Virtual reality (VR) training has a prominent role in promoting functional recovery post stroke. Stroke survivors with upper limb hemiplegia lack the cognitive ability to anticipate the required control. The Cortical Excitability of the anticipatory phase for upper limb movement after VR training remains unknown. This study aims to investigate the changes of cortical excitability of VR training on the motion anticipation of upper limb hemiplegic in subacute stroke survivors.

In this randomized, controlled, single blind trial, 40 stroke survivors with upper limb hemiparesis resulting from the first occurrence of unilateral brain lesion within 1 to 6 months were recruited. Participants was randomized to either a group receiving VR training or dose matched conventional occupational training in addition to standard rehabilitation, 30min per day and 5 days a week for 3 weeks. The primary outcome measure was the movement-related potentials (MRPS), the electroencephalogram recordings during the acquisition phase, subjects were asked to performed a self-paced voluntary palmar grasp; secondary outcome measures were the the Action Research Arm Test (ARAT) and the Upper Limb Fugl-Meyer Assessment (UL-FMA). Participants were assessed at baseline and after intervention.

There were a long latency and large peak amplitude MRPS of hand motor impairment at baseline and hand motor recovery over time. After treatment, the VR group exhibited a significant difference in the decrease of the latency and the peak amplitude (P<0.05), not significant difference in the control group (P>0.05). A significant improvement in the ARAT and UL-FMA within both groups before and after treatment.

VR training is a promising tools for rehabilitation could pomote motor anticipatory and upper limb motor function after stroke. Their introduction in combination with traditional physical and occupational therapy may enhance cortical reorganization after stroke. Clinicians may consider adding VR training as an adjucnt to routine rehabilitation training.