Draft:Somato-Cognitive Coordination Therapy (SCCT)

Somato-Cognitive Coordination Therapy (SCCT) is the name of a new treatment method using virtual reality (VR) technology. The term was first used in the journal, J Parkinsons Dis (PMID: 38607764 DOI: 10.3233/JPD-240011) published on April 1, 2024 [Ref.7].

Treatment Principles

SCCT is a method of improving physical movement and attentional function by emphasizing the interaction between bodily sensation and cognition, and by unconsciously applying an approach that allows the patient to better understand his or her own body. The development of this method has been advanced through industry-academic collaborations with the Osaka University Graduate School of Medicine. The new mapping of the primary motor cortex has been reported in Nature in 2023. The classical map, known as Penfield's homunculus, has been rewritten by functional MRI analysis. That is, this new map indicates the presence of a region responsible for coordinated movements, called the Somato-Cognitive Action Network (SCAN), as described by the marionette puppets (PMID: 37076628 DOI: 10.1038/s41586-023-05964-2). It is also important to note that the basic regions of the hand, foot, mouth, etc. are distributed concentrically (symmetrically in coronal section) around the proximal part of the body; SCCT is recognized as a treatment that visualizes and unravels this tangle of the SCAN and provides interventions to untangle it.

Treatment Methods

The SCCT is typically performed in a seated position with alternating left and right reaching movements. The patient wears an immersive head-mounted display and holds a controller in both hands. In an environment where the patient's own body is not visible, the controller, which is an extension of the body, is superimposed on specific coordinates in the VR space, using a mechanism called "point estimation". Within these highly specialized environments or conditions (invisible body and point estimation), patients are prompted to alternately reach out their hands, which allows for the precise delineation of the entanglement location of SCAN as indicated by AL. In SCCT, the location of the SCAN entanglement is identified and treated using the AL as an indicator. This allows treatment to be tailored to the individual patient's condition. Treatments are performed by specialized rehabilitation physicians or therapists (SCCT interventionists) and often last 20-40 minutes per session. Treatment effects are thought to improve in a frequency-dependent manner (20 minutes of SCCT over 3 days is more effective than 1 hour per day), and in the case of sudden onset disease, treatment effects are thought to be retained in procedural memory (in the case of chronic disease, the rate of retention of treatment effects varies widely from disease to disease).

Therapeutic Effects and Indications

SCCT has shown interventional effects not only on physical function, but also on cognitive function, and is applied to a wide range of conditions, from cerebrovascular disease to neurodegenerative disorders, trauma and orthopedic disorders, and pediatric developmental disorders.

Research and Outlook

Although research on SCCT is still in its early stages, several clinical trials have suggested its effectiveness. Further studies are expected to expand the effectiveness and reach of the treatment.

Certification System

The certification system for SCCT interventionists is divided into four different levels, each reflecting a different level of competence and responsibility. The first level, Bronze, is for beginners who have mastered the basic operations of SCCT and are classified as entry-level or novice therapists. These therapists are capable of performing basic tasks, but require guidance for more complex treatments. Moving up, the Silver level represents intermediate therapists who are able to perform basic therapeutic interventions independently. These practitioners are referred to as intermediate or expert therapists who have developed a more comprehensive understanding of therapy through extensive practice and training. The Gold level is for advanced practitioners who not only perform comprehensive treatments independently, but also have the skills necessary to train and mentor other therapists. These individuals are recognized as master therapists or proctors, reflecting their deep expertise and leadership in SCCT. At the highest leve, Platinum, practitioners have achieved a level of expertise and experience that qualifies them to issue official certifications. This level represents the pinnacle of professional achievement in SCCT, signifying exceptional competence and a significant contribution to the field through both practice and mentorship.

Aliases

Somato-Cognitive Coordination Therapy (SCCT) is known by several other names, including Somato-Cognitive Coordination (SCC), Brain Reprogramming Therapy (BRT), Brain Rewiring Therapy (BRT), Brain Reorganization Therapy (BRT), and Motor Coordination Therapy (MCT). These terms are used interchangeably to describe the same therapeutic approach.

References

8. Kitano M, Nakamoto M, Kawanishi K, Hara M, Kudo S. Analysis of muscle thickness changes in the lateral abdominal muscles during exercise using virtual reality. J Phys Ther Sci. 2024. in press.
7. Hara M, Murakawa Y, Wagatsuma T, Shinmoto K, Tamaki M. Feasibility of somato-cognitive coordination therapy using virtual reality for patients with advanced severe Parkinson’s disease. J Parkinsons Dis. 2024 Epub ahead of print.
6. Yamaguchi T, Miwa T, Tamura K, Inoue F, Umezawa N, Maetani T, Hara M, Kanemaru S. Temporal virtual reality-guided, dual-task, body trunk-balance training in a sitting position improved persistent postural-perceptual dizziness: proof of concept. J NeuroEngineering Rehab 2022;19:92.
5. Michibata A, Haraguchi M, Murakawa Y, Ishikawa H. Electrical stimulation and virtual reality-guided balance training for managing paraplegia and trunk dysfunction due to spinal cord infarction. BMJ Case Rep 2022;15:e244091.
4. Nakamoto M, Kakuda A, Miyashita T, Kitagawa T, Kitano M, Hara M, Kudo S. Seated virtual reality-guided exercise improved gait in a postoperative hallux valgus case. Int J Environ Res Public Health 2021;18:13267.
3. Takimoto K, Omon K, Murakawa Y, Ishikawa H. Case of cerebellar ataxia successfully treated by virtual reality-guided rehabilitation. BMJ Case Rep 2021;14:e242287.
2. Omon K, Hara M, Ishikawa H. Virtual reality-guided dual-task body trunk balance training in a sitting position improved walking ability without improving leg strength. Prog Rehabil Med 2019;4:20190011.
1. Hara M, Kitamura T, Murakawa Y, Shimba K, Yamaguchi S, Tamaki M. Safety and feasibility of dual-task rehabilitation program for body trunk balance using virtual reality and three-dimensional tracking technologies. Prog Rehabil Med 2018;3:20180016.