Effects of Action Observation Therapy Based on Virtual Reality for Upper Extremity Rehabilitation in Stroke

NCT ID: NCT06196229

Last Updated: 2024-06-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

36 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-11-25

Study Completion Date

2024-07-01

Brief Summary

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This study aims to conduct a randomized controlled trial (RCT) assessing the effectiveness of combining Action Observation (AO) with Virtual Reality (VR) in improving upper limb function for stroke patients compared to AO therapy alone.

Individuals who meet the inclusion criteria will be assigned by lottery into one of two groups: Group A will receive only AO therapy, watching daily actions and then executing them, while Group B will receive both AO and VR therapy, using VR glasses to complete tasks. The Box and Block Test for manual dexterity, the Timed Test, the Modified Ashworth Scale for spasticity, the Rankin Scale for symptom severity, and the Fugl-Meyer Assessment for motor, balance, sensation, and joint function will all be used in the evaluation, both before and after the intervention. Every participant will go through 18 sessions totaling 60

Detailed Description

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The rehabilitation of paretic stroke patients uses a wide range of intervention programs to improve the function of impaired upper limb. A new rehabilitative approach, called action observation therapy (AOT) is based on the discovery of mirror neurons and has been used to improve the motor functions of adult stroke patients and children with cerebral palsy. Recently, virtual reality (VR) has provided the potential to increase the frequency and effectiveness of rehabilitation treatment by offering challenging and motivating tasks. The purpose of the present project is to design a randomized controlled trial (RCT) to evaluate whether action observation (AO) added to standard VR (AO+VR) is effective in improving upper limb function in patients with stroke, compared with an action observation therapy alone.

Non-probability sampling technique will be used. After signing the consent form, the participant who met the inclusion criteria will be allocated to this study. Lottery Method will be used for the randomization of subjects in two groups. For the blindness of the accessor, the concealment process (Closed Envelope Method) will be maintained. Group A (will be given Action Observation Therapy only), During each training session, participants will be asked to observe a specific object-directed daily action presented on a computer screen, and afterward they will perform what they have observed. Group B (will be given Action Observation Therapy combined with Virtual Reality), the participant will sit in the center of the set zone and will be assisted to wear the VR glasses. After the participant will confirm that the sight and sound is clear and comfortable, the tasks will be done using virtual reality videos. Data will be collected at baseline and after 6 weeks using Box and Block Test (Measures unilateral gross manual dexterity), Timed Test (To check the time duration for each task), Modified Ashworth Scale (To assess spasticity), Rankin Scale (To categorize severity of symptoms) and Fugl-Meyer Assessment for Upper Extremity (FMA-UE): to assess motor functioning, balance, sensation and joint functioning. All participants will receive 18 sessions of intervention for 60 min/day, 3 days/week for 6 weeks.

Conditions

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Stroke

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Action Observation Therapy

During each training session, participants were asked to observe a specific object-directed daily action presented on a computer screen, and afterward they performed what they have observed, 5 repetitions of each task, time duration was noted.

16 motor tasks related to their daily living that were performed with their own hands which are following

1. Folding a towel
2. Cutting a toilet roll
3. Using scissors
4. Tightening shoelaces
5. Opening and closing a square airtight container
6. Opening a bottle top
7. Turning a faucet
8. Using a field of billfold
9. Drinking water
10. Setting a seal
11. Changing batteries
12. Opening and closing a zipper
13. Turning over pages of a book
14. Plugging the outlet
15. Spraying water with a sprayer
16. Sorting chopsticks and spoons and putting them in a box • The participants were advised to keep focusing on their affected arm/hand action observational tasks

Group Type ACTIVE_COMPARATOR

Action Observation Therapy

Intervention Type OTHER

During each training session, participants were asked to observe a specific object-directed daily action presented on a computer screen, and afterward they performed what they have observed, 5 repetitions of each task, time duration was noted .

16 motor tasks related to their daily living that were performed with their own hands which are following

1. Folding a towel
2. Cutting a toilet roll
3. Using scissors
4. Tightening shoelaces
5. Opening and closing a square airtight container
6. Opening a bottle top
7. Turning a faucet
8. Using a field of billfold
9. Drinking water
10. Setting a seal
11. Changing batteries
12. Opening and closing a zipper
13. Turning over pages of a book
14. Plugging the outlet
15. Spraying water with a sprayer
16. Sorting chopsticks and spoons and putting them in a box • The participants were advised to keep focusing on their affected arm/hand action observational tasks

Action Observation Therapy combined with Virtual Reality

In the VRT group, participants will execute VR-based activities conducted by the same therapist .

