Posts Tagged Action observation



Imagery, mirror box therapy and action observation are simple, inexpensive and patient led treatments that can be used to aid in the improvement of motor function in both the upper- and lower-extremities post-stroke. This thesis examined the effects of imagery on physical movement post-stroke and therapists’ use of imagery, mirror box therapy and action observation as part of stroke rehabilitation. Study one was a metaanalysis investigating the effect of imagery on upper- and lower-limb movement ability post-stroke. The results revealed that imagery produced a moderate mean treatment effect (p= 0.03; d= 0.48; 95% confidence interval: 0.05 to 0.91). Imagery that was performed in the third person and performance analysis (the identification of incorrect task performance to help facilitate a positive change in performance) showed the largest improvements in movement. However, the effectiveness of imagery during stroke rehabilitation is still uncertain, as indicated by the large confidence interval. The second study investigated the extent to which physiotherapists and occupational therapists in the UK used cognitive therapies during stroke rehabilitation. In addition, how the therapies were conducted and the therapists’ views on their delivery were investigated. The skill audit had a response rate of 25% and showed that during stroke rehabilitation 68% (91/133) of therapists used imagery, 53% (68/129) used action observation and 41% (52/128) used mirror box therapy. Only 12% of therapists had received specific training in these therapies and therapists would like guidance on how to administer cognitive therapies. Unfortunately, due to the poor response rate the skill audit data may not be generalizable to the whole stroke therapy population. To conclude, the metaanalysis and skill audit have highlighted the potential of cognitive therapies and will help inform the production of clinical guidelines on the use of cognitive therapies during stroke rehabilitation. Clinical guidelines would help standardise the delivery of cognitive therapies and inform therapists how to motivate patients’, post-stroke.

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[ARTICLE] Action observation for upper limb function after stroke: evidence-based review of randomized controlled trials – Full Text PDF


[Purpose] The purpose of this study was to suggest evidenced information about action observation to improve upper limb function after stroke.

[Methods] A systematic review of randomized controlled trials involving adults aged 18 years or over and including descriptions of action observation for improving upper limb function was undertaken. Electronic databases were searched, including MEDLINE, CINAHL, and PEDro (the Physiotherapy Evidence Database), for articles published between 2000 to 2014. Following completion of the searches, two reviewers independently assessed the trials and extracted data using a data extraction form. The same two reviewers independently documented the methodological quality of the trials by using the PEDro scale.

[Results] Five randomized controlled trials were ultimately included in this review, and four of them (80%) reported statistically significant effects for motor recovery of upper limb using action observation intervention in between groups.

[Conclusion] This review of the literature presents evidence attesting to the benefits conferred on stroke patints resulting from participation in an action observation intervention. The body of literature in this field is growing steadily. Further work needs to be done to evaluate the evidence for different conditions after stroke and different duration of intervention.

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Source: Action observation for upper limb function after stroke: evidence-based review of randomized controlled trials

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[ARTICLE] Rehabilitation with Poststroke Motor Recovery: A Review with a Focus on Neural Plasticity – Full Text HTML


Motor recovery after stroke is related to neural plasticity, which involves developing new neuronal interconnections, acquiring new functions, and compensating for impairment. However, neural plasticity is impaired in the stroke-affected hemisphere. Therefore, it is important that motor recovery therapies facilitate neural plasticity to compensate for functional loss. Stroke rehabilitation programs should include meaningful, repetitive, intensive, and task-specific movement training in an enriched environment to promote neural plasticity and motor recovery. Various novel stroke rehabilitation techniques for motor recovery have been developed based on basic science and clinical studies of neural plasticity. However, the effectiveness of rehabilitative interventions among patients with stroke varies widely because the mechanisms underlying motor recovery are heterogeneous. Neurophysiological and neuroimaging studies have been developed to evaluate the heterogeneity of mechanisms underlying motor recovery for effective rehabilitation interventions after stroke. Here, we review novel stroke rehabilitation techniques associated with neural plasticity and discuss individualized strategies to identify appropriate therapeutic goals, prevent maladaptive plasticity, and maximize functional gain in patients with stroke.

