Virtual reality (VR) is considered to be a promising therapeutic technology for the rehabilitation of upper extremities (UEs) post-stroke. Recently, we designed and then implemented a neuroscientifically grounded VR protocol for the rehabilitation of patients with stroke. The system provides unilateral and bilateral limb mirroring exercises in a fully immersive virtual environment that may stimulate and activate the mirror neuron system in the brain to help patients for their rehabilitation. Twelve patients with subacute stroke underwent the newly implemented VR treatment in addition to conventional rehabilitation for 8 consecutive weekdays. The treatment effect on brain reorganization and motor function was investigated using resting-state fMRI (rs-fMRI) and the Fugl-Meyer assessment for Upper Extremity (FM-UE), respectively. Fifteen healthy controls (HCs) also underwent rs-fMRI scanning one time. The study finally obtained usable data from 8 patients and 13 HCs. After the intervention, patients demonstrated significant improvement in their FM-UE scores (p values < 0.042). Voxel-wise functional connectivity (FC) analysis based on the rs-fMRI data found that HCs showed widespread bilateral FC patterns associated with the dominant hemispheric primary motor cortex (M1). However, the FC patterns in patients revealed intra-hemispheric association with the ipsilesional M1 seed and this association became visible in the contra-hemisphere after the intervention. Moreover, the change of FC values between the bilateral M1 was significantly correlated with the changes in FM-UE scores (p values < 0.037). We conclude that unilateral and bilateral limb mirroring exercise in an immersive virtual environment may enhance cortical reorganization and lead to improved motor function.

虚拟现实 (VR) 被认为是一种很有前途的治疗技术，可用于中风后上肢 (UE) 的康复。最近，我们设计并实施了一种基于神经科学的 VR 协议，用于中风患者的康复。该系统在完全沉浸式的虚拟环境中提供单侧和双侧肢体镜像练习，可以刺激和激活大脑中的镜像神经元系统，帮助患者康复。12 名亚急性脑卒中患者在连续 8 个工作日的常规康复治疗之外，还接受了新实施的 VR 治疗。分别使用静息状态 fMRI (rs-fMRI) 和 Fugl-Meyer 上肢评估 (FM-UE) 研究治疗对大脑重组和运动功能的影响。15 名健康对照 (HC) 也接受了一次 rs-fMRI 扫描。该研究最终从 8 名患者和 13 名 HC 中获得了可用数据。干预后，患者的 FM-UE 评分显着提高（p值 < 0.042)。基于 rs-fMRI 数据的体素功能连接 (FC) 分析发现，HC 显示出与优势半球初级运动皮层 (M1) 相关的广泛双边 FC 模式。然而，患者的 FC 模式揭示了与同侧 M1 种子的半球内关联，并且这种关联在干预后在对侧半球变得可见。此外，双侧M1之间FC值的变化与FM-UE评分的变化显着相关（p值<0.037）。我们得出结论，沉浸式虚拟环境中的单侧和双侧肢体镜像练习可以增强皮质重组并改善运动功能。