Even with limited help stroke survivors would gladly do the work. NOW WHERE ARE THE VIDEOS WE CAN WATCH?
Action observation for arm rehabilitation after stroke
Review question
We sought to compare the effects of action observation on arm
and hand function after stroke with an alternative intervention or no
intervention. In addition, we observed the effects of this therapy on
upper extremity performance, everyday activities, quality of life, and
activation of brain areas.
Background
Individuals who survive a stroke often have difficulty moving
their arms, which can lead to problems with everyday activities and
reduced participation in daily situations. Action observation is a
physical rehabilitation approach proposed for arm rehabilitation, in
which the person with stroke observes a healthy individual performing a
task, either on video or in person, followed or not by execution of the
same task. This safe technique can be performed without expensive and
complicated equipment and requires minimal therapist supervision. Trials
show that action observation activates brain areas similar to those
activated when performing the same action, and may favor movement
recovery after stroke.
Trial characteristics
We identified 16 trials involving 574 individuals after stroke.
Most used video sequences and action observation followed by some form
of motor practice, using a range of activities, with task complexity
increased over the course of training or when it was easy for the
participant to carry out. The evidence is current to May 2021.
Key results
Trials tested whether the use of action observation compared
with an alternative intervention or no intervention resulted in
participants' improved ability to use their arms and hands, and found
that action observation might have a small effect on arm function (11
trials) and a large effect on hand function (five trials). There is no
evidence of benefit or detriment from this therapy on everyday
activities and quality of life of stroke patients. It was not possible
to evaluate the results of upper extremity performance and activation of
brain areas.
Certainty of the evidence
The certainty of the evidence was low for arm function and hand
function, and very low for everyday activities and quality of life.(But better than the nothing we are getting today)
Participants could engage in this therapy safely, since adverse events
were not significant in scale or magnitude. The certainty of the
evidence for each outcome was limited due to the small number of study
participants, low study quality, and poor reporting of study details.
The effects of AO are small for arm function compared to any control group; for hand function the effects are large, but not clinically significant. For both, the certainty of evidence is low. There is no evidence of benefit or detriment from AO on ADL and quality of life of people with stroke; however, the certainty of evidence is very low. As such, our confidence in the effect estimate is limited because it will likely change with future research.
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