To investigate the effects of an exercise program with action observation versus conventional physical therapy on upper limb functionality in chronic stroke subjects.
In this controlled clinical trial, thirty-five stroke patients were divided into two groups, experimental group, comprising eighteen patients that received an exercise program with action observation; and a control group, comprising seventeen patients that received conventional exercise program. Functional recovery was assessed with the Fugl-Meyer Scale, manual dexterity was assessed with the Box and Blocks test, and the functional use of the affected upper limb was assessed with the Reach scale. Evaluations occurred at baseline, after three and six months of intervention. Statistical analyses were performed with the Repeated Measures Analysis of Variance and the Friedman test, under a 5% significance.
Both interventions provided benefits to chronic stroke patients. Exercise program with action observation presented better results on motor recovery (p < 0.001) and functional use of the affected limb (p < 0.001) when compared with conventional therapy. Both treatments improved the manual dexterity of the participants (p = 0.002), but in a similar way (p = 0.461).
A six-month exercise program with action observation provided benefits on functional recovery and functional use of an affected upper limb in chronic stroke patients. Exercises with action observation demonstrated the potential for improving affected upper limb in chronic stroke patients.
Recovery of the affected upper limb is one of the great challenges in the rehabilitation of stroke patients. Approximately 60% of severely affected individuals do not present manual dexterity six months after the stroke1. The functional deficits of the upper limb affect the ability for self-care, contribute to low perceived quality of life and higher healthcare services costs2,3.
Exercise programs should start early, be intensive and developed with the active participation of patients to promote motor learning and minimize functional deficits4. Action observation training (AO) is an alternative treatment in which the individual observes an action and then imitates the task5.
AO stimulates the mirror neuron system, a special type of neurons activated by the execution and observation of action6. Initially studied in monkeys, the mirror neuron system is associated with the premotor cortex, supplementary motor area, primary somatosensory cortex, and inferior parietal cortex. By its connections with neurocognitive processing, exercises programs that stimulate the mirror neuron system may promote important benefits to stroke patients6,7.
During AO there is an activation of several cortical areas. An internal representation of the action can potentiate motor learning and functional recovery8,9. AO uses movements guided by external stimuli in which visual attention recruits the cerebellar-thalamic-cortical circuit10. This circuit is involved in neural integration during the initial stages of motor learning. In this matter, Wright and collegues11 showed that directed attention facilitates corticospinal excitability of the brain.
Previous studies using AO showed positive results in the recovery of the affected upper limb in stroke12 13 14 15 16–17. There were improvements in functionality, on the ability to perform activities of daily living and on manual dexterity. Nevertheless, there are still few studies comparing the effects of AO versus conventional therapy (exercise without AO) aiming to see how effective AO is in relation to exercise programs already consecrated.
Thus, in the present study, we investigated the benefits of AO in comparison to conventional physical therapy on upper limb functional recovery, manual dexterity and everyday use of the affected upper limb in individuals with stroke. We hypothesized that AO would present better outcomes to patients with stroke than a conventional exercise program.[…]