Study of Cerebral Activation During Different Rehabilitation Tasks in Mirror Therapy in Healthy Subjects
Condition: Healthy
Study type: Interventional

Summary: 
      The purpose of this study is to investigate the cerebral activation during Classic Mirror
      Therapy (TMC) and especially during Virtual Mirror Therapy (TMV) in healthy subjects. It
      seems that the precuneus is involved in the effectiveness of mirror therapy. One goal of this
      study is to determine if there is a better activation of the precuneus during TMV than during
      TMC. Others goals are to compare cerebral activation during three different tasks (TMV, TMC
      and a simple motor task), to study the intra-subjects reproducibility of the measurement and
      the correlation between cerebral activation and feelings of the participants about the
      efficacity of the tasks.
    

Detailed description: 
      Mirror therapy is a rehabilitation technique that has been shown to be effective in restoring
      upper limb motor skills in patients with stroke. However, it comes up against certain
      constraints of clinical use such as installation difficulties or the obligation of
      symmetrical bilateral work. These constraints can be limited by the use of so-called 2nd
      generation virtual mirror therapy technologies. It is therefore likely that these new
      technologies will improve the feasibility and effectiveness of mirror therapy in
      rehabilitation. While the brain mechanisms involved in mirror therapy are not yet fully
      understood, the involvement of the precuneus has been demonstrated by a booming imaging
      method: fNIRS (functional Near Infra Red Spectroscopy). This method allows (like fMRI) to
      study cerebral neurovascular coupling. It is based on the fact that an activated region of
      the brain increases its local blood flow. Oxygenated hemoglobin (HbO) and deoxygenated (HbR)
      absorb infrared light and it is then possible to identify the cortical regions of the brain
      involved in a given task. This technique therefore makes it possible to study brain
      activation under more ecological conditions than fMRI and is therefore particularly suitable
      for exploring rehabilitation techniques.

      This research aims to study and compare in healthy subjects, using a fNIRS apparatus, the
      brain regions involved in the performance of a classic mirror therapy task and a virtual
      mirror therapy task with the IVS3 (Intensive Visual Simulation) apparatus (Dessintey
      Technology).

      The investigations will be carried out by the principal investigator or by specialized
      technicians from the neurology functional exploration department.

      Each acquisition has a duration of 620 seconds, it begins with a rest period of 120 seconds,
      which corresponds to the baseline.

      For each condition the movements are performed at a frequency of 0.5 Hz which seems to be the
      optimal frequency for observing cortical activation using a metronome. Each movement is
      therefore performed 10 times per block.

      The order of placing the various conditions will be balanced. Between periods of movement,
      the subject is in a resting position for 30 seconds.

      The "movement" and "rest" instructions are given at the start of each phase. The entire test
      will be repeated one week apart to assess the reproducibility of the measurements in healthy
      subjects.

      The protocol has 3 conditions:

        -  A virtual TM task (TMV)

        -  A classic TM task (TMC)

        -  A control task (TC) Healthy subjects participating in the study will have two different
           acquisition times, each comprising 3 conditions.

      After recruiting the subjects, the study investigator will check the inclusion and
      non-inclusion criteria.

      If the subject can integrate the protocol, the two acquisition stages will then be scheduled
      one week apart.

      On the day of the first acquisition, the subject will present to the neurology department at
      the time of his appointment.

      The order of the 3 conditions will then be randomized to avoid potential biases linked to the
      sequence of conditions.

      Then the fNIRS acquisition headset (Brite 24) will be installed by a specialized technician
      and the procurement instructions will be given.

      The acquisition under the 3 conditions is then carried out: TC1, TMC1, TMV1 with a rest time
      of 10 minutes between each condition.

      The subject's feelings after the TMC and TMV conditions will be evaluated using the visual
      analogue scale (VAS). 0 corresponding to a zero feeling and 10 to a very important feeling.
      The subject will be explained that the feeling could correspond to tingling sensations, a
      desire to mobilize the hand which is behind the mirror, a "disturbing", "bizarre" sensation.

      The helmet is only removed at the end of the 3 spots The subject returns a week later for the
      2nd acquisition phase during which the same acquisitions as during the 1st meeting are
      carried out and then participation in the study is terminated.

      There will therefore be 6 tests for each healthy subject.
    

Intervention name(s): Therapy Mirror task
Intervention type(s): Other
Intervention description(s): The protocol has 3 conditions:
A virtual TM task (TMV
A classic TM task (TMC)
A control task (TC)
The order of the 3 conditions will then be randomized to avoid potential biases linked to the sequence of conditions.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: mirror therapy; near infrared spectroscopy; cerebral activation