Effects of Action Observation Exercises with Complex Tasks on Upper Limb Function in Acute Stroke

Main Article Content

Zohaib Khalid
Gulalai
Kashif Qamar
Maaz Khan
Ayesha Afridi
Amina Rahat

Abstract

Background: Stroke is a leading cause of disability worldwide, necessitating effective rehabilitation strategies. Action observation therapy, a novel approach in stroke rehabilitation, focuses on improving motor function and functional recovery by leveraging the activation of mirror neurons through the observation and subsequent replication of actions.


Objective: The study aimed to compare the effects of action observation therapy with conventional therapy on motor function, manual dexterity, and functional recovery in patients with acute stroke.


Methods: This randomized control trial enrolled 58 acute stroke patients, divided equally into an experimental group (action observation therapy) and a control group (conventional therapy). Participants, aged 40-75 years, were selected using non-probability purposive sampling and randomized via a coin toss method. The study was conducted at Rafsan Neuro Rehab Center, Peshawar, over six months. Inclusion criteria included acute stroke phase, MMSE >24, and Fugl-Meyer Assessment score ≥20. Exclusion criteria were posterior circulation infarction, multiple strokes, and cognitive impairments. Outcome measures included the Fugl-Meyer Assessment scale, Box and Block test, and the REACH scale. Data were analyzed using SPSS v25, employing parametric and non-parametric tests as appropriate.


Results: The experimental group showed a significant improvement in motor functions and functional recovery, with post-treatment Fugl-Meyer scores increasing from 29.69 ± 5.04 to 57.31 ± 4.01 (p = 0.001). The control group also exhibited improvement, with scores rising from 27.00 ± 4.71 to 54.24 ± 5.14 (p = 0.001). However, improvements in manual dexterity, as measured by the Box and Block test, were not statistically significant.


Conclusion: Action observation therapy significantly enhances motor functions and functional recovery in acute stroke patients compared to conventional therapy, although its impact on manual dexterity requires further investigation. These findings suggest that incorporating action observation into stroke rehabilitation protocols could be beneficial.

Article Details

How to Cite
Khalid, Z., Gulalai, Qamar, K., Khan, M., Afridi, A., & Rahat, A. (2024). Effects of Action Observation Exercises with Complex Tasks on Upper Limb Function in Acute Stroke. Journal of Health and Rehabilitation Research, 4(1), 318–324. https://doi.org/10.61919/jhrr.v4i1.397
Section
Articles
Author Biographies

Zohaib Khalid, Active Health Clinic New Zealand

Physiotherapist.

Gulalai, Center of Excellence for Special Children with Autism Peshawar (SWD) Pakistan.

Occupational Therapist, Occupational Therapy Department.

Kashif Qamar, Active Health Clinic New Zealand

Physiotherapist.

Maaz Khan, City General Hospital Peshawar Pakistan.

Physiotherapist.

Ayesha Afridi, Riphah International University Islamabad Pakistan.

Assistant Professor, MS-NMPT (RIPHAH), DPT(RIPHAH).

Amina Rahat, University of Peshawar Pakistan.

Assistant Professor, Department of Food and Nutrition, College of Home Economics.

References

Ghodsi H, Khoshdel AR, Shekarchi B. Evaluation of combining Alberta Stroke Program Early CT Score (ASPECTS) with mean platelet volume, plateletcrit, and platelet count in predicting short-and long-term prognosis of patients with acute ischemic stroke. Clinical Neurology and Neurosurgery. 2021:106830.

Johnson W, Onuma O, Owolabi M, Sachdev S. Democratic Republic of the Congo». Bulletin of the World Health Organization. 2016;94:634-A.

Sherin A, Ul-Haq Z, Fazid S, Shah BH, Khattak MI, Nabi F. Prevalence of stroke in Pakistan: Findings from Khyber Pakhtunkhwa integrated population health survey (KP-IPHS) 2016-17. Pakistan Journal of Medical Sciences. 2020;36(7):1435.

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. JPMA. 2019;69(1242).

Hu L, Ji J, Li Y, Liu B, Zhang Y. Quantile regression forests to identify determinants of neighborhood stroke prevalence in 500 cities in the USA: implications for neighborhoods with high prevalence. Journal of Urban Health. 2020:1-12.

Bhojo A. Khealani and Mohammad Wasay. The burden of stroke in Pakistan. Int J Stroke. 2008;3:293-6.

Xavier D, Liu L, Zhang H, Chin S, Rao-Melacini P. INTERSTROKE investigators: risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries: A Case-Control Study. Lancet. 2010;376(9735):112-23.

Park E-Y, Kim W-H. Participation and Activities of Daily Living, Cognition, And Motor Function According to Residential Area in Stroke Survivors. Journal of the Korean Society of Physical Medicine. 2021;16(2):53-62.

Stroke P. Robotic devices and brain–machine interfaces for hand rehabilitation post-stroke. J Rehabil Med. 2017;49:449-60.

Harmsen WJ, Bussmann JB, Selles RW, Hurkmans HL, Ribbers GM. A mirror therapy–based action observation protocol to improve motor learning after stroke. Neurorehabilitation and neural repair. 2015;29(6):509-16.

Masiero S, Poli P, Rosati G, Zanotto D, Iosa M, Paolucci S, et al. The value of robotic systems in stroke rehabilitation. Expert review of medical devices. 2014;11(2):187-98.

Ferrarello F, Baccini M, Rinaldi LA, Cavallini MC, Mossello E, Masotti G, et al. Efficacy of physiotherapy interventions late after stroke: a meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry. 2011;82(2):136-43.

Franceschini M, Agosti M, Cantagallo A, Sale P, Mancuso M, Buccino G. Mirror neurons: action observation treatment as a tool in stroke rehabilitation. Eur J Phys Rehabil Med. 2010;46(4):517-23.

Franceschini M, Ceravolo MG, Agosti M, Cavallini P, Bonassi S, Dall’Armi V, et al. Clinical relevance of action observation in upper-limb stroke rehabilitation: a possible role in recovery of functional dexterity. A randomized clinical trial. Neurorehabilitation and neural repair. 2012;26(5):456-62.

Sale P, Franceschini M. Action observation and mirror neuron network: a tool for motor stroke rehabilitation. Eur J Phys Rehabil Med. 2012;48(2):313-8.

Sale P, Bovolenta F, Agosti M, Clerici P, Franceschini M. Short-term and long-term outcomes of serial robotic training for improving upper limb function in chronic stroke. International Journal of Rehabilitation Research. 2014;37(1):67-73.

Bang D-H, Shin W-S, Choi H-S. Effects of modified constraint-induced movement therapy with trunk restraint in early stroke patients: A single-blinded, randomized, controlled, pilot trial. NeuroRehabilitation. 2018;42(1):29-35.

Hidler J, Sainburg R. Role of robotics in neurorehabilitation. Topics in spinal cord injury rehabilitation. 2011;17(1):42-9.

Corbetta D, Imeri F, Gatti R. Rehabilitation that incorporates virtual reality is more effective than standard rehabilitation for improving walking speed, balance and mobility after stroke: a systematic review. Journal of physiotherapy. 2015;61(3):117-24.

Victoria GD, Carmen E-V, Alexandru S, Antoanela O, Florin C, Daniel D. THE PNF (PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION) STRETCHING TECHNIQUE-A BRIEF REVIEW. Ovidius University Annals, Series Physical Education & Sport/Science, Movement & Health. 2013;13.

Thant AA, Wanpen S, Nualnetr N, Puntumetakul R, Chatchawan U, Hla KM, et al. Effects of task-oriented training on upper extremity functional performance in patients with sub-acute stroke: a randomized controlled trial. Journal of physical therapy science. 2019;31(1):82-7.

Carr JH, Shepherd RB. Neurological Rehabilitation, 2e: Elsevier India; 2011.

