Date Presented 03/27/20
With 65% of survivors left with hemiparesis affecting activities of daily living (ADL) performance at six months poststroke, as motor control recovery plateaus at five weeks post stroke, there is a need to identify effective interventions that can begin immediately. This review asked: What is the effectiveness of action observation intervention, as compared to usual rehabilitation therapy, no treatment, or sham treatment for improving upper extremity function or ADL function in stroke survivors with motor impairment?
Primary Author and Speaker: Carly Goldberg
Additional Authors and Speakers: Dawn Nilsen
PURPOSE: Stroke affects 795,000 Americans each year, and eight out of ten of those who survive are left with residual hemiparesis that impacts ADL performance. Approximately 65% of stroke survivors still cannot use their affected hand within functional activities six months post-stroke. Recent reports have shown that motor control recovery plateaus at approximately 5 weeks post-stroke. Therefore, there is a need to identify effective interventions which can begin immediately following a stroke. Action observation intervention (AOI) involves a patient observing another person performing a functional task prior to practicing that same task immediately thereafter. The mirror neuron system allows for brain activation of the same neural structures involved in actual execution of a task in the absence of actual movement through the observation of others performing everyday actions. Thus, AOI may be an effective adjunct to standard OT after stroke. This review aimed to answer the question: What is the effectiveness of action observation intervention, as compared to usual rehabilitation therapy, no treatment, or sham treatment for improving upper extremity function and/or ADL function in stroke survivors with motor impairment?
DESIGN: Systematic Review
METHODS: Search terms were generated and 11 databases were searched through, October 2018. Two reviewers independently screened titles, abstracts, and full texts. Eligibility criteria: RCT; participants aged 18 or older with a diagnosis of stroke and some resultant hemiparesis; any variation of an intervention of “action observation”; outcome measures assessing upper extremity function and/or participation in activities of daily living. Data was collected using a form adapted from the Cochrane Collaboration. General information, study characteristics, characteristics of participants, intervention groups, outcome measures, and adverse events were extracted for all included studies. Data was then organized related to the primary (changes in UE function) and secondary (changes in ADL function) outcome measures, and the number of studies reporting statistically significant findings were counted. Risk of bias was assessed for each study using the Cochrane Risk of Bias tool.
RESULTS: Of the initial 983 references identified, 16 studies were included. In the 16 studies, there were a total of 616 participants. Of those, 327 were male, 236 female, and 53 were not reported. Mean age ranged from 48.65-77.2 years across groups, and mean time post stroke ranged from 17.8-1472.9 days. In total, 334 of the 616 participants received the intervention as compared to 282 participants receiving the control intervention. In regards to the method of delivery, 14 of the studies used video, one study used live demonstration, and one study was unclear. Ten of the 16 studies showed statistically significant findings across all measures used, in favor of the experimental group, and 4 additional studies showed statistically significant findings in favor of the experimental group at least one of their included outcome measures. Of the 10 studies reporting on UE function, 9 of those studies demonstrated significant findings on at least one measure for improved upper extremity function. Of the 11 studies reporting on ADL function, 9 of those studies demonstrated significant findings on at least one measure for improved ADL performance.
CONCLUSION: According to AOTA Guidelines for Systematic Reviews (2017), this review demonstrated strong evidence in support of AOI for increasing upper extremity function and ADL performance.
IMPACT STATEMENT: Clinicians can proceed in using AOI with confidence based on the results of this review. Future research should be done in regards to stage of recovery and intervention parameters.
References
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Buccino G. (2014). Action observation treatment: a novel tool in neurorehabilitation. Philosophical Transactions of the Royal Society B, 369(1644), 20130185. doi: 10.1098/rstb.2013.0185
Cortes, J. C., Goldsmith, J., Harran, M. D., Xu, J., Kim, N., Schambra, H. M., ... & Kitago, T. (2017). A short and distinct time window for recovery of arm motor control early after stroke revealed with a global measure of trajectory kinematics. Neurorehabilitation and neural repair, 31(6), 552-560.
