Published Online
on May 12, 2005

A more recent version of this article appeared on June 1, 2005

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Submitted on November 29, 2004
Revised on January 7, 2005
Accepted on January 24, 2005

Virtual Reality-Induced Cortical Reorganization and Associated Locomotor Recovery in Chronic Stroke. An Experimenter-Blind Randomized Study

Sung H. You PT, PhD^*; Sung Ho Jang MD; Yun-Hee Kim MD, PhD; Mark Hallett MD; Sang Ho Ahn MD; Yong-Hyun Kwon PT, MS; Joong Hwi Kim PT, MS; and Mi Young Lee PT

From the Physical Therapy Program (S.H.Y.), Hampton University, Virginia; Department of Physical Medicine and Rehabilitation (S.H.J., S.H.A., Y.-H. Kwon, J.H.K., M.Y.L.), College of Medicine, Yeungnam University, Taegu, Republic of Korea; Department of Physical Medicine and Rehabilitation (Y.-H. Kim), School of Medicine, Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea; and National Institute of Neurological Disorders and Stroke (M.H.), Human Motor Control Section, Bethesda, Md.

^* To whom correspondence should be addressed. E-mail: sung.you{at}hamptonu.edu.

Background and Purpose--Virtual reality (VR) is a new promising computer-assisted technology to promote motor recovery in stroke patients. VR-induced neuroplasticity supporting locomotor recovery is not known. We investigated the effects of VR intervention on cortical reorganization and associated locomotor recovery in stroke patients.

Methods--Ten chronic stroke patients were assigned randomly to either the control group or the VR group. VR was designed to provide interactive real-life practice environments in which practice parameters can be individualized to optimize motor relearning. Laterality index (LI) in the regions of interests (ROIs) and locomotor recovery were measured before and after VR using functional MRI (fMRI) and standardized locomotor tests, respectively. The t test and nonparametric test were performed to compare the mean differences at P<0.05.

Results--There was a significant difference in the interval change in the LI score for the primary sensorimotor cortex (SMC) between the groups (P<0.05), indicating that VR practice produced a greater increase in LI for the control group. However, the interval changes in the other ROIs were not significantly different (P>0.05). Motor function was significantly improved after VR (P<0.05).

Conclusions--Our novel findings suggest that VR could induce cortical reorganization from aberrant ipsilateral to contralateral SMC activation. This enhanced cortical reorganization might play an important role in recovery of locomotor function in patients with chronic stroke. This is the first fMRI study in the literature that provides evidence for neuroplasticity and associated locomotor recovery after VR.

Key words: gait • magnetic resonance imaging • rehabilitation

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