Action observation for arm rehabilitation after stroke

 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

uthors: 

Borges LRDM, Fernandes ABGS, Oliveira dos Passos J, Rego IAnanda Oliveira, Campos TF

Primary Review Group: 

Stroke Group

See the full Review on

the Cochrane Library

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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.

Authors' conclusions: 

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.