Rosenthal O, Wing AM, Wyatt JL, Punt D, Brownless B, Ko-Ko C, et al. Boosting robot-assisted rehabilitation of stroke hemiparesis by individualized selection of upper limb movements–a pilot study. Journal of neuroengineering and rehabilitation. 2019;16(1):1-14.

Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, et al. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health technology assessment (Winchester, England). 2020;24(54):1.

Laver KE, Lange B, George S, Deutsch JE, Saposnik G, Crotty M. Virtual reality for stroke rehabilitation. Cochrane database of systematic reviews. 2017(11).

Buccino G. Action observation treatment: a novel tool in neurorehabilitation. Philosophical Transactions of the Royal Society B: Biological Sciences. 2014;369(1644):20130185.

Ertelt D, Hemmelmann C, Dettmers C, Ziegler A, Binkofski F. Observation and execution of upper-limb movements as a tool for rehabilitation of motor deficits in paretic stroke patients: protocol of a randomized clinical trial. BMC neurology. 2012;12(1):1-10.

Caspers S, Zilles K, Laird AR, Eickhoff SB. ALE meta-analysis of action observation and imitation in the human brain. Neuroimage. 2010;50(3):1148-67.

Lima ACd, Christofoletti G. Exercises with action observation contribute to upper limb recovery in chronic stroke patients: a controlled clinical trial. Motriz: Revista de Educação Física. 2020;26(1).

Vickers NJ. Animal communication: when i’m calling you, will you answer too? Current biology. 2017;27(14):R713-R5.

Fu J, Zeng M, Shen F, Cui Y, Zhu M, Gu X, et al. Effects of action observation therapy on upper extremity function, daily activities and motion evoked potential in cerebral infarction patients. Medicine. 2017;96(42).

Lima ACd, Christofoletti G. Exercises with action observation contribute to upper limb recovery in chronic stroke patients: a controlled clinical trial. Motriz: Revista de Educação Física. 2020;26.

Amano S, Umeji A, Uchita A, Hashimoto Y, Takebayashi T, Kanata Y, et al. Reliability of remote evaluation for the Fugl–Meyer assessment and the action research arm test in hemiparetic patients after stroke. Topics in stroke rehabilitation. 2018;25(6):432-7.

Lundquist CB, Maribo T. The Fugl–Meyer assessment of the upper extremity: reliability, responsiveness and validity of the Danish version. Disability and rehabilitation. 2017;39(9):934-9.

Alvarez-Rodríguez M, López-Dolado E, Salas-Monedero M, Lozano-Berrio V, Ceruelo-Abajo S, Gil-Agudo A, et al. Concurrent Validity of a Virtual Version of Box and Block Test for Patients with Neurological Disorders. World Journal of Neuroscience. 2020;10(01):79.

Simpson LA, Eng JJ, Backman CL, Miller WC. Rating of Everyday Arm-Use in the Community and Home (REACH) scale for capturing affected arm-use after stroke: development, reliability, and validity. PLoS One. 2013;8(12):e83405.

Ertelt D, Small S, Solodkin A, Dettmers C, McNamara A, Binkofski F, et al. Action observation has a positive impact on rehabilitation of motor deficits after stroke. Neuroimage. 2007;36:T164-T73.

Garrison KA, Aziz-Zadeh L, Wong SW, Liew S-L, Winstein CJ. Modulating the motor system by action observation after stroke. Stroke. 2013;44(8):2247-53.

Hsieh Y-W, Lin Y-H, Zhu J-D, Wu C-Y, Lin Y-P, Chen C-C. Treatment effects of upper limb action observation therapy and mirror therapy on rehabilitation outcomes after subacute stroke: A pilot study. Behavioural neurology. 2020;2020.

Sale P, Ceravolo MG, Franceschini M. Action observation therapy in the subacute phase promotes dexterity recovery in right-hemisphere stroke patients. BioMed research international. 2014;2014.

Zhu M-H, Wang J, Gu X-D, Shi M-F, Zeng M, Wang C-Y, et al. Effect of action observation therapy on daily activities and motor recovery in stroke patients. International Journal of Nursing Sciences. 2015;2(3):279-82.

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