* 16 tasks will be assigned in each session. VR SHINECON 3D Glasses will be used
* The virtual environment was set in a 6 m2 physical space
* At the beginning of each session, the participant will sit in the center of the set zone and will be assisted to wear the VR glasses
* After the participant will confirm that the sight and sound is clear and comfortable, the tasks mentioned in action observation therapy will be done using virtual reality videos
* The Extrinsic feedback will be provided, including the time left, number of repetitions, and record number of repetitions

Group Type EXPERIMENTAL

Action Observation Therapy combined with Virtual Reality

Intervention Type OTHER

In the VRT group, participants will execute VR-based activities conducted by the same therapist.

* 16 tasks will be assigned in each session. VR SHINECON 3D Glasses will be used
* The virtual environment was set in a 6 m2 physical space
* At the beginning of each session, the participant will sit in the center of the set zone and will be assisted to wear the VR glasses
* After the participant will confirm that the sight and sound is clear and comfortable, the tasks mentioned in action observation therapy will be done using virtual reality videos
* The Extrinsic feedback will be provided, including the time left, number of repetitions, and record number of repetitions

Interventions

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Action Observation Therapy

During each training session, participants were asked to observe a specific object-directed daily action presented on a computer screen, and afterward they performed what they have observed, 5 repetitions of each task, time duration was noted .

16 motor tasks related to their daily living that were performed with their own hands which are following

1. Folding a towel
2. Cutting a toilet roll
3. Using scissors
4. Tightening shoelaces
5. Opening and closing a square airtight container
6. Opening a bottle top
7. Turning a faucet
8. Using a field of billfold
9. Drinking water
10. Setting a seal
11. Changing batteries
12. Opening and closing a zipper
13. Turning over pages of a book
14. Plugging the outlet
15. Spraying water with a sprayer
16. Sorting chopsticks and spoons and putting them in a box • The participants were advised to keep focusing on their affected arm/hand action observational tasks

Intervention Type OTHER

Action Observation Therapy combined with Virtual Reality

In the VRT group, participants will execute VR-based activities conducted by the same therapist.

* 16 tasks will be assigned in each session. VR SHINECON 3D Glasses will be used
* The virtual environment was set in a 6 m2 physical space
* At the beginning of each session, the participant will sit in the center of the set zone and will be assisted to wear the VR glasses
* After the participant will confirm that the sight and sound is clear and comfortable, the tasks mentioned in action observation therapy will be done using virtual reality videos
* The Extrinsic feedback will be provided, including the time left, number of repetitions, and record number of repetitions

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* • Both Male \& Female

* 40-60 years of age
* Primarily motor symptoms with unilateral upper limb paresis (controlled via standard neurological examination)
* Residual movement ability of the paretic upper limb, controlled by Medical Research Council (MRC) index (\> 2 and \< 4), active use of the hemiplegic limb, from minimal (mainly for assistance tasks to the preserved limb) to discrete (characterized by coarse manipulation and an inability to perform precision grip)
* mini-mental state examination (MME) score ≥27
* Sufficient cooperation and cognitive understanding to participate to the activities, controlled by the investigator recruiting the patient

Exclusion Criteria

* • Presence of severe cognitive impairment (score \< 20 at Mini Mental State Examination \[MMSE\])

* Presence of severe forms of unilateral spatial neglect, controlled using the Bells Test (cut-off = / \> 50%)
* Presence of severe ideomotor Apraxia
* Presence of severe anosognosia, assessed by clinical examination
* Presence of severe language comprehension deficits, assessed by clinical examination.
* Presence of severe untreated psychiatric disorders
* Sensory impairments hindering participation and/or not compensated visual deficits of central origin
* Drug-resistant epilepsy
Minimum Eligible Age

40 Years

Maximum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Riphah International University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Tasneem Shahzadi, Phd*

Role: PRINCIPAL_INVESTIGATOR

Riphah International University

Locations

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Riphah International University

Lahore, Punjab Province, Pakistan

Site Status RECRUITING

Countries

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Pakistan

Central Contacts

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Imran Amjad, Phd

Role: CONTACT

033224390125

Facility Contacts

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imran Amjad, Phd

Role: primary

033224390125

Tasneem Shahzadi, Phd*

Role: backup

03104108327

References

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Zhang B, Kan L, Dong A, Zhang J, Bai Z, Xie Y, Liu Q, Peng Y. The effects of action observation training on improving upper limb motor functions in people with stroke: A systematic review and meta-analysis. PLoS One. 2019 Aug 30;14(8):e0221166. doi: 10.1371/journal.pone.0221166. eCollection 2019.

Reference Type BACKGROUND
PMID: 31469840 (View on PubMed)

Rizzolatti G, Cattaneo L, Fabbri-Destro M, Rozzi S. Cortical mechanisms underlying the organization of goal-directed actions and mirror neuron-based action understanding. Physiol Rev. 2014 Apr;94(2):655-706. doi: 10.1152/physrev.00009.2013.

Reference Type BACKGROUND
PMID: 24692357 (View on PubMed)

Alamer A, Melese H, Adugna B. Effectiveness of Action Observation Training on Upper Limb Motor Function in Children with Hemiplegic Cerebral Palsy: A Systematic Review of Randomized Controlled Trials. Pediatric Health Med Ther. 2020 Sep 15;11:335-346. doi: 10.2147/PHMT.S266720. eCollection 2020.

