Deans' stroke musings: Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, July 24, 2025

Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis

Since you didn't create ANY PROTOCOLS ON THIS YOU MISERABLY FAILED AT YOUR ONLY JOB!

Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis

Dan Lin1*, Daniel Lloyd Eaves2, John Derek Franklin1, Jonathan Richard Robinson1, Jack Aaron Binks3 and Jonathan Reyes Emerson4

1School of Health and Life Sciences, Teesside University, Middlesbrough, United Kingdom

2Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom

3Population Health Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom

4Kleijnen Systematic Reviews (KSR) Ltd, York, United Kingdom

Edited by

Noman Naseer, Air University, Pakistan

Reviewed by

Floriana Pichiorri, Santa Lucia Foundation (IRCCS), Italy

Takao Kaneko, Yamagata Prefectural Central Hospital, Japan

*Correspondence

Dan Lin, d.lin@tees.ac.uk; danlin333777@gmail.com

Received 27 January 2025

Accepted 30 June 2025

Published 23 July 2025

Citation

Lin D, Eaves DL, Franklin JD, Robinson JR, Binks JA and Emerson JR (2025) Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis. Front. Neurol. 16:1567421. doi: 10.3389/fneur.2025.1567421

Introduction: Optimal upper limb recovery requires high-dose physiotherapy; however, this essential component of rehabilitation is under-delivered. Mental practice represents an accessible and cost-effective adjunct to conventional therapy. We therefore evaluated the efficacy of an enhanced mental practice treatment (combined action observation and motor imagery, AO + MI) for promoting upper limb recovery post stroke.

Methods: Searching 10 databases, we identified 18 eligible studies (N = 336), comprising nine randomized controlled trials (RCTs) and nine non-randomized controlled trials (non-RCTs). RCTs were meta-analyzed using upper limb function outcomes (Fugl-Meyer Assessment for upper extremity, FMA-UE; Action Research Arm Test, ARAT). Non-RCTs (not eligible for meta-analysis) were narratively synthesized using upper limb and neuroimaging outcomes.

Results: Seven RCTs reported FMA-UE scores (n = 189), where the standardized mean difference (SMD) for AO + MI treatments was moderate (SMD = 0.58, 95%CI: 0.13–1.04, p = 0.02). Two additional RCTs reported ARAT scores. Meta-analyzing the combined FMA-UE and ARAT scores (n = 239) revealed SMD = 0.70 (95%CI: 0.32–1.09, p = 0.003). No significant correlations existed between the pooled effect size and several moderators (age, time since stroke, intervention duration, control condition, outcome measure and AO + MI arrangement), indicating consistent AO + MI practice effects. Overall, AO + MI significantly improved upper limb function across all nine RCTs, and all nine narratively synthesized studies, including neuroimaging outcomes. Limitations included inconsistent terminology, intervention design, clarity of reporting, and modality.

Discussion: AO + MI practice can promote upper limb recovery following stroke. AO + MI can therefore be used as a bridge between AO therapy (requiring little effort in early recovery), and the more cognitively demanding MI. Researchers must adopt standardized reporting(WRONG, What's needed are rehab protocols, And you don't know that? WHAT FUCKING STUPIDITY!) protocols to further establish AO + MI practice efficacy.(Yeah, that's called A REHAB PROTOCOL!)

Systematic review registration: The review was registered with PROSPERO under the registration number CRD42023418370. The registration is publicly accessible at the following URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023418370.

Keywords

combined action observation and motor imagery; mental practice; stroke survivors; stroke rehabilitation; upper limb recovery; mirror neurons; imitation learning; neuroplasticity