Posts Tagged Action observation

[Abstract + References] Multimodal Head-Mounted Virtual-Reality Brain-Computer Interface for Stroke Rehabilitation – Conference paper

Abstract

Rehabilitation after stroke requires the exploitation of active movement by the patient in order to efficiently re-train the affected side. Individuals with severe stroke cannot benefit from many training solutions since they have paresis and/or spasticity, limiting volitional movement. Nonetheless, research has shown that individuals with severe stroke may have modest benefits from action observation, virtual reality, and neurofeedback from brain-computer interfaces (BCIs). In this study, we combined the principles of action observation in VR together with BCI neurofeedback for stroke rehabilitation to try to elicit optimal rehabilitation gains. Here, we illustrate the development of the REINVENT platform, which takes post-stroke brain signals indicating an attempt to move and drives a virtual avatar arm, providing patient-driven action observation in head-mounted VR. We also present a longitudinal case study with a single individual to demonstrate the feasibility and potentially efficacy of the REINVENT system.

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via Multimodal Head-Mounted Virtual-Reality Brain-Computer Interface for Stroke Rehabilitation | SpringerLink

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[ARTICLE] Effects of a Brain-Computer Interface With Virtual Reality (VR) Neurofeedback: A Pilot Study in Chronic Stroke Patients – Full Text

Rehabilitation for stroke patients with severe motor impairments (e.g., inability to perform wrist or finger extension on the affected side) is burdensome and difficult because most current rehabilitation options require some volitional movement to retrain the affected side. However, although these patients participate in therapy requiring volitional movement, previous research has shown that they may receive modest benefits from action observation, virtual reality (VR), and brain-computer interfaces (BCIs). These approaches have shown some success in strengthening key motor pathways thought to support motor recovery after stroke, in the absence of volitional movement. The purpose of this study was to combine the principles of VR and BCI in a platform called REINVENT and assess its effects on four chronic stroke patients across different levels of motor impairment. REINVENT acquires post-stroke EEG signals that indicate an attempt to move and drives the movement of a virtual avatar arm, allowing patient-driven action observation neurofeedback in VR. In addition, synchronous electromyography (EMG) data were also captured to monitor overt muscle activity. Here we tested four chronic stroke survivors and show that this EEG-based BCI can be safely used over repeated sessions by stroke survivors across a wide range of motor disabilities. Finally, individual results suggest that patients with more severe motor impairments may benefit the most from EEG-based neurofeedback, while patients with more mild impairments may benefit more from EMG-based feedback, harnessing existing sensorimotor pathways. We note that although this work is promising, due to the small sample size, these results are preliminary. Future research is needed to confirm these findings in a larger and more diverse population.

Introduction

Stroke is a leading cause of adult long-term disability worldwide (Mozaffarian et al., 2015), and an increasing number of stroke survivors suffer from severe cognitive and motor impairments each year. This results in a loss of independence in their daily life, such as decreased ability to perform self-care tasks and decreased participation in social activities (Miller et al., 2010). Rehabilitation following stroke focuses on maximizing restoration of lost motor and cognitive functions and on relearning skills to better perform activities of daily living (ADLs). There is increasing evidence that the brain remains plastic at later stages after stroke, suggesting additional recovery remains possible (Page et al., 2004Butler and Page, 2006). To maximize brain plasticity, several rehabilitation strategies have been exploited, including the use of intensive rehabilitation (Wittenberg et al., 2016), repetitive motor training (Thomas et al., 2017), mirror therapy (Pérez-Cruzado et al., 2017), motor-imagery (Kho et al., 2014), and action observation (Celnik et al., 2008), amongst others.

Recently, growing evidence of the positive impact of virtual reality (VR) techniques on recovery following stroke has accumulated (Bermúdez i Badia et al., 2016). When combined with conventional therapy, VR is able to effectively incorporate rehabilitation strategies such as intensity, frequency, and duration of therapy in a novel and low-cost approach in the stroke population (Laver et al., 2017). However, patients with low levels of motor control cannot benefit from current VR tools due to their low volitional motor control, range of motion, pain, and fatigue. Rehabilitation for these individuals is challenging because most current training options require some volitional movement to train the affected side, however, research has shown that individuals with severe stroke may receive modest benefits from action observation and brain-computer interfaces (BCIs) (Silvoni et al., 2011).

Merging BCIs with VR allows for a wide range of experiences in which patients can feel immersed in various aspects of their environment. This allows patients to control their experiences in VR using only brain activity, either directly (e.g., movement in VR through explicit control) or indirectly (e.g., modulating task difficulty level based on workload as implicit control) (Vourvopoulos et al., 2016Friedman, 2017). This direct brain-to-VR communication can induce a sensorimotor contingency between the patient’s internal intentions and the environment’s responsive actions, increasing the patient’s sense of embodiment of their virtual avatar (Slater, 2009Ramos-Murguialday et al., 2013).

After a stroke resulting in severe motor impairments (e.g., inability to perform wrist or finger extension on the affected side), research shows that action observation combined with physical training enhances the effects of motor training (Celnik et al., 2008), eliciting motor-related brain activity in the lesioned hemisphere, leading to modest motor improvements (Ertelt et al., 2007Garrison et al., 2013). Moreover, action observation in a head-mounted VR increases motor activity in both healthy and the post-stroke brains (Ballester et al., 2015Vourvopoulos and Bermúdez i Badia, 2016a).

In addition, neurofeedback through BCIs has been proposed for individuals with severe stroke because BCIs do not require active motor control. Research on BCIs for rehabilitation has shown that motor-related brain signals are reinforced by rewarding feedback so they can be used to strengthen key motor pathways that are thought to support motor recovery after stroke (Wolpaw, 2012). Such feedback has previously shown modest success in motor rehabilitation for severe stroke patients (Soekadar et al., 2015).

The most common brain signal acquisition technology used with BCIs in stroke patients is non-invasive electroencephalography (EEG) (Wolpaw, 2012), which provide a cost-effective BCI platform (Vourvopoulos and Bermúdez i Badia, 2016b). In BCI paradigms for motor rehabilitation, EEG signals related to motor planning and execution are utilized. During a motor attempt, the temporal pattern of the Alpha rhythm (8–12 Hz) desynchronizes. The Alpha rhythm is also termed Rolandic mu or the sensorimotor rhythm (SMR) when it is localized over the sensorimotor cortices of the brain. Mu rhythms (8–12 Hz) are considered indirect indications of the action observation network (Kropotov, 2016) and reflect general sensorimotor activity. Mu rhythms are often detected with changes in the Beta rhythm (12–30 Hz) in the form of event-related desynchronization (ERD), in which a motor action is executed (Pfurtscheller and Lopes da Silva, 1999). These EEG rhythms, or motor-related EEG signatures, are primarily detected during task-based EEG (i.e., when the patient is actively moving or imagining movement) and used for neurofeedback.

Further, neurofeedback-induced changes in brain activity have also been linked to changes in brain activity at rest. That is, after training one’s brain activity using neurofeedback, the intrinsic, resting brain activity (i.e., EEG activity in the absence of a task) may also show changes. This resting brain activity can be used to assess more generalized brain changes, and baseline resting-state signatures may be used to predict recovery (Wu et al., 2015) or response to treatments (Zhou et al., 2018). When combined with neural injury information, resting EEG parameters can also help predict the efficacy of stroke therapy.

In this study, our goal was to combine the principles of virtual reality and BCIs to elicit optimal rehabilitation gains for stroke survivors. We hypothesized that merging BCIs with VR should induce illusions of movement and a strong feeling of embodiment within a virtual body via the action observation network, activating brain areas that overlap with those controlling actual movement, which is important for mobilizing neuroplastic changes (Dobkin, 2007). Using a VR-based BCI, those with severe stroke impairments can trigger voluntary movements of the virtual arm in a closed neurofeedback loop. This helps to increase the illusion of one’s own movements through the coordination between one’s intention and the observed first-person virtual action. Therefore, we developed a training platform called REINVENT, which uses post-stroke brain signals that indicate an attempt to move and then drives the movement of a virtual avatar arm, providing patient-driven action observation in head-mounted VR (Spicer et al., 2017). Our previous work using REINVENT with healthy individuals indeed showed that the combination of VR integrated into a BCI encouraged greater embodiment, and greater embodiment was related to greater neurofeedback performance (Anglin et al., 2019).

