Study Results
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Basic Information
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COMPLETED
NA
58 participants
INTERVENTIONAL
2020-12-01
2021-08-27
Brief Summary
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Action observation training can prime the motor system through the mirror neuron network that offers a mechanism for promoting neuroplasticity and reimbursement of motor control following stroke hemiparesis that would otherwise be restricted to use-dependent therapies.
Detailed Description
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A study done in Pakistan shows that about 85% of stroke patients experience initial upper limb paresis even after 3 to 6 months. Stroke is causing motor deficits in both upper and lower limbs however evidence shows that there is only about 12% of complete functional recovery in stroke patients after a time period of 6 months while the remaining 88% of stroke patients have motor deficits in their upper limb that are disabling and are having a negative impact on their activities of daily living. Another study shows that in hemiplegic stroke patients about 30% to 66% of patients' paretic arm is still without function after 6 months post-stroke while in 5% to 20% there is the complete functional recovery of the paretic upper limb. Another study done in Italy by Stefano et al shows that about 38% of stroke patients have partial recovery in dexterity as compared to full recovery in 11.6%. More than 50% of post-stroke patients have impaired upper limb motor function. Rehabilitative interventions are more important because they can regain independence and also promote the recovery of functions that are lost. In the last few years, several approaches have been used for the recovery of hand dexterity after stroke. Among them, task-oriented therapy, robot-assisted rehabilitation and action observation have gained the greatest attention. Action observation training is one of the new developing rehabilitation technique that targets motor learning by the activation of mirror neurons and is the most important approach that targets motor and functional recovery in stroke patients. The mirror neuron system is activated during both the execution and observation of action and is the area responsible for the action observation.In inaction observation training there are actually two phases, the Observation phase and the execution phase. In the observation phase, participants are advised to observe the motor activities that are performed by a healthy individual while in the execution phase the participants are asked to practice these motor functions. In action observation training the movements are produced because of the external stimuli in which actually the visual attention recruit the cerebellar-thalamic-cortical circuit of the brain. Previous studies that were done on subacute and chronic stroke patients showed that there were positive effects of action observation training on the recovery of upper limb functions. Action observation training has a positive effect on the recovery of motor functions in stroke patients. Another study shows that action observation training in association with physical training will increase the effects of motor training in post-stroke patients. Action observation training is concerned with mirror neurons systems and they discharge mostly in association with complex tasks as compared to simple tasks.
Evidence show improvement in upper limb functional recovery, manual dexterity and upper limb activities of daily living by action observation therapy in stroke patients. However, there is not any study done on acute stroke patients. This study will be able to determine the effects of action observation therapy as compared with conventional therapy on improving upper limb motor functions like functional recovery, dexterity and everyday use of the affected upper limb in individuals with acute stroke patients.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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Action observation training group
The experimental group will receive a training program with Action observation by watching videos of complex tasks while imitating them. All the movements will be performed bilaterally so that regardless of the affected side the patient had the correct perspective to perform the exercise.
action observation therapy
The participants will be three meters from the screen onto which the videos will be projected. The initial posture will vary depending on each movement, lying down, sitting, or standing and ensuring a clear field of vision. The sessions will be performed in groups of three to four patients
Conventional therapy group
The control group will receive conventional rehabilitation, with exercises of bimanual activities that will target their shoulder, elbow, wrist and finger joints similar to the experimental group but without Action observation
conventional physical therapy
Verbal instructions will be given to perform and correct the movements requested. The sessions will be conducted in groups of three to four patients and all participants will have 3 to 4 assistants in the session, they will help them achieve their active-assisted range of motion requested in the exercises, when necessary.
Interventions
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action observation therapy
The participants will be three meters from the screen onto which the videos will be projected. The initial posture will vary depending on each movement, lying down, sitting, or standing and ensuring a clear field of vision. The sessions will be performed in groups of three to four patients
conventional physical therapy
Verbal instructions will be given to perform and correct the movements requested. The sessions will be conducted in groups of three to four patients and all participants will have 3 to 4 assistants in the session, they will help them achieve their active-assisted range of motion requested in the exercises, when necessary.
Eligibility Criteria
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Inclusion Criteria
* Acute phase of stroke (\< 3 months)
* Without cognitive impairments (Mini-Mental State Examination \>23)
* No visual or auditory abnormalities
* Preserved visual acuity
* Middle cerebral artery infarction
* Fugl-Meyer assessment (FMA) score ≥20 for upper extremity status
* Dominant hand
Exclusion Criteria
* Comorbidities that influence voluntary upper-extremity function or multiple strokes.
* Apraxia and agnosia
* Cognitive defects or other neurological disorders
40 Years
75 Years
ALL
No
Sponsors
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Riphah International University
OTHER
Responsible Party
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Principal Investigators
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Ayesha Afridi, PhD*
Role: PRINCIPAL_INVESTIGATOR
Riphah International University
Locations
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Rafsan Neuro Rehab Center
Peshawar, , Pakistan
Countries
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References
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Warlow C, van Gijn J, Dennis M, Wardlaw J, Bamford J. Stroke: practical management. 3rd edn, Peter L and Martin D editors. Oxford: Wiley-Blackwell; 2008.
Sale P, Ceravolo MG, Franceschini M. Action observation therapy in the subacute phase promotes dexterity recovery in right-hemisphere stroke patients. Biomed Res Int. 2014;2014:457538. doi: 10.1155/2014/457538. Epub 2014 May 22.
Shelton FN, Reding MJ. Effect of lesion location on upper limb motor recovery after stroke. Stroke. 2001 Jan;32(1):107-12. doi: 10.1161/01.str.32.1.107.
Harmsen WJ, Bussmann JB, Selles RW, Hurkmans HL, Ribbers GM. A Mirror Therapy-Based Action Observation Protocol to Improve Motor Learning After Stroke. Neurorehabil Neural Repair. 2015 Jul;29(6):509-16. doi: 10.1177/1545968314558598. Epub 2014 Nov 21.
Wallace AC, Talelli P, Dileone M, Oliver R, Ward N, Cloud G, Greenwood R, Di Lazzaro V, Rothwell JC, Marsden JF. Standardizing the intensity of upper limb treatment in rehabilitation medicine. Clin Rehabil. 2010 May;24(5):471-8. doi: 10.1177/0269215509358944. Epub 2010 Mar 17.
Jan S, Arsh A, Darain H, Gul S. A randomized control trial comparing the effects of motor relearning programme and mirror therapy for improving upper limb motor functions in stroke patients. J Pak Med Assoc. 2019 Sep;69(9):1242-1245.
Borges LR, Fernandes AB, Oliveira Dos Passos J, Rego IAO, Campos TF. Action observation for upper limb rehabilitation after stroke. Cochrane Database Syst Rev. 2022 Aug 5;8(8):CD011887. doi: 10.1002/14651858.CD011887.pub3.
Other Identifiers
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REC/00816 Zohaib
Identifier Type: -
Identifier Source: org_study_id