Action Observation Therapy for Stroke
Condition: Acute Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      Stroke is a medical condition that causes the cessation of blood flow to the brain cells and
      eventually results in cell death. It's a condition that appears out of nowhere and has
      long-term implications. It is a common Global health-related problem that is disabling in
      nature and is the second common cause of death, leading to disability in the geriatric
      population worldwide. Most of the stroke affects the middle cerebral arteries that's why
      there will be more disability of upper limb, as compared to lower limb and loss of the upper
      limb function, is one of the most common deficits that a person experience after stroke.

      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: 
      Stroke is a medical condition that causes the cessation of blood flow to the brain cells and
      eventually results in cell death. It is a common Global health-related problem that is
      disabling in nature and is the second common cause of death, leading to disability in the
      geriatric population worldwide. The incidence of stroke is increasing day by day in
      low-income countries as compared to high-income countries because of the effects of not using
      evidence-based practice in health-related conditions in low-income countries. Loss of the
      upper limb function is one of the most common deficit that a person experience after stroke.
      Most of the stroke affects the middle cerebral arteries that are why there will be more
      disability of the upper limb as compared to the lower limb. In post-stroke patients, the
      affected limb develop loss of coordination and dexterity, if rehabilitation not performed
      effectively then can develop spasticity. Functional recovery of upper and lower limb depends
      on the size, site and area of the brain that is damaged post-stroke as well as the quality
      and type of rehabilitative intervention.

      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.
    

Intervention name(s): action observation therapy; conventional physical therapy
Intervention type(s): Other; Other
Intervention description(s): 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; 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.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment