Virtual reality rehabilitation system for neuropathic pain and motor dysfunction in spinal cord injury patients

Spinal cord injury (SCI) causes both lower limb motor dysfunction and associated neuropathic pain. Although these two conditions share related cortical mechanisms, different interventions are currently used to treat each condition. With intensive training using entertaining virtual reality (VR) scenarios, it may be possible to reshape cortical networks thereby reducing neuropathic pain and improving motor function. We have created the first VR training system combining action observation and execution addressing lower limb function in incomplete SCI (iSCI) patients. A particular feature of the system is the use of size-adjustable shoes with integrated motion sensors. A pilot single-case clinical study is currently being conducted on six iSCI patients. Two patients tested to date were highly motivated to perform and reported improved physical well-being. They improved in playing skill and in controlling the virtual lower limbs. There were post-intervention indications of neuropathic pain decrease, muscle strength increase, faster walking speed and improved performance on items relevant for ambulation. In addition functional MRI before and after treatment revealed a decreased activation pattern. We interpret this result as an improvement of neuronal synergies for this task. These results suggest that our VR system may be beneficial for both reducing neuropathic pain and improving motor function in iSCI patients

Observing Virtual Arms that You Imagine Are Yours Increases the Galvanic Skin Response to an Unexpected Threat

Multi-modal visuo-tactile stimulation of the type performed in the rubber hand illusion can induce the brain to temporarily incorporate external objects into the body image. In this study we show that audio-visual stimulation combined with mental imagery more rapidly elicits an elevated physiological response (skin conductance) after an unexpected threat to a virtual limb, compared to audio-visual stimulation alone. Two groups of subjects seated in front of a monitor watched a first-person perspective view of slow movements of two virtual arms intercepting virtual balls rolling towards the viewer. One group was instructed to simply observe the movements of the two virtual arms, while the other group was instructed to observe the virtual arms and imagine that the arms were their own. After 84 seconds the right virtual arm was unexpectedly “stabbed” by a knife and began “bleeding”. This aversive stimulus caused both groups to show a significant increase in skin conductance. In addition, the observation-with-imagery group showed a significantly higher skin conductance (p<0.05) than the observation-only group over a 2-second period shortly after the aversive stimulus onset. No corresponding change was found in subjects' heart rates. Our results suggest that simple visual input combined with mental imagery may induce the brain to measurably temporarily incorporate external objects into its body image

The functional role of different neural activation profiles during precision grip: an artificial neural network approach

A dynamic and recurrent artificial neural network was used to investigate the functional properties of firing patterns observed in the primary motor (M1) and the primary somatosensory (S1) cortex of the behaving monkey during control of precision grip force. In the behaving monkey it was found that neurons in M1 and in S1 increase their firing activity with increasing grip force, as do the intrinsic and extrinsic hand muscles implicated in the task. However, some neurons also decreased their activity as a function of increasing force. The functional implication of these latter neurons is not clear and has not been elucidated so far. In order to explore their functional implication, we therefore simulated patterns of neural activity in artificial neural networks that represent cortical, spinal and afferent neural populations and tested whether particular activity profiles would emerge as a function of the input and of the connectivity of these networks. The functional implication of units with emergent or imposed decreasing activity was then explored. Decreasing patterns of activity in M1 units did not emerge from the networks. However, the same networks generated decreasing activity if imposed as target patterns. As indicated by the emerging weight space, M1 projection units with decreasing patterns are functionally less involved in driving alpha motoneurons than units with increasing profiles. Furthermore, these units did not provide significant fusimotor drive, whereas those with increasing profiles did. Fusimotor drive was a function of the (imposed) form of muscle spindle afferent activity: with gamma (fusimotor) drive, muscle spindle afferents provided signals other than muscle length (as observed experimentally). The network solutions thus predict a functional dichotomy between increasing and decreasing M1 neurons: the former primarily drive alpha and gamma motoneurons, the latter only weakly alpha motoneurons

Gamma-range cortico-muscular coherence during dynamic force output

The beta-range synchronization between cortical motor and muscular activity as revealed by EEG/MEG-EMG coherence has been extensively investigated for steady-state motor output. However, there is a lack of information on the modulation of the corticomuscular coherence in conjunction with dynamic force output. We addressed this question comparing the EEG-EMG coherence and the cortical motor spectral power in eight healthy subjects in a visuomotor task, in which the subjects exerted a steady-state or periodically modulated dynamic isometric force output with their right-index finger to keep a visual cursor within a target zone. In the static condition, significant coherence was confined to the beta-range. In the dynamic condition, the most distinct coherence occurred in the gamma-range and the significant beta-range coherence was strikingly reduced. The cortical motor power in the beta-range during dynamic force output was decreased, whereas the power in the gamma-range remained without significant change. We conclude that during dynamic force the corticospinal oscillation mode of the sensorimotor system shifts towards higher (principally gamma) frequencies for the rapid integration of the visual and somatosensory information required to produce the appropriate motor command