify neurological impairment the stroke patients were evaluated through the National Institute Health Stroke Scale (NIHSS) presenting a neurologic impairment of “mild”. The motor evaluation was performed by the Fugl-Meyer Scale using the upper limb subsection which specifically evaluates the reflex activity, isolated movements and synergistic patterns, hand activities, as well as motor coordination and speed of movement. Stroke participants presented a motor impairment of “mild to moderate”. The participants performed 15 trials during a real dart throwing task (using a professional dart board, and a set of three darts) and 15 trials during a virtual dart throwing task, using the Kinect Sports game and the Xbox 360º Kinect console. The participants with stroke performed the tasks with the paretic upper limb, one of the healthy participants performed with the right limb and the other with the left limb. To avoid fatigue practice was distributed in 3 blocks of 5 trials with a 5 minute rest period between each block. Each participant started each trial with the elbow flexed and the hand positioned in front of the target. The brain activity, registered for each block of trials, was captured with an Emotiv EPOC® system, which is a portable EEG system with 16 sensors aligned according to the international 10–20 system. EEG data processing used EEGLAB software (version 7.1.3.13). Artifacts were removed through visual inspection; data were high and low pass filtered at 1 Hz and 50 Hz respectively; a brain mapping for each block of trials was generated using an independent component analysis (ICA) process. The brain activity data was supported on power spectral analysis of Beta waves at 22 Hz, usually associated with cognitive attention and interaction with the environment, and Gamma waves at 40Hz, associated with information processing from different brain areas. The intensity of these waves on the scalp was analyzed through the color graduation, in which red color represents higher activation and dark blue represents few or no activation. The kinematic analysis of elbow movement amplitude was assessed using a Qualisys Motion Capture System, composed of 8 video cameras, a group of infrared reflectors, and a group of body reflectors placed on the arm (19 mm spherical passive markers). Data processing included a filter with a frequency of 6 Hz. Statistical procedures used Kolmogorov-Smirnov tests to verify the normality of kinematic data, and T-Student tests to compare motor performance between virtual and real environments. Data revealed similarities on brain activity between virtual and real dart game tasks, with activation of the primary motor cortex in the right cerebral hemisphere (FC6), for both stroke and healthy participants. Performing the throwing task in the virtual environment activated more areas of multisensory integration (parietal, temporal and occipital cortices). Results indicate prevalence in the activation of the primary motor cortex and the parietal cortex, including the somatosensory and visuo-spatial processing areas, which might have revealed the sensory-perceptual-motor demands of the virtual practice. Neuroscience research highlights that the right brain hemisphere can be understood as dominate when it comes to spatial attention and perception6. Therefore, our data corroborate results from previous research. By displaying that independently of the laterality of the arm used to perform and the injured hemisphere, the right hemisphere was the most activated in the course of action for both (i.e., real and virtual) performance environments. By stimulating the right brain hemisphere in both practice conditions (i.e., real and virtual) our results sustain the use of virtual game tasks for motor rehabilitation of stroke patients7. The virtual and real dart game tasks also differ in the kinematic parameters. Results revealed a wider angle of the elbow extension while performing the real game task. These data can be associated with task constraints as weight, size and thickness of the dart which requires a larger arm movement in order to throw the dart in the most accurate flight path towards the target. On the contrary for the virtual game task, due to the absence of the dart, this wider arm movement is not required. Another important issue is that a smaller range of motion of the elbow in the virtual game task can also be beneficial for patients with elbow extension restrictions due to moderate or severe spasticity, or joint stiffness8. On the other hand, the real game task which requires a wider angle of the elbow may be indicated when the aim of the rehabilitation is an increase on motion amplitude of this joint. The results allow us to infer that the virtual and the real environments may offer different advantages for Neurorehabilitation inducing different behaviors.

References

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4. Wallet G, Sauzéon H, Rodrigues J, N’Kaoua B. Transfer of spatial knowledge from a virtual environment to reality: Impact of route complexity and subject’s strategy on the exploration mode. JVRB. 2009;6(4).
5. Tamei T, Obayashi C, Shibata T. Throwing darts utilizes the interaction torque of the elbow joint. Conf Proc IEEE Eng Med Biol Soc. 2011;1283-6.
6. Dietz MJ, Friston KJ, Mattingley JB, Roepstorff A, Garrido MI. Effective connectivity reveals right-hemisphere dominance in audiospatial perception: implications for models of spatial neglect. J Neurosci. 2014;34(14):5003–11.
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8. Fernandes ABG, Passos JO, Brito DP, Campos TF. Comparison of the immediate effect of the training with a virtual reality game in stroke patients according side brain injury. NeuroRehabilitation. 2014;35(1):39-45

Keywords: Stroke, Dart throwing, virtual reality, Brain activity, Rehabilitation

Conference: SAN2016 Meeting, Corfu, Greece, 6 Oct - 9 Oct, 2016.

Presentation Type: Poster Presentation in SAN2016 Conference

Topic: Posters

Citation: Melo FS, Passos JO, Brito DP, Passos P, Fernandes AS, Campos T and Barreiros J (2016). Brain activity during virtual and real dart throwing tasks in patients with stroke: A pilot study. Conference Abstract: SAN2016 Meeting. doi: 10.3389/conf.fnhum.2016.220.00079

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Received: 29 Jul 2016; Published Online: 01 Aug 2016.

* Correspondence: Prof. Filipe S Melo, Faculdade de Motricidade Humana, Sport and Health Sciences Department, Cruz Quebrada, Portugal, 1495-688, Portugal, fmelo@fmh.utl.pt