Efficacy of Action Observation Therapy and Mirror Therapy on Upper Limb Spasticity, Motor Performance and Functional Activities in Patients with Chronic Stroke: A Randomized Controlled Trial

Stroke, as defined by the World Health Organization, is the rapid development of clinical signs of focal or global disturbance of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin [1]. Risk factors associated with stroke are classified as non-modifiable (age, gender, race, and genetics) or modifiable (hypertension, smoking, alcohol use, physical inactivity, diabetes, and atrial fibrillation) [2-4]. In India, stroke is a leading cause of death and disability, with an estimated annual cumulative incidence of 105–152 per 100,000 persons and a crude prevalence ranging from 44 to 559 per 100,000. Among survivors, 15-30% become severely handicapped, and 40% experience persistent functional deficits, impacting functional independence [5].

Post-stroke impairments are multifaceted, encompassing sensory

1. WHO. Stroke definition. World Health Organization; 1970. [Google Scholar] [Crossref]

2. Warlow C, Sudlow C, Dennis M, et al. Stroke. Lancet. 2003;362(9391):1211-24. [Google Scholar] [Crossref]

3. Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet. 2008;371(9624):1612-23. [Google Scholar] [Crossref]

4. O'Donnell MJ, Xavier D, Liu L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study). Lancet. 2010;376(9735):112-23. [Google Scholar] [Crossref]

5. Pandian JD, Sudhan P. Stroke epidemiology and stroke care in India. Neurology India. 2013;61(3):223-6. [Google Scholar] [Crossref]

6. Lawrence ES, Coshall C, Dundas R, et al. Estimates of the prevalence of acute stroke impairments and disability in a multiethnic population. Stroke. 2001;32(6):1279-84. [Google Scholar] [Crossref]

7. Sommerfeld DK, Eek EU, Svensson AK, et al. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke. 2004;35(1):134-9. [Google Scholar] [Crossref]

8. Parker VM, Wade DT, Langton Hewer R. Loss of arm function after stroke: measurement, frequency, and recovery. Int Rehabil Med. 1986;8(2):69-73. [Google Scholar] [Crossref]

9. Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Biol Sci. 1996;263(1369):377-86. [Google Scholar] [Crossref]

10. Altschuler EL, Wisdom SB, Stone L, et al. Rehabilitation of hemiparesis after stroke with a mirror. Lancet. 1999;353(9169):2035-6. [Google Scholar] [Crossref]

11. Deconinck FJ, Smorenburg AR, Benham A, et al. Reflections on mirror therapy: a systematic review of the effect of mirror visual feedback on the brain. Neurorehabil Neural Repair. 2015;29(4):349-61. [Google Scholar] [Crossref]

12. Rizzolatti G, Craighero L. The mirror-neuron system. Annu Rev Neurosci. 2004;27:169-92. [Google Scholar] [Crossref]

13. Ertelt D, Small S, Solodkin A, et al. Action observation has a positive impact on rehabilitation of motor deficits after stroke. Neuroimage. 2007;36(Suppl 2):T164-73. [Google Scholar] [Crossref]

14. Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67(2):206-7. [Google Scholar] [Crossref]

15. Fugl-Meyer AR, Jääskö L, Leyman I, et al. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13-31. [Google Scholar] [Crossref]

16. Barreca S, Gowland CK, Stratford P, et al. Development of the Chedoke Arm and Hand Activity Inventory: a measure of "activity" for the hemiplegic arm. Can J Occup Ther. 2004;71(2):101-12. [Google Scholar] [Crossref]

17. Hsieh YW, Chang KC, Hung JW, et al. Effects of action observation therapy and mirror therapy after stroke: a randomized controlled trial. Clin Rehabil. 2018;32(6):757-767. [Google Scholar] [Crossref]

18. Buccino, G., Action observation treatment: a novel tool in neurorehabilitation. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 2014. 369(1644): p. 20130185-20130185. [Google Scholar] [Crossref]

19. Deakin, A., H. Hill, and V.M. Pomeroy, Rough Guide to the Fugl-Meyer Assessment: Upper limb section. Physiotherapy, 2003. 89(12): p. 751-763. [Google Scholar] [Crossref]

20. Barreca, S.R., et al., Test-retest reliability, validity, and sensitivity of the Chedoke arm and hand activity inventory: a new measure of upper-limb function for survivors of stroke. Arch Phys Med Rehabil, 2005. 86(8): p. 1616-22. [Google Scholar] [Crossref]

21. Sekhar, D.P.K.C., Efficacy of isokinetic strength training and balance exercises on lower limb muscles in subjects with stroke. International journal of physiotherapy and research, 2003. 2: p. 25-29. [Google Scholar] [Crossref]

22. Venkatanaga Prahalada, K., M. Ramadevi, and M. Ammar Mohammed Ali, EFFECTIVENESS OF MIRROR THERAPY ON HANDFUNCTIONS IN SUBACUTE STROKE PATIENTS. International Journal of Physiotherapy, 2015. 2(4). [Google Scholar] [Crossref]

23. Hsieh, Y.-W., et al., Treatment Effects of Upper Limb Action Observation Therapy and Mirror Therapy on Rehabilitation Outcomes after Subacute Stroke: A Pilot Study. Behavioural Neