The experimental results show that virtual reality-based interventions can enhance the effects of motor learning on the brain plasticity mechanisms. Virtual reality can help to design intensive, repetitive, task-oriented, and difficulty adapted exercises to promote neural and functional recovery [4] even several months after the onset.

1. Flexion-extension of the elbow: paretic arm; non-paretic arm.
MethodObjective
Clinical and brain imaging changes after upper-limb
rehabilitation with a virtual reality tabletop system:
a case study
The objective of this study is to
determine the clinical effectiveness
of a virtual reality-based
experimental intervention based on
motor learning mechanisms [1] that
enhance neural recovery [2] to
promote functional improvement of
the hemiparetic upper limb in chronic
individuals post-stroke.
Roberto Lloréns1,2, Carolina Colomer2, Amparo Baldoví-Felici2, Ignacio Verdecho2
Results
Conclusions
The experimental results show that virtual reality-based interventions
can enhance the effects of motor learning on the brain plasticity
mechanisms. Virtual reality can help to design intensive, repetitive,
task-oriented, and difficulty adapted exercises to promote neural and
functional recovery [4] even several months after the onset.
1. Krakauer, JW (2006), Motor learning: its relevance to stroke recovery and neurorehabilitation,
Curr Opin Neurol, 19, 1, pp. 84-90.
2. Dancause, N and Nudo, RJ (2011), Shaping plasticity to enhance recovery after injury, Prog
Brain Res, 192, 273-295.
3. Jang, SH, Kim, YH, Cho, SH, Lee, JH, Park, JW and Kwon, YH (2003), Cortical reorganization
induced by task-oriented training in chronic hemiplegic stroke patients, Neuroreport, 14, 1, pp.
137-141.
4, Levin, MF, Kleim, JA and Wolf, SL (2009), What Do Motor “Recovery” and “Compensation”
Mean in Patients Following Stroke?, Neurorehabilitation and Neural Repair, 23, 4, pp. 313-319.
Intervention
10 individuals with chronic stroke (8
males and 2 females) with a mean
age of 53.65±17.32 years old
participated in the study.
Participants presented a
hemorrhagic (n=7) or ischemic
stroke (n=3) with a right (n=6) or
left (n=4) hemiparesis.
1Instituto Interuniversitario de Investigación en Bioingeniería y Tecnología Orientada al Ser Humano, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain.
2Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA. Fundación Hospitales NISA, Valencia, Spain
Measure
Start of
phase A
(Ai)
Start of
phase B
(Bi)
End of
phase B
(Bf)
End of
phase A
(Af)
Significance
Manual Function Test 21.30±4.59 22.10±4.72 22.70±4.64 22.60±4.74 NS
Wolf Motor Function Test 76.22±53.36 77.59±61.75 40.87±20.59 48.22±25.83 Bi>Bf*
Box and Blocks Test 19.90±10.39 21.20±11.39 26.60±10.94 25.80±11.74 Ai<Bf**
Ai<Af**
Bi<Bf**
Bi<Af*
Nine Hole Peg Test 53.51±21.95 48.30±20.81 40.74±17.81 42.40±19.10 Ai>Bf**
Ai>Af*
Bi>Bf*
Bi>Af*
Motor Activity Log –
Quality of Movement
80.25±30.44 82.90±26.10 100.75±25.65 97.05±19.69 Ai<Bf**
Ai<Af*
Bi<Bf**
Bi<Af**
Motor Activity Log –
Amount of use
72.35±38.16 76.35±32.21 98.85±32.06 93.65±33.65 Ai<Bf**
Ai<Af**
Bi<Bf**
Bi<Af**
Exercises of the experimental intervention include flexion-extensión of the elbow, wrist, grasping, pincer grips, etc.
Ai
Phase A Phase B Phase A
Conventional
therapy
Conventional
therapy
Virtual reality-
based therapy
AfBfBi
Participants
Both phases consisted of 30 training sessions. The sessions were
45-minute long and were administered with a frequency of
three to five days a week.
Significant improvement after the experimental intervention (from
Bi to Bf), which was not detected after the previous (from Ai to Bi)
or following conventional intervention (from Bf to Af).
Increased ipsilesional activation after the experimental intervention.
Mean laterality index [3] improved from -0,7 to 0.6 in sensorimotor
cortex. Contralesional cerebellar activation was also detected after
the intervention.
Prototype of the system
Pre (Bi)
Post (Bf)