Magnifying vision improves motor performance in individuals with stroke

Virtual body continuity during action observation affects motor cortical excitability

Body ownership, the sense that the body belongs to oneself, can be altered by inducing body manipulations in Virtual Reality, such as by increasing the visual discontinuity between the avatar's hand and body. Body representation manipulations can also influence motor cortex excitability. We hypothesized that the degree of body continuity between one's body and the observed virtual body would affect ownership feelings and impact motor cortex excitability during action observation. Participants observed virtual hand movements from a first-person perspective with the virtual hand presented with different level of connection with their real hand; the virtual hand could be part of a full virtual body co-located with the real body (Full-Body condition), it could appear as connected to an upper limb visually discontinuous from the real body (Upper Limb condition), or the virtual hand appeared in isolation, fully discontinuous (Detached Hand condition). Results showed increased corticospinal excitability when body continuity is higher (Full-Body and Upper Limb). This effect was mediated by ownership and disownership feelings, supporting the relationship between body perception and motor system.

Task-based and Magnified Mirror Therapy for Unilateral Spatial Neglect among post-stroke subjects: Study protocol for a randomized controlled trial

BACKGROUND

Unilateral spatial neglect (USN) is a commonly occurring neurocognitive disability after a stroke. The neglect may affect the motor recovery of the upper and lower limbs and functional performances. Mirror therapy, a simple and economical approach has the potential to reduce the USN and related impairments.

AIM

The primary objective of this study is to determine the effectiveness of task-based and magnified mirror therapy on the USN and on the motor recovery of the post-stroke subjects. The secondary objective is to investigate the effectiveness of the intervention on the function and disability of the subjects.

METHODS

In this randomized controlled, assessor-blinded trial, 86 post-stroke subjects will be recruited from the neuro-rehabilitation laboratory of a rehabilitation institute, located in northern India. The participants,aged20 to 80 years, with 1 to 36 months of stroke onset, hemiparesis, and the USN, will be considered eligible for the study. In addition to the conventional rehabilitation, the experimental group(n = 43) will receive 40 sessions (8 weeks) of Task-based and MAGnified Mirror Therapy for Unilateral Spatial Neglect (T-MAGUSN). The control group (n = 43) will undergo a dose-matched conventional program only. The participants will be assessed at baseline, post-intervention and 4-week follow-up using primary (Line Bisection Test, Letter Cancellation Test, and Fugl-Myer Assessment) and secondary (Catherine Bergego Scale, Berg Balance Scale, Functional Ambulation Classification, Modified Rankin Scale) outcome measures.

DISCUSSION

This proposed study will lead to the development of a novel rehabilitation protocol for the management of USN, aiming to enhance motor and functional recovery. The investigation will consider both the upper and lower limbs for the intervention, reducing the impact of cognitive disability in stroke.

TRIAL REGISTRATION

Clinical Trial Registry of India (CTRI) as CTRI/2023/05/053184 (www.ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=74659).

Apparent increase in lip size influences two-point discrimination

Magnified vision of one's body part has been shown to improve tactile discrimination. We used an anesthetic cream (AC) to determine if somesthetic stimulation that alters the perception of the size of one's body would also improve two point-discrimination (2PD). In Experiment 1, application of AC caused an increase in perceived lip size and an improvement in a 2PD. As perceived lip size increased, subjects became more accurate in identifying that they had been touched in two locations. Experiment 2 confirmed this effect in a larger sample and introduced a control condition (no AC) that demonstrated that the change in performance was not attributable to practice or familiarity with the task. In Experiment 3, we showed that both AC and moisturizing cream improved subjects' ability to indicate that they had been touched in 2 locations, but the improvement was modulated by perceived lip size only for AC. These results support the idea that changes in the body representation influence 2PD.