Continue —> Rehabilitation with Poststroke Motor Recovery: A Review with a Focus on Neural Plasticity.

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[ARTICLE] Multisensory Stimulation in Stroke Rehabilitation – Full Text

The brain has a large capacity for automatic simultaneous processing and integration of sensory information. Combining information from different sensory modalities facilitates our ability to detect, discriminate, and recognize sensory stimuli, and learning is often optimal in a multisensory environment. Currently used multisensory stimulation methods in stroke rehabilitation include motor imagery, action observation, training with a mirror or in a virtual environment, and various kinds of music therapy. Non-invasive brain stimulation has showed promising preliminary results in aphasia and neglect. Patient heterogeneity and the interaction of age, gender, genes, and environment are discussed. Randomized controlled longitudinal trials starting earlier post-stroke are needed. The advance in brain network science and neuroimaging enabling longitudinal studies of structural and functional networks are likely to have an important impact on patient selection for specific interventions in future stroke rehabilitation. It is proposed that we should pay more attention to age, gender, and laterality in clinical studies.


We live in a multisensory environment and the interaction between our genes and the environment shapes our brains. The brain has a large capacity for automatic simultaneous processing and integration of sensory information, and multisensory influences are integral to primary as well as higher order cortical operations (Ghazanfar and Schroeder, 2006). Combining information from different sensory modalities facilitates our ability to detect, discriminate, and recognize sensory stimuli (Driver and Noesselt, 2008; Shams and Seitz, 2008; Gentile et al., 2011). Non-invasive brain stimulation does not only affect the targeted local regions but also activity in remote interconnected regions. Although repetitive transcranial magnetic stimulation (rTMS) cannot directly target subcortical structures, the activity in thalamus can be modulated by stimulation of parietal cortex, an observation that open up new possibilities for studies of cortical–subcortical interactions in multisensory processing (Blankenburg et al., 2008, 2010). Multisensory enhancement of detection sensitivity for low-contrast visual stimuli by sounds reflects a brain network involving not only established multisensory and sensory-specific cortex but also visual and auditory thalamus (Noesselt et al., 2010). Diffusion tensor imaging and tractography have enhanced the opportunity to study white matter tract networks and compare structural and functional connectivity in humans (Ciccarelli et al., 2008). Combining non-invasive brain stimulation with neuroimaging offers an opportunity to study causal relations between specific brain regions and individual cognitive and perceptual functions (Driver and Noesselt, 2008; Driver et al., 2009; Bolognini and Maravita, 2011; Zamora-López et al., 2011). Non-invasive brain stimulation techniques have the advantage that they can be used both as diagnostic tools and in treatment.

Figure 1. Dendritic branching and spines in pyramidal neurons in parietal cortex in rats housed in standard laboratory cages (A) and rats in enriched environment with opportunity for various activities (B), Johansson and Belichenko (2002).

Continue —>  Frontiers | Multisensory Stimulation in Stroke Rehabilitation | Frontiers in Human Neuroscience.

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[ARTICLE] A Mirror Therapy–Based Action Observation Protocol to Improve Motor Learning After Stroke – Full Text HTML


Background. Mirror therapy is a priming technique to improve motor function of the affected arm after stroke.

Objective. To investigate whether a mirror therapy–based action observation (AO) protocol contributes to motor learning of the affected arm after stroke.

Methods. A total of 37 participants in the chronic stage after stroke were randomly allocated to the AO or control observation (CO) group. Participants were instructed to perform an upper-arm reaching task as fast and as fluently as possible. All participants trained the upper-arm reaching task with their affected arm alternated with either AO or CO. Participants in the AO group observed mirrored video tapes of reaching movements performed by their unaffected arm, whereas participants in the CO group observed static photographs of landscapes. The experimental condition effect was investigated by evaluating the primary outcome measure: movement time (in seconds) of the reaching movement, measured by accelerometry.