For this study, we recruited four chronic stroke survivors to undergo a longitudinal BCI-VR intervention using REINVENT to provide EEG-based neurofeedback with simultaneous EMG acquisition. We assessed intervention results using clinical measures, Transcranial Magnetic Stimulation (TMS) and Magnetic Resonance Imaging (MRI) and compared these measures before and after the intervention. The purpose of this study was twofold. First, we sought to determine whether REINVENT is feasible for stroke patients to use across repeated sessions and second, whether REINVENT might be able to strengthen motor-related brain signals in individuals with differing levels of motor impairment after stroke.[…]

 

Continue —>  Frontiers | Effects of a Brain-Computer Interface With Virtual Reality (VR) Neurofeedback: A Pilot Study in Chronic Stroke Patients | Frontiers in Human Neuroscience

Figure 1. System architecture of a closed neurofeedback loop. From left, (1) the evoked physiological responses are captured at the interfacing layer through the data acquisition clients, (2) sent to the processing layer where the signals are filtered and logged, and then, (3) the extracted features (e.g., EEG bands) are sent to the interaction layer where VR training occurs. Written permission to use this photo was obtained from the individual.

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[Abstract] Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis

This study was to investigate the effectiveness of action observation therapy on arm and hand motor function, walking ability, gait performance, and activities of daily living in stroke patients.

Systematic review and meta-analysis of randomized controlled trials.

Searches were completed in January 2019 from electronic databases, including PubMed, Scopus, the Cochrane Library, and OTseeker.

Two independent reviewers performed data extraction and evaluated the study quality by the PEDro scale. The pooled effect sizes on different aspects of outcome measures were calculated. Subgroup analyses were performed to examine the impact of stroke phases on treatment efficacy.

Included were 17 articles with 600 patients. Compared with control treatments, the action observation therapy had a moderate effect size on arm and hand motor outcomes (Hedge’s g = 0.564; P < 0.001), a moderate to large effect size on walking outcomes (Hedge’s g = 0.779; P < 0.001), a large effect size on gait velocity (Hedge’s g = 0.990; P < 0.001), and a moderate to large effect size on activities of daily function (Hedge’s g = 0. 728; P = 0.004). Based on subgroup analyses, the action observation therapy showed moderate to large effect sizes in the studies of patients with acute/subacute stroke or those with chronic stroke (Hedge’s g = 0.661 and 0.783).

This review suggests that action observation therapy is an effective approach for stroke patients to improve arm and hand motor function, walking ability, gait velocity, and daily activity performance.

via Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis – Tzu-Hsuan Peng, Jun-Ding Zhu, Chih-Chi Chen, Ruei-Yi Tai, Chia-Yi Lee, Yu-Wei Hsieh, 2019

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[Abstract] Action observation for upper limb rehabilitation after stroke

Abstract

BACKGROUND:

Action observation (AO) is a physical rehabilitation approach that facilitates the occurrence of neural plasticity through the activation of the mirror-neural system, promoting motor recovery in people with stroke.

OBJECTIVES:

To assess whether action observation enhances motor function and upper limb motor performance and cortical activation in people with stroke.

SEARCH METHODS:

We searched the Cochrane Stroke Group Trials Register (last searched 4 September 2017), the Central Register of Controlled Trials (24 October 2017), MEDLINE (1946 to 24 October 2017), Embase (1974 to 24 October 2017) and five additional databases. We also searched trial registries and reference lists.

SELECTION CRITERIA:

Randomized controlled trials (RCTs) of AO, alone or associated with physical practice in adults after stroke. The primary outcome was upper limb motor function. Secondary outcomes included dependence on activities of daily living (ADL), motor performance, cortical activation, quality of life, and adverse effects.

DATA COLLECTION AND ANALYSIS:

Two review authors independently selected trials according to the pre-defined inclusion criteria, extracted data, assessed risk of bias, and applied the GRADE approach to assess the quality of the evidence. The reviews authors contacted trial authors for clarification and missing information.

MAIN RESULTS:

We included 12 trials involving 478 individuals. A number of trials showed a high risk of bias and others an unclear risk of bias due to poor reporting. The quality of the evidence was ‘low’ for most of the outcomes and ‘moderate’ for hand function, according to the GRADE system. In most of the studies, AO was followed by some form of physical activity.

