Effectiveness of action observation therapy based on virtual reality technology in the motor rehabilitation of paretic stroke patients: a randomized clinical trial

Abstract

Background The rehabilitation of paretic stroke patients uses a wide range of intervention programs to improve the function of impaired upper limb. A new rehabilitative approach, called action observation therapy (AOT) is based on the discovery of mirror neurons and has been used to improve the motor functions of adult stroke patients and children with cerebral palsy. Recently, virtual reality (VR) has provided the potential to increase the frequency and effectiveness of rehabilitation treatment by offering challenging and motivating tasks. Methods The purpose of the present project is to design a randomized controlled six-month follow-up trial (RCT) to evaluate whether action observation (AO) added to standard VR (AO + VR) is effective in improving upper limb function in patients with stroke, compared with a control treatment consisting of observation of naturalistic scenes (CO) without any action content, followed by VR training (CO + VR). Discussion AO + VR treatment may provide an addition to the rehabilitative interventions currently available for recovery after stroke and could be utilized within standard sensorimotor training or in individualized tele-rehabilitation. Trial registration The trial has been prospectively registered on ClinicalTrials.gov. NCT05163210. 17 December 2021.

Early sleep after action observation and motor imagery training boosts improvements in manual dexterity

“…This reactivation process is documented by specific EEG markers (e.g., sleep spindles) and involves the cortico-striato-cerebellar network, where the degree of reactivation seems to be related to ameliorations in terms of motor performance 23 . Previous studies demonstrated benefits induced by AO/AO + MI in terms of manual dexterity 13,15,27,28 . However, the timing of AO + MI-training administration proposed in the current study seems to further enhance the training effects, leading us to account larger manual dexterity improvements experienced by AOMI-sleep group to a motor learning consolidation process induced by early sleep 18,19 .…”

Mirror neurons 30 years later: implications and applications

“…simply observed with no prior request to imitate the observed gesture, suggesting that observational learning techniques may boost plastic changes [93]. From a technological point of view, leveraging virtual reality can make it possible to personalize the best stimuli for promoting the desired plastic changes following the intervention, and is suitable for use even in telerehabilitation protocols [94]. Although still limited in this respect, the existing literature has shown that another potentially relevant approach consists in the use of stimuli for AOT protocols that depict actions performed by models with levels of motor skill comparable to those of the observer [95].…”

Overcoming a Knowledge Gap of Healthcare Professionals: The Influence of Previous Experience on the (Non-)Adoption of VR in Medical Rehabilitation (Preprint)

“…VRbased medical rehabilitation offers real-time performance feedback, allowing post-session performance analysis [14]. Moreover, greater autonomy is seen as an added value of the technology, as it allows patients to perform exercises without close supervision by a therapist, reducing HC professionals' guidance [15].…”