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- Virtual reality for sensorimotor rehabilitation post stroke: design principles and evidencePublication . Bermúdez i Badia, Sergi; Fluet, Gerard G.; Llorens, Roberto; Deutsch, Judith E.n the recent years, the use of virtual reality (VR) to enhance motor skills of persons with activity and participation restriction due to disease or injury has been become an important area of research. In this chapter, we describe the design of such VR systems and their underlying principles, such as experience-dependent neuroplasticity and motor learning. Further, psychological constructs related to motivation including salience, goal setting, and rewards are commonly utilized in VR to optimize motivation during rehabilitation activities. Hence, virtually simulated activities are considered to be ideal for (1) the delivery of specifi c feedback, (2) the a bility to perform large volumes of training, and (3) the presentation of precisely calibrated diffi culty levels, which maintain a high level of challenge throughout long training sessions. These underlying principles are contrasted with a growing body of research comparing the effi cacy of VR with traditionally presented rehabilitation activities in persons with stroke that demonstrate comparable or better outcomes for VR. In addition, a small body of literature has utilized direct assays of neuroplasticity to evaluate the effects of virtual rehabilitation interventions in persons with stroke. Promising developments and fi ndings also arise from the use of off-the-s helf video game systems for virtual rehabilitation purposes and the integration of VR with robots and brain-computer interfaces. Several challenges limiting the translation of virtual rehabilitation into routine rehabilitation practice need to be addressed but the fi eld continues to hold promise to answer key issues faced by modern healthcare.
- Body schema plasticity after stroke: subjective and neurophysiological correlates of the rubber hand illusionPublication . Llorens, Roberto; Borrego, Adrián; Palomo, Priscila; Cebolla, Ausiàs; Noé, Enrique; Bermúdez i Badia, Sergi; Baños, RosaStroke can lead to motor impairments that can affect the body structure and restraint mobility. We hypothesize that brain lesions and their motor sequelae can distort the body schema, a sensorimotor map of body parts and elements in the peripersonal space through which human beings embody the reachable space and ready the body for forthcoming movements. Two main constructs have been identified in the embodiment mechanism: body-ownership, the sense that the body that one inhabits is his/her own, and agency, the sense that one can move and control his/her body. To test this, the present study simultaneously investigated different embodiment subcomponents (body-ownership, localization, and agency) and different neurophysiological measures (galvanic skin response, skin temperature, and surface electromyographic activity), and the interaction between them, in clinically-controlled hemiparetic individuals with stroke and in healthy subjects after the rubber hand illusion. Individuals with stroke reported significantly stronger body-ownership and agency and reduced increase of galvanic skin response, skin temperature, and muscular activity in the stimulated hand. We suggest that differences in embodiment could have been motivated by increased plasticity of the body schema and pathological predominance of the visual input over proprioception. We also suggest that differences in neurophysiological responses could have been promoted by a suppression of the reflex activity of the sympathetic nervous system and by the involvement of the premotor cortex in the reconfiguration of the body schema. These results could evidence a body schema plasticity promoted by the brain lesion and a main role of the premotor cortex in this mechanism.