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Engaging Stroke Survivors with Virtual Neurorehabilitation Technology
Published in Christopher M. Hayre, Dave J. Muller, Marcia J. Scherer, Virtual Reality in Health and Rehabilitation, 2020
Marcus King, Holger Regenbrecht, Simon Hoermann, Chris Heinrich, Leigh Hale
The potential for VR to change beliefs solves a problem that occurs when using traditional mirror therapy: the issue of the patient's potential disbelief. In traditional upper limb mirror therapy, the patient's impaired limb is placed behind an optical mirror; the patient knows that the impaired limb is unable to move and so has to develop a suspension of disbelief when observing their unimpaired limb moving in the mirror for the therapy to take effect. They have to believe that what they see in the mirror is their impaired limb moving. VR is less obvious in its inner workings and can be seen more as “magic” by the patient when they observe their impaired limb “moving” and therefore requires much less belief.
Developing an optimized strategy with transcranial direct current stimulation to enhance the endogenous pain control system in fibromyalgia
Published in Expert Review of Medical Devices, 2018
Dante Duarte, Luis Eduardo Coutinho Castelo-Branco, Elif Uygur Kucukseymen, Felipe Fregni
Mendonça et al. [22] obtained positive and larger effects on pain relief, quality of life, depression, and anxiety by combining tDCS with aerobic exercise for the treatment of fibromyalgia. In addition, preliminary data regarding non-invasive brain stimulation for fibromyalgia and aerobic exercise have shown that these techniques yield significant results when compared to control interventions and baseline symptoms [16,21,65,66]. Pinto et al. is using mirror therapy with tDCS to treat phantom limb pain, exemplifying a combined therapy with tDCS as a strategy to enhance sensory afference [67]. Moreover, it was demonstrated that the combination between tDCS and visual illusion provides long term effects in pain relief of spinal cord injury patients [68] and leads to significant alterations in contact heat-evoked potential (CHEPS) and pain thresholds [69]. In this context, some studies have shown the activation of sensorimotor cortex after mirror therapy, mirror illusion and visual feedback when combined with M1 tDCS, therefore inferring the potential benefits of this strategy [70,71]. In addition, for chronic low back pain, the combination of tDCS and peripheral electrical stimulation seems to improve pain and sensitization, in a greater magnitude than when compared with control or when performed alone [72,73]. It is important to point out that the main characteristic to consider for selecting an optimized combination therapy is to ensure that both interventions target neural networks synergistically, driving the neurophysiological mechanisms of each treatment alone toward similar directions or pathways.