Functional evaluation of computer game-based uper-extremity rehabilitation efects after stroke

Summary form only given: A random-effect group analysis done on functional magnetic resonance images corresponding to hand-righted stroke patients who were rehabilitated with a computer game showed in a statistical way that for those whose paretic arm is the right one their brains had 10% increase in the number of activated voxels on the left primary motor area. However when there is paresis on the left arm there is no significant increase in number of activated voxels on patients´ right primary motor area: it is rather a sparse rewiring that takes place. Nevertheless for both types of patients, other statistically-visualized areas presented activation as wel: pre-frontal area, supplementary motor area, and sensory motor and parietal areas. And for just few the cerebelum itself was activated. 4 men and 6 women composed the sample of in-average 50-year-old right-handed patients with more than 12 months of stroke evolution: with a 50%-50% right and left paretic-arm distribution within the sample. Patients followed rehabilitation sessions in which they played a game on a personal computer a paddle adapted to the mouse device and fixed to the patients´ paretic with some bands. Twelve 10-minute rehabilitation sessions took place with frequency of 3 times a week. Functional evaluation was carried out with motor paradigm focused on hand functionality. Such a paradigm consisted of instructing the patients to touch their thumb to each of their four fingers sequentially, back and forth, at a self-paced rate, having a start points two auditive stimulus for alternating 30-second periods of movement and rest events - for those who could not perform the movements because of serious paretic reasons, they were instructed to show of intention of movement. The 1-minute set of two events was repeated 5 times for a total of 360 seconds each session: one hand at a time per functional magnetic resonance imaging (fMRI) session. Imaging data was acquired on a 3.0-Tesla General electric S- igna scanner with an echo planar sequence 64times64 matrix; flip angle=90; TR=3 s; TE=40 ms; FOV=24 cm; 28 continuous axial slices for each of the 10 volumes) for each session: right hand, left hand, before and after rehabilitation treatment. Functional-scan images were motion corrected, normalized, spatially smoothed statistically processed to model patient´ brain performance and visualize most-likely statistical activated regions. Search of evidence clues of brain re-activation rewiring was focused on expected areas [1] 2] [3]: bilateral pre-motor cortex, bilateral superior temporal gyrus, motor and supplementary areas and contra-lateral supra-marginal gyrus. Subtracting pre-activations from post-activations, special attention was paid to brain-rewiring in (Fig. 1). This study leads us consider computer game-based rehabilitation as a strong alternative traditional rehabilitation sessions for stroke patient since there is evidence of brain functional effects [1] [3] that go along with practical results on the strength of the patients´ paretic arm (measured by means of the Motricity Index, e.g. [4]). As a future work, we look forward to assessing functional effects on stroke patients who use a low-cost technology-based virtual game system 5] that could be affordable by those who are in trouble to show up in a hospital´s rehabilitation center and needs solution that provides them with some independence (i.e. they cannot spend every rehabilitation day under the therapistpsila supervision).