Advanced Technologies in Neurorehabilitation to enhance
Sensorimotor Integration in the Control of Posture and Balance
Joyce Fung, PhD, PT, Member, IEEE
T
he control of posture and upright balance requires
complex multisensory integration and sensorimotor
coordination. Sensory and motor systems compromised with
aging or neurological diseases such as stroke likely impede
this process. Sensory and motor functions, as well as their
integration, however, can improve via experience-dependent
neuroplasticity, which is achieved through motor learning
and rehabilitation. Evidence-based technologies to evaluate
and enhance functional recovery in posture and balance
control after stroke will be presented in this minisymposium.
I. NEUROPLASTICITY AND REHABILITATION
Human and animal studies incorporating advanced neurophysiological and neuroimaging techniques provided
evidence that the cerebral cortex is capable of widespread
functional and structural plasticity [1]. In addition to
functional substitution by the residual CNS structures and
pathways, post-injury behavioral experience plays an
important role in functional reorganization of the remaining
intact CNS system. The inability to walk and regain balance
control is one of the more devastating consequences of
stroke and regaining mobility is the most common
rehabilitation goal expressed by stroke patients [2].
Technologies to promote the recovery and relearning of
balance and mobility skills must take advantage of the
processes of neuroplasticity and comply with the elements
required for the consolidation of motor skills. Extensive
human and animal studies have shown that improvements in
sensorimotor functions result from experience-dependent
neuroplasticity which can be achieved through salient,
repetitive, intensive and motivating practice, with
demanding and varied environmental contexts, as well as
increased patient empowerment [3].
events are not only sensed, but the user can anticipate and
react to them as though they were real [5]. The technology,
with the capacity of simulating environments, offers a new
and safe way to not only increase practice time but also to
offer the varied environments and controlled constraints
needed to maximize learning. An advanced balance and
locomotor system that combines VR with a self-paced
treadmill mounted on a motion platform has been developed
to allow patients to be exposed to more complex physical
environments (both indoors and outdoors) including
environmental hazards without physical danger [6]. It also
provides a gaming environment to motivate patients to
adhere to training. Results showed that subjects could be
trained have full control of their balance both on the
treadmill and within the VE, while experiencing a strong
sense of presence.
III. SENSORIMOTOR INTEGRATION
VR systems can be combined with the manipulation of
physical environments and sensory feedback to create a
mixed reality system for multisensory integration and
sensorimotor enhancement. Sensory manipulation with
augmented cues from the visual, auditory and proprioceptive
systems can be used to enhance motor functions for the
control of balance. Haptic touch has emerged as a novel and
efficient technique to improve postural control and dynamic
stability. The enhancement of balance and mobility
functions post stroke with a mixed reality system
incorporating VR, surface perturbations and haptic
manipulation is evidenced by kinematic and kinetic changes
in postural adaptations and reactions.
REFERENCES
[1]
II. VIRTUAL REALITY TECHNOLOGY
Virtual reality (VR) refers to a range of computing
technologies that present artificially generated sensory
information in a form that people perceive as similar to realworld objects and events [4]. The simulated objects and
This work was supported in part by an emerging team grant from the
Canada Institutes of Health Research (Regenerative Medicine and Nanomedicine program) to the SensoriMotor Rehabilitation Research Team
http://errsm.ca/en/homepage.html
J Fung is Assoicate Professor and William Dawson Scholar with the
School of Physical and Occupational Therapy, McGill University, and
Director of Research with the Feil/Oberfeld/CRIR Research Centre of the
Jewish Rehabilitation Hospital (JRH) in Montreal, Quebec, Canada. (phone:
450-688-9550 ext. 529; fax: 450-688-3673; e-mail: joyce.fung@mcgill.ca).
[2]
[3]
[4]
[5]
[6]
J.A. Kleim and T.A.Jones, ³Principles of experience-dependent neural
plasticity: implications for rehabilitation after brain damage´ -
Speech Lang. Hear. Res., vol. 51, pp. S225-S239, 2008.
S. E. Lord, K. McPherson, H. K. McNaughton, L. Rochester, and M.
:HDWKHUDOO³Community ambulation after stroke: how important and
obtainable is it and what measures appear predictive?´ Arch. Phys.
Med. Rehabil., vol 85, pp. 234-239, 2004.
R. Teasell, N.A.Bayona, and J.Bitensky, ³Plasticity and reorganization
of the brain post stroke,´ Top. Stroke Rehabil., vol. 12, pp. 11-26,
2005. R. S. Kalawsky, The science of virtual reality and virtual
environment. Wokingham: Addison-Weslay, 1993.
R. S. Kalawsky,
The science of virtual reality and virtual
environment. Wokingham: Addison-Weslay, 1993.
Steuer J. ³Defining virtual reality: dimensions determining
WHOHSUHVHQFH´ J. Commun., vol. 2, pp. 17-27, 1992.
J. Fung, C.L.Richards, F.Malouin, B.J.McFadyen, and A.Lamontagne,
³A treadmill and motion coupled virtual reality system for gait
training post-stroke,´ Cyberpsychol. Behav, vol. 9, pp. 157-162, 2006.