Cortical reorganization and associated functional motor recovery after virtual reality in patients with chronic stroke: An experimenter-blind preliminary study

Objective: To investigate the effects of virtual reality (VR) on cortical reorganization and motor recovery. Design: Nonparametric pre- and posttest design with experimenter blinded. Setting: University medical center. Participants: Five patients with hemiparesis (age, 59.8+/-3.4y) were recruited. Intervention: Five patients received VR for 60 minutes a day, 5 times a week for 4 weeks. VR was designed to provide a virtual rehabilitation scene where the intensity of practice and sensory feedback could be systematically manipulated to provide the most appropriate, individualized motor retraining program. Main Outcome Measures: Cortical activation and associated motor recovery were measured before and after VR using functional magnetic resonance imaging and standardized motor tests, respectively. Nonparametric tests were used at P less than .05. Results: Prior to VR, the bilateral primary sensorimotor cortices (SM1s), contralesional premotor cortex, and contralesional or ipsilesional supplementary motor area were activated. After VR, the altered activations disappeared and predominantly the ipsilesional SM1 was activated (P<.05). Motor function was improved (P<.05). Conclusions: This is a novel demonstration of VR-induced neuroplastic changes and associated motor recovery in chronic stroke.