For a long time, the cerebellum has been known to be a structure related to posture and equilibrium control. According to the anatomic structure of inputs and internal structure of the cerebellum,...

Traumatic brain injury (TBI) disrupts the central and executive mechanisms of arm(s) and postural (trunk and legs) coordination. To address these issues, we developed a 3D immersive videogame-- Octopus. The game was developed using the basic principles of videogame design and previous experience of using videogames for rehabilitation of patients with acquired brain injuries. Unlike many other custom-designed virtual environments, Octopus included an actual gaming component with a system of multiple rewards, making the game challenging, competitive, motivating and fun. Effect of a short-term practice with the Octopus game on arm-postural coordination in patients with TBI was tested.

Primary objective: The study objective was to test the efficacy of game-based virtual reality (VR) therapy as a mean of correcting postural and co-ordination abnormalities in individuals with traumatic brain injury (TBI). Therapy was done with interactive customized VR games and scenarios, utilizing an Xbox Kinect sensor. Research design: The study was a pilot project using the structure of a phase II clinical trial. Methods and procedures: Fifteen participants with mild-to-moderate chronic TBI-related balance and motor co-ordination impairments participated in 15 sessions, each lasting ∼50–55 minutes, scheduled 2–3 times a week over 5–6 consecutive weeks. Participants were evaluated at baseline, immediately after the final session and in a 1-month follow-up with a battery of clinical tests (measuring postural stability, gait and co-ordination) and movement performance parameters. Movement parameters included arm–leg co-ordination, dynamic stability and arm precision, calculated from kinematic data recorded with Xbox Kinect sensor. Results: Following therapy, most participants improved their static and dynamic postural stability, gait and arm movements. These effects persisted over the retention interval. Conclusions: Results will be used to improve the VR program, with the goal of producing a cost-effective, accessible and easy to individualize therapeutic approach. The pilot data will be used for designing a larger scale clinical trial.

To determine how arm movements influence postural sway in the upright position after stroke, interactions between arm, trunk, and center of pressure (CoP) displacements in the sagittal direction were investigated in participants with hemiparesis and healthy subjects. Participants swung both arms sagittally in either of 2 directions (in-phase, anti-phase) and at 2 speeds (preferred, fast) while standing on separate force plates. Variables measured included amplitude and frequency of arm swinging, shoulder and trunk range of motion, CoP displacements under each foot and of the whole body, and the relationships between the arm, trunk, and CoP displacements. CoP displacements under the non-paretic leg were greater than those under the paretic leg, which may in part be related to the larger amplitude of swinging of the non-paretic arm. CoP displacements under each foot were not related to arm swinging during in-phase swinging at the preferred speed in healthy subjects. When speed of arm swinging was increased, however, the CoP moved in a direction opposite to the arm movement. In contrast, in individuals with hemiparesis, CoPs and arms moved in the same direction for both speeds. During anti-phase swinging in healthy subjects, the trunk counterbalanced the arm movements, while in participants with hemiparesis, the trunk moved with the affected arm. Results show that stroke resulted in abnormal patterns of arm-trunk-CoP interactions that may be related to a greater involvement of the trunk in arm transport, an altered pattern of coordination between arm and CoP displacements, and an impaired ability of the damaged nervous system to adapt postural synergies to changes in movement velocity.

Purpose: The purpose of this study was to test the effects of navigated repetitive transcranial magnetic stimulation, delivered in different modes, on motor impairments and functional limitations after stroke. Methods: The study sample included 42 patients (58.5 ± 10.7 years; 26 males) who experienced a single unilateral stroke (1–12 months previously) in the area of the middle cerebral artery. Patients completed a course of conventional rehabilitation, together with 10 sessions of navigated repetitive transcranial magnetic stimulation or sham stimulation. Stimulation was scheduled five times a week over two consecutive weeks in an inpatient clinical setting. Patients were randomly assigned to one of four groups and received sham stimulation (n = 10), low-frequency (1-Hz) stimulation of the nonaffected hemisphere (n = 11), high-frequency (10-Hz) stimulation of the affected hemisphere (n = 13), or sequential combination of low- and high-frequency stimulations (n = 8). Participants were evaluated before and after stimulation with clinical tests, including the arm and hand section of the Fugl–Meyer Assessment Scale, modified Ashworth Scale of Muscle Spasticity, and Barthel Index of Activities of Daily Living. Results: Participants in the three groups receiving navigated repetitive transcranial magnetic stimulation showed improvements in arm and hand functions on the Fugl–Meyer Stroke Assessment Scale. Ashworth Scale of Muscle Spasticity and Barthel Index scores were significantly reduced in groups receiving low- or high-frequency stimulation alone. Conclusions: Including navigated repetitive transcranial magnetic stimulation in a conventional rehabilitation program positively influenced motor and functional recovery in study participants, demonstrating the clinical potential of the method. The results of this study will be used for designing a large-scale clinical trial.