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Case Reports
. 2020 Oct 28:5:20200025.
doi: 10.2490/prm.20200025. eCollection 2020.

Feasibility Case Study for Treating a Patient with Sensory Ataxia Following a Stroke with Kinesthetic Illusion Induced by Visual Stimulation

Toshiyuki Aoyama  1 , Atsushi Kanazawa  2 , Yutaka Kohno  3 , Shinya Watanabe  4 , Kazuhide Tomita  1 , Takehide Kimura  5 , Yusuke Endo  6 , Fuminari Kaneko  7
Affiliations
Case Reports

Feasibility Case Study for Treating a Patient with Sensory Ataxia Following a Stroke with Kinesthetic Illusion Induced by Visual Stimulation

Toshiyuki Aoyama et al. Prog Rehabil Med. .

Abstract

Background: Sensory ataxia is a disorder of movement coordination caused by sensory deficits, especially in kinesthetic perception. Visual stimulus-induced kinesthetic illusion (KINVIS) is a method used to provide vivid kinesthetic perception without peripheral sensory input by using a video showing pre-recorded limb movements while the actual limb remains stationary. We examined the effects of KINVIS intervention in a patient with sensory ataxia.

Case: The patient was a 59-year-old man with a severe proprioceptive deficit caused by left thalamic hemorrhage. During KINVIS intervention, a computer screen displayed a pre-recorded mirror image video of the patient's unaffected hand performing flexion-extension movements as if it were attached to the patient's affected forearm. Kinematics during the flexion-extension movements of the paretic hand were recorded before and after 20-min interventions. Transcranial magnetic stimulation was applied to the affected and non-affected hemispheres. The amplitude of the motor-evoked potential (MEP) at rest was recorded for the muscles of both hands. After the intervention, the total trajectory length and the rectangular area bounding the trajectory of the index fingertip decreased. The MEP amplitude of the paretic hand increased, whereas the MEP amplitude of the non-paretic hand was unchanged.

Discussion: The changes in kinematics after the intervention suggested that KINVIS therapy may be a useful new intervention for sensory ataxia, a condition for which few effective treatments are currently available. Studies in larger numbers of patients are needed to clarify the mechanisms underlying this therapeutic effect.

Keywords: body ownership; kinesthetic illusion; sensory ataxia; stroke; transcranial magnetic stimulation.

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Conflict of interest statement

CONFLICTS OF INTEREST: FK is the founding scientist of Connect Inc., a commercial company set up in October 2018 for the development of rehabilitation devices. This company does not have any relationship with the device or setup used in the present study. FK received license fees from Inter Reha Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1.
Fig. 1.
Computed tomography image of the patient 14 days after stroke onset showing left thalamic hemorrhage.
Fig. 2.
Fig. 2.
Flexion angles of the metacarpophalangeal (MP) joint and the proximal interphalangeal (PIP) joint are shown before (left) and after (right) kinesthetic illusion induced by visual stimulus intervention. Also shown are electromyography (EMG) recordings of the activities of the extensor digitorum muscle (ED), the flexor digitorum superficialis muscle (FDS), and the first dorsal interosseous muscle (FDI) during hand flexion–extension movements (black lines, raw EMG; white lines, rectified and smoothed EMG). The co-contraction index between FDS and ED is also given.
Fig. 3.
Fig. 3.
The trajectory of the index fingertip during hand flexion–extension movements before and after KINVIS.
Fig. 4.
Fig. 4.
Amplitude of the motor-evoked potential (MEP) at two stimulus intensities [50% and 60% of maximum stimulation output (MSO)] recorded for the paretic and non-paretic FDI muscles and the paretic ED and FDS muscles before and after KINVIS.
See this image and copyright information in PMC

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