PRIMARY OUTCOME:

the impact of AO on arm function showed a small significant effect (standardized mean difference (SMD) 0.36, 95% CI 0.13 to 0.60; 8 studies; 314 participants; low-quality evidence); and a large significant effect (mean difference (MD) 2.90, 95% CI 1.13 to 4.66; 3 studies; 132 participants; moderate-quality evidence) on hand function.

SECONDARY OUTCOMES:

there was a large significant effect for ADL outcome (SMD 0.86, 95% CI 0.11 to 1.61; 4 studies, 226 participants; low-quality evidence). We were unable to pool other secondary outcomes to extract the evidence. Only two studies reported adverse effects without significant adverse AO events.

AUTHORS’ CONCLUSIONS:

We found evidence that AO is beneficial in improving upper limb motor function and dependence in activities of daily living (ADL) in people with stroke, when compared with any control group; however, we considered the quality of the evidence to be low. We considered the effect of AO on hand function to be large, but it does not appear to be clinically relevant, although we considered the quality of the evidence as moderate. As such, our confidence in the effect estimate is limited because it will likely change with future research.

 

via Action observation for upper limb rehabilitation after stroke. – PubMed – NCBI

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[Poster] Action Observation in Upper Extremity Rehabilitation for Moderately Impaired Stroke: A Literature Review

To determine the efficacy of action observation (AO) for upper extremity (UE) rehabilitation in moderately impaired stroke survivors as reported in current literature.

First page of article

via Action Observation in Upper Extremity Rehabilitation for Moderately Impaired Stroke: A Literature Review – Archives of Physical Medicine and Rehabilitation

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[Abstract] Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial

Objective: To determine the effect of activity-based mirror therapy (MT) on motor recovery and gait in chronic poststroke hemiparetic subjects.

Design: A randomised, controlled, assessor-blinded trial.

Setting: Rehabilitation institute.

Participants: Thirty-six chronic poststroke (15.89 ± 9.01 months) hemiparetic subjects (age: 46.44 ± 7.89 years, 30 men and functional ambulation classification of median level 3).

Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management.

Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT).

Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference = 3.29, 95% CI = 1.23–5.35, p = .003) and RVGA (mean difference = 5.41, 95% CI = 1.12–9.71, p = .015) in comparison to the control group. No considerable changes were observed on 10-MWT.

Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects.

 

via Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial: Neuropsychological Rehabilitation: Vol 0, No 0

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[ARTICLE] Effects of action observation therapy and mirror therapy after stroke on rehabilitation outcomes and neural mechanisms by MEG: study protocol for a randomized controlled trial – Full Text

Abstract

Background

Loss of upper-extremity motor function is one of the most debilitating deficits following stroke. Two promising treatment approaches, action observation therapy (AOT) and mirror therapy (MT), aim to enhance motor learning and promote neural reorganization in patients through different afferent inputs and patterns of visual feedback. Both approaches involve different patterns of motor observation, imitation, and execution but share some similar neural bases of the mirror neuron system. AOT and MT used in stroke rehabilitation may confer differential benefits and neural activities that remain to be determined. This clinical trial aims to investigate and compare treatment effects and neural activity changes of AOT and MT with those of the control intervention in patients with subacute stroke.

Methods/design

An estimated total of 90 patients with subacute stroke will be recruited for this study. All participants will be randomly assigned to receive AOT, MT, or control intervention for a 3-week training period (15 sessions). Outcome measurements will be taken at baseline, immediately after treatment, and at the 3-month follow-up. For the magnetoencephalography (MEG) study, we anticipate that we will recruit 12 to 15 patients per group. The primary outcome will be the Fugl-Meyer Assessment score. Secondary outcomes will include the modified Rankin Scale, the Box and Block Test, the ABILHAND questionnaire, the Questionnaire Upon Mental Imagery, the Functional Independence Measure, activity monitors, the Stroke Impact Scale version 3.0, and MEG signals.

Discussion

This clinical trial will provide scientific evidence of treatment effects on motor, functional outcomes, and neural activity mechanisms after AOT and MT in patients with subacute stroke. Further application and use of AOT and MT may include telerehabilitation or home-based rehabilitation through web-based or video teaching.

