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

Abstract

BackgroundLoss 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/designAn 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.DiscussionThis 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.Trial registrationClinicalTrials.gov, ID: NCT02871700. Registered on 1 August 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2205-z) contains supplementary material, which is available to authorized users.

The Activation of the Mirror Neuron System during Action Observation and Action Execution with Mirror Visual Feedback in Stroke: A Systematic Review

“…Therefore, these two modalities can be viewed as optional motor priming tools for stroke rehabilitation. However, there is still a lack of studies directly comparing the clinical improvements and the pattern of neuroplasticity induced by MVF and AO [ 69 ] and whether or not the activation pattern is congruent with the clinical improvements in patients with stroke.…”

Treatment Effects of Upper Limb Action Observation Therapy and Mirror Therapy on Rehabilitation Outcomes after Subacute Stroke: A Pilot Study

“…This was a three-arm, single-blind, randomized controlled trial. We followed the methods of Shih et al which is Methods/design of this trial [31]. However, given the limited funding and study resources, we only applied and analysed some secondary outcomes of the published study protocol [31] in this pilot study.…”

“…We followed the methods of Shih et al which is Methods/design of this trial [31]. However, given the limited funding and study resources, we only applied and analysed some secondary outcomes of the published study protocol [31] in this pilot study. Each participant received intervention for 15 training sessions (60 minutes/day, 5 days/week for 3 weeks).…”

Mirror neurons and their relationship with neurodegenerative disorders

“…Several works found that action observation training (AOT), which includes observation and execution of an action (Ertelt & Binkofski, ) and is evidently based on the stimulation of the MN system (Shih et al, ), has a positive effect on PD rehabilitation. During a typical rehabilitation session, patients must observe a specific daily action presented through a video clip on the computer screen and then perform what they have observed.…”