Abstract
Due to the complexity of the interventions for upper limb recovery, at the moment there is a lack of evidence regarding innovative and effective rehabilitative interventions. Action Observation Training (AOT) constitutes a promising rehabilitative method to improve upper limb motor recovery in stroke patients. The aim of the present study was to evaluate the potential efficacy of AOT, both in upper limb recovery and in functional outcomes when compared to patients treated with task oriented training (TOT). Both treatments were added to traditional rehabilitative treatment. Thirty-two acute stroke patients at 15.6 days (±8.3) from onset, with moderate to severe upper limb impairment at baseline following their first-ever stroke, were enrolled and randomized into two groups: 16 in the experimental group (EG) and 16 in the control group (CG). The EG underwent 30 min sessions of AOT, and the CG underwent 30 min sessions of TOT. All participants received 20 sessions of treatment for four consecutive weeks (five days/week). The Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Box and Block Test (BBT), Functional Independence Measure (FIM) and Modified Ashworth Scale (MAS) were administered at baseline (T0) and at the end of treatment (T1). No statistical differences were found at T0 for inclusion criteria between the CG and EG, whereas both groups improved significantly at T1. After the treatment period, the rehabilitative gain was greater in the EG compared to the CG for FMA-UE and FIM (all p < 0.05). Our results suggest that AOT can contribute to increased motor recovery in subacute stroke patients with moderate to severe upper limb impairment in the early phase after stroke. The improvements presented in this article, together with the lack of adverse events, confirm that the use of AOT should be broadened out to larger pools of subacute stroke patients.
Highlights
It is well known that stroke is the leading cause of death [1] and one of the greatest causes of long-term motor disability in adults [2]
Starting from the evidence that Action Observation Training (AOT) promotes motor learning, improving outcomes after rehabilitation [17,52], we studied a sample of post-stroke patients with impairment of the upper limb, comparing AOT to a very similar treatment in task oriented training (TOT)
AOT movement sequences are standard, regardless of the patient’s level of functionality, whereas in task-oriented training the level of difficulty is decided by the therapist in relation to the functional level of the patients
Summary
It is well known that stroke is the leading cause of death [1] and one of the greatest causes of long-term motor disability in adults [2]. More than 80% of patients show upper limb impairment after a stroke, and approximately half of them maintain a reduction in voluntary movements of the upper limbs. Even if gait and mobility are recovered after rehabilitation, they are not enough to give back autonomy in daily activities, which are based on dexterity of the upper limbs. Many daily activities, including eating, dressing, and washing, are based on the ability to move and coordinate the arms, hands, and fingers. Limb impairment affects the abilities of patients
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