Background

Stroke is the leading cause of long-term adult disability worldwide [1]. Most patients with stroke experience upper-extremity (UE) motor impairment [2] and show minimal recovery of the affected arm even 6 months after stroke [3]. Due to the potentially severe adverse effects after stroke, it is critical in clinical practice to develop effective and specific stroke interventions to improve arm function and to explore the neural mechanisms involved [45]. Action observation therapy (AOT) and mirror therapy (MT) are two examples of novel approaches concerning stroke motor recovery that are supported by neuroscientific foundations [67]. However, the relative efficacy of AOT versus MT has not been validated in patients with stroke.

AOT is a promising approach grounded in basic neuroscience and the recent discovery of the mirror neuron system (MNS) [6]. AOT commonly includes action observation and action execution and allows patients to safely practice movements and motor tasks. AOT is recommended to help patients with stroke to form accurate images of motor actions [8] and to mediate their motor relearning process after stroke [6]. Researchers have found that AOT can induce stronger cognitive activity than motor imagery in patients with stroke and have suggested that AOT could be an effective approach for patients who have difficulty with motor representation [9]. AOT is a new approach in stroke rehabilitation; therefore, only a few studies have targeted enhancement of UE motor recovery and investigated the effects of AOT in patients with stroke [81011121314]. Based on these studies, AOT has been shown to be a beneficial and effective approach to improve patient motor function. However, the heterogeneity of study designs and small sample sizes of the studies lead to no clear conclusions about the efficacy of AOT in stroke rehabilitation.

MT has emerged as another novel stroke-rehabilitation approach during the last decade [151617]. In this treatment, participants are instructed to move their arms and watch the action reflection of the non-affected arm in the mirror, as if it were the affected one. The process creates the visual illusion of the non-affected arm as the affected arm is normally moving. MT focuses on visual and proprioceptive feedback of the non-affected limb, which may provide substitute inputs for absent or reduced proprioceptive feedback from the affected side of the body [18]. A growing amount of academic literature has demonstrated that patients with stroke gain improvements in motor and daily function, movement control strategies, and activities of daily living [1617] after treatment with MT, which supports its use in stroke rehabilitation. In short, MT is potentially a simpler, less expensive, and effective stroke-rehabilitation approach for practical implementation in clinical settings.

Action observation is based on activities of the MNS and mainly involves brain areas of the inferior parietal lobe, inferior frontal gyrus, and ventral premotor cortex [19]. Mirror neurons discharge both during the execution of motor acts or goal-directed actions and during the observation of other people performing the same or similar actions [20]. Experimental studies in healthy adults have demonstrated that the MNS was activated during both the observation and execution of movements, which helped to form new motor patterns during action observation [212223]. In addition, although positive effects of MT have been demonstrated in patients with stroke [24], there is no consensus about the underlying neural mechanisms of MT. Three hypotheses have been recently proposed to explain the beneficial effects of MT on motor recovery [7]. Accordingly, MT may affect perceptual motor processes via three functional neural networks: (1) activation of brain regions associated with MNS [2526], (2) recruitment of ipsilateral motor pathways [27], and (3) substitution of abnormal proprioception from the affected limb with feedback from the non-affected limb [1518]. Few AOT and MT neurophysiological or imaging studies have been conducted in patients with stroke. No studies have directly compared and unraveled the similarities or differences in neural plastic changes between AOT and MT in these patients. It is crucial to compare neuroplasticity mechanisms between these intervention regimens to optimize rehabilitative outcomes.

Objectives

The main purposes of this clinical trial are to (1) compare the immediate and retention treatment effects of AOT and MT on different outcomes with those of a dose-matched control group and (2) explore and compare the neural mechanisms and changes in cortical neural activity associated with the effects of AOT and MT in stroke patients, using magnetoencephalography (MEG).[…]

Continue —> Effects of action observation therapy and mirror therapy after stroke on rehabilitation outcomes and neural mechanisms by MEG: study protocol for a randomized controlled trial | Trials | Full Text

Fig. 2 Action observation therapy. a Observation of task. b Execution of task

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[THESIS] IMAGERY, MIRROR BOX THERAPY AND ACTION OBSERVATION IN STROKE – Full Text PDF

Abstract

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

Abstract

[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

Abstract

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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