The body-ownership is unconsciously distorted in the brain: An event-related potential study of rubber hand illusion

Many studies have reported that bottom-up multisensory integration of visual, tactile, and proprioceptive information can distort our sense of body-ownership, producing rubber hand illusion (RHI). There is less evidence about when and how the body-ownership is distorted in the brain during RHI. To examine whether this illusion effect occurs preattentively at an early stage of processing, we monitored the visual mismatch negativity (vMMN) component (the index of automatic deviant detection) and N2 (the index for conflict monitoring). Participants first performed an RHI elicitation task in a synchronous or asynchronous setting and then finished a passive visual oddball task in which the deviant stimuli were unrelated to the explicit task. A significant interaction between Deviancy (deviant hand vs. standard hand) and Group (synchronous vs. asynchronous) was found. The asynchronous group showed clear mismatch effects in both vMMN and N2, while the synchronous group had such effect only in N2. The results indicate that after the elicitation of RHI bottom-up integration could be retrieved at the early stage of sensory processing before top-down processing, providing evidence for the priority of the bottom-up processes after the generation of RHI and revealing the mechanism of how the body-ownership is unconsciously distorted in the brain.

Changing Body Representation Through Full Body Ownership Illusions Might Foster Motor Rehabilitation Outcome in Patients With Stroke

How our brain represents our body through the integration of internal and external sensory information so that we can interact with our surrounding environment has become a matter of interest especially in the field of neurorehabilitation. In this regard, there is an increasing interest in the use of multisensory integration techniques—such as the use of body ownership illusions—to modulate distorted body representations after brain damage. In particular, cross-modal illusions such as mirror visual feedback therapy (MVFT) have been widely used for motor rehabilitation. Despite the effectiveness of the MVFT for motor rehabilitation, there are some limitations to fully modify the distorted internal representation of the paretic limb in patients with stroke. A possible explanation for this relies on the physical limitations of the mirror in reproducing upper-limb distortions, which can result in a reduced sense of ownership of the mirrored limb. New digital technologies such as virtual reality (VR) and 360° videos allow researchers to create body ownership illusions by adapting virtual bodies so that they represent specific morphological characteristics including upper-limb distortions. In this manuscript, we present a new rehabilitation approach that employs full virtual body ownership illusions, using a 360° video system, for the assessment and modulation of the internal representation of the affected upper limb in stroke patients. We suggest modifying the internal representation of the upper limb to a normal position before starting motor rehabilitation training.

Virtual image of a hand displaced in space influences action performance of the real hand

The rubber hand illusion (RHI) demonstrates that under some circumstances a fake hand can be regarded as part of one’s body; the RHI and related phenomena have been used to explore the flexibility of the body schema. Recent work has shown that a sense of embodiment may be generated by virtual reality (VR). In a series of experiments, we used VR to assess the effects of the displacement of the virtual image of subjects’ hands on action. Specifically, we tested whether spatial and temporal parameters of action change when participants perform a reaching movement towards the location of their virtual hand, the position of which was distorted on some trials. In different experiments, participants were sometimes provided with incorrect visual feedback regarding the position of the to-be-touched hand (Experiment 1), were deprived of visual feedback regarding the position of the reaching hand when acting (Experiment 2) or reached with the hand, the apparent position of which had been manipulated (Experiment 3). The effect was greatest when participants reached towards (Experiment 1) or with (Experiment 3) the displaced hand when the hand was visible during the reaching, but not when the vision of the hand was removed during the action (Experiment 2). Taken together, these data suggest that visual images of one’s hand presented in VR influence the body schema and action performance.

Increasing perceived hand size improves motor performance in individuals with stroke: a home-based training study

Background

Increasing perceived hand size with magnifying lenses improves tactile discrimination and induces changes in action performance. We previously demonstrated that motor skills (tested with grip force, finger tapping, and a reach to grasp tasks) improved when actions were performed with magnified compared to normal vision; twenty-eight percent of 25 participants with stroke exhibited significant improvement on a composite measure of motor performance with magnification as compared to a session without magnification.

Methods

To investigate the potential implications of magnification of vision for motor rehabilitation, we recruited individuals with stroke from the original cohort who exhibited an improvement of at least 10% in grip force and/or finger tapping for a home training protocol. Six individuals with stroke completed a two-week home-based training program in which they performed a range of activities while looking at their hand magnified. Motor skills were measured before, immediately after, and two weeks after the training.

Results

Five of the six participants showed an improvement on motor tasks when tested after the training. In two participants the improvement was evident immediately after the training and persisted in time, while it occurred at two-weeks post-training in the other participants. These results suggest that the magnification of vision is a potential tool for the rehabilitation of post-stroke motor deficits.