Reference Type BACKGROUND
PMID: 32982541 (View on PubMed)

Buccino G, Molinaro A, Ambrosi C, Arisi D, Mascaro L, Pinardi C, Rossi A, Gasparotti R, Fazzi E, Galli J. Action Observation Treatment Improves Upper Limb Motor Functions in Children with Cerebral Palsy: A Combined Clinical and Brain Imaging Study. Neural Plast. 2018 Jul 4;2018:4843985. doi: 10.1155/2018/4843985. eCollection 2018.

Reference Type BACKGROUND
PMID: 30123250 (View on PubMed)

Caligiore D, Mustile M, Spalletta G, Baldassarre G. Action observation and motor imagery for rehabilitation in Parkinson's disease: A systematic review and an integrative hypothesis. Neurosci Biobehav Rev. 2017 Jan;72:210-222. doi: 10.1016/j.neubiorev.2016.11.005. Epub 2016 Nov 16.

Reference Type BACKGROUND
PMID: 27865800 (View on PubMed)

Rizzolatti G, Fogassi L. The mirror mechanism: recent findings and perspectives. Philos Trans R Soc Lond B Biol Sci. 2014 Apr 28;369(1644):20130420. doi: 10.1098/rstb.2013.0420. Print 2014.

Reference Type BACKGROUND
PMID: 24778385 (View on PubMed)

Lee SH, Kim SS, Lee BH. Action observation training and brain-computer interface controlled functional electrical stimulation enhance upper extremity performance and cortical activation in patients with stroke: a randomized controlled trial. Physiother Theory Pract. 2022 Sep;38(9):1126-1134. doi: 10.1080/09593985.2020.1831114. Epub 2020 Oct 7.

Reference Type BACKGROUND
PMID: 33026895 (View on PubMed)

Fu J, Zeng M, Shen F, Cui Y, Zhu M, Gu X, Sun Y. Effects of action observation therapy on upper extremity function, daily activities and motion evoked potential in cerebral infarction patients. Medicine (Baltimore). 2017 Oct;96(42):e8080. doi: 10.1097/MD.0000000000008080.

Reference Type BACKGROUND
PMID: 29049194 (View on PubMed)

Mancuso M, Damora A, Abbruzzese L, Navarrete E, Basagni B, Galardi G, Caputo M, Bartalini B, Bartolo M, Zucchella C, Carboncini MC, Dei S, Zoccolotti P, Antonucci G, De Tanti A. A New Standardization of the Bells Test: An Italian Multi-Center Normative Study. Front Psychol. 2019 Jan 22;9:2745. doi: 10.3389/fpsyg.2018.02745. eCollection 2018.

Reference Type BACKGROUND
PMID: 30723446 (View on PubMed)

Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation. Cochrane Database Syst Rev. 2017 Nov 20;11(11):CD008349. doi: 10.1002/14651858.CD008349.pub4.

Reference Type BACKGROUND
PMID: 29156493 (View on PubMed)

Alaca N, Ocal NM. Proprioceptive based training or modified constraint-induced movement therapy on upper extremity motor functions in chronic stroke patients: A randomized controlled study. NeuroRehabilitation. 2022;51(2):271-282. doi: 10.3233/NRE-220009.

Reference Type BACKGROUND
PMID: 35599504 (View on PubMed)

Desrosiers J, Bravo G, Hebert R, Dutil E, Mercier L. Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Arch Phys Med Rehabil. 1994 Jul;75(7):751-5.

Reference Type BACKGROUND
PMID: 8024419 (View on PubMed)

Montgomery P, Grant S, Mayo-Wilson E, Macdonald G, Michie S, Hopewell S, Moher D; CONSORT-SPI Group. Reporting randomised trials of social and psychological interventions: the CONSORT-SPI 2018 Extension. Trials. 2018 Jul 31;19(1):407. doi: 10.1186/s13063-018-2733-1.

Reference Type BACKGROUND
PMID: 30060754 (View on PubMed)

Errante A, Saviola D, Cantoni M, Iannuzzelli K, Ziccarelli S, Togni F, Simonini M, Malchiodi C, Bertoni D, Inzaghi MG, Bozzetti F, Menozzi R, Quarenghi A, Quarenghi P, Bosone D, Fogassi L, Salvi GP, De Tanti A. Effectiveness of action observation therapy based on virtual reality technology in the motor rehabilitation of paretic stroke patients: a randomized clinical trial. BMC Neurol. 2022 Mar 22;22(1):109. doi: 10.1186/s12883-022-02640-2.

Reference Type BACKGROUND
PMID: 35317736 (View on PubMed)

Other Identifiers

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REC/RCR & AHS/23/0254

Identifier Type: -

Identifier Source: org_study_id

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