Results. Movement time decreased significantly in both groups: 18.3% in the AO and 9.1% in the CO group. Decrease in movement time was significantly more in the AO compared with the CO group (mean difference = 0.14 s; 95% confidence interval = 0.02, 0.26; P = .026).

Conclusion. The present study showed that a mirror therapy–based AO protocol contributes to motor learning after stroke.

Continue Full Text HTML —> A Mirror Therapy–Based Action Observation Protocol to Improve Motor Learning After Stroke.

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[ARTICLE] Motor Priming in Neurorehabilitation.


Priming is a type of implicit learning wherein a stimulus prompts a change in behavior. Priming has been long studied in the field of psychology. More recently, rehabilitation researchers have studied motor priming as a possible way to facilitate motor learning. For example, priming of the motor cortex is associated with changes in neuroplasticity that are associated with improvements in motor performance.

Of the numerous motor priming paradigms under investigation, only a few are practical for the current clinical environment, and the optimal priming modalities for specific clinical presentations are not known. Accordingly, developing an understanding of the various types of motor priming paradigms and their underlying neural mechanisms is an important step for therapists in neurorehabilitation. Most importantly, an understanding of the methods and their underlying mechanisms is essential for optimizing rehabilitation outcomes.

The future of neurorehabilitation is likely to include these priming methods, which are delivered prior to or in conjunction with primary neurorehabilitation therapies. In this Special Interest article, we discuss those priming paradigms that are supported by the greatest amount of evidence, including

  • (i) stimulation-based priming,
  • (ii) motor imagery and action observation,
  • (iii) sensory priming,
  • (iv) movement-based priming, and
  • (v) pharmacological priming.

via Motor Priming in Neurorehabilitation. : Journal of Neurologic Physical Therapy.

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[ARTICLE] “Video Therapy”: Promoting Hand Function after Stroke by Action Observation Training – a Pilot Randomized Controlled Trial – Full Text


Background: Action observation improves excitability of the primary motor cortex and the encoding of motor engrams as well as motor-learning.

Objective: The intention of our pilot-study was to evaluate the feasibility of a six weeks home-based action observation training (video therapy) in stroke patients.

Methods: 56 patients (age 58 ± 13; time since onset 40 ± 82 months; NIHSS 3.5 ± 1.8) with a hand paresis following stroke were recruited from two rehabilitation clinics. Before discharge from the clinic the intervention group received a DVD displaying ten object-related motor tasks of varying difficulty, each lasting five minutes. Patients were requested to imitate the motor tasks one hour daily for six weeks (“video group”). A control group performed the same tasks with written instructions without observation/imitation (“text group”). A second control group was discharged without specific homework (“usual care group”).

Results: There was no dropout in the video group. Quality and speed of the Motor Activity Log (MAL) increased significantly in the video and text group. Nine Hole Peg test (NHPT) and Stroke Impact Scale (SIS) improved only in the video group. Questionnaires (MAL and SIS), obtained twelve months after training in fourteen and eleven participants of both active groups, indicated significant differences in favor of the video group.

Conclusions: Video training is easy to deliver and highly accepted by patients. Six weeks of home based training suggests improvement of hand function, activities of daily living and quality of life. Video-therapy appears to be promising, as an adjunct to conventional neurorehabilitation – especially with regards to non-supervised, home-based training.

via “Video Therapy”: Promoting Hand Function after Stroke by Action Observation Training – a Pilot Randomized Controlled Trial | Open Access | OMICS Publishing Group.

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[ARTICLE] A Mirror Therapy-Based Action Observation Protocol to Improve Motor Learning After Stroke


A mirror therapy-based AO protocol significantly contributes to motor learning of the affected in patients in the chronic stage after stroke…

via A Mirror Therapy-Based Action Observation Protocol to Improve Motor Learning After Stroke – Archives of Physical Medicine and Rehabilitation.

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