You didn't write protocols on this; so, you completely fucking failed at your task!
Harnessing Mirror Neurons: Improving Balance and Quality of Life After a Stroke
DOI: 10.7759/cureus.81290
Cite this article as: Sharma P, Ali Z, George S S (March 27, 2025) Harnessing Mirror Neurons: Improving Balance and Quality of Life After a Stroke. Cureus 17(3): e81290. doi:10.7759/cureus.81290
Abstract
Background:
Action observation engages brain motor networks, and action imitation helps neurological and musculoskeletal problem patients improve motor learning and functional recovery. In this study, we focused on identifying the impact of action observation training (AOT) on balance and quality of life (QOL) in hemiparetic stroke patients.
Method:
A quasi-experimental study in Bengaluru (from December 2021 to July 2022) involved 60 hemiparetic patients randomly divided into two groups. Group A received 30 minutes of AOT alongside standard physiotherapy, while Group B received conventional therapy. Sessions focused on balance exercises, and outcomes were assessed using the Berg Balance Scale (BBS) and the Stroke-Specific Quality of Life (ss-QOL) scale. Statistical analyses, including paired and independent t-tests, highlighted significant differences, ensuring methodological rigor and ethical compliance.
Results: The findings show a significant difference in the pretest BBS scores between the experimental and control groups (p = 0.010), with the experimental group having a lower baseline. However, there was no significant difference in posttest BBS scores (p = 0.431). Both groups showed significant improvements in their BBS and ss-QOL scores (p < 0.05). The experimental group showed a larger improvement in BBS (p = 0.001), while ss-QOL improvements were not statistically significant (p = 0.732).
Conclusion:
The study concluded that the experimental and control groups demonstrated significant improvements in balance and QOL after the intervention, with the experimental group showing significantly larger improvements in balance, compared to control group.
Introduction
Stroke is the major cause of adult disability and also a predominant reason for mortality and morbidity in developed countries and is a notable global health problem [1]. It is advancing in low-middle-income countries where the burden is above and beyond that of high-income countries [2]. Per annum, 15 million people suffer from a stroke at a global level. Out of all this, five million die, and another five million continue to live with a remained permanent disability, being a burden on family and community. The remaining five million people from the 15 million who suffer an episode of stroke each year are those who survive but recover to some degree, either fully or with some level of impairment that is not permanent [3]. In India, stroke’s prevalence rate is anticipated to be 84-262 out of 100,000 people in rural areas and 334-424 out of 100,000 people in city locations [4]. Based on the latest population-based studies, the incidence rate has come out to be 119-145 in 100,000 people [4]. This leads to motor impairments and functional disabilities, followed by a stroke [1].
Stroke is defined as "rapidly developed clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than of vascular origin," as stated by the World Health Organization in 1970 [5]. The commonest category of it is ischemic stroke, impacting about 80% of individuals. When the brain is deprived of vital oxygen and nutrients, it leads to impaired blood flow or a clot blockage. Although ischemic stroke is relatively common among all stroke cases, hemorrhagic stroke still contributes significantly to the global burden of disability-adjusted life-years [6,7].
Stroke is the main reason for disability, which compromises ambulation and a person’s ability to execute daily living activities [1]. One of the most common deficits following a stroke is lower limb impairments and postural imbalance, which drastically impact physical ability [8]. The neurological deficit, which is one of the most frequent after stroke, is hemiparesis [9]. Anterior cerebral artery strokes often result in contralateral hemiparesis and sensory loss, with a greater impact on the lower extremity than the upper extremity (UE). Hemiparesis is a leading cause of long-term disability, affecting mobility in 50% of stroke survivors and leaving 26% unable to perform basic daily activities independently. Approximately 80% of stroke patients exhibit some degree of contralateral hemiparesis, significantly affecting their health-related quality of life (HRQOL) and ability to engage in personal and domestic activities of daily living (ADLs). These challenges often lead to declines in mental health, well-being, and overall quality of life (QOL) [10-12].
Within six months after stroke, 73% of patients experience falls due to balance impairments linked to sensory, cognitive, motor, or integrative movement control deficits. Additional complications such as muscle weakness, sensory deficits, cognitive impairments, joint range of motion (ROM) limitations, altered muscle tone, and abnormal postural reactions exacerbate balance issues [13-16].
The Berg Balance Scale (BBS) is widely recognized for assessing balance in acute stroke patients, offering a standardized tool for neurological rehabilitation practitioners.
(I thought the Berg Balance Scale testing that was common, was totally worthless since there never was any specific therapy given to address the failure points I had in that test. There is really no point in measuring something if you have nothing that will improve your ability for the next test.)
For measuring HRQOL, the Stroke-Specific Quality of Life (ss-QOL) scale is validated across diverse stroke populations, making it a valuable measure for this study [17-20].
Rehabilitation strategies aim to improve motor relearning through neuroplasticity-focused approaches, such as constraint-induced movement therapy, robot-assisted therapy, and virtual reality-based rehabilitation [21-23]. These techniques work intensively to retrain motor functions in the affected hemispheres. However, overcoming the "learned nonuse" phenomenon and enhancing ipsilateral motor cortex function remain essential for severe hemiparesis cases [24-26].
Functional improvement, including balance, posture symmetry, and weight-shifting abilities, is critical for enabling stroke patients to perform ADLs effectively and enhance social participation [27-30]. Innovative therapies like action observation training (AOT) leverage the mirror neuron system (MNS) to activate motor-related cortical regions through goal-directed activity observation followed by replication [31-35]. This activation facilitates the strengthening of intact cortical networks and the repair of damaged ones, preventing cortical deterioration in immobile patients.
Our study hypothesizes that AOT may provide superior outcomes in enhancing balance and QOL for hemiparetic stroke patients, emphasizing the potential of action observation followed by execution over passive observation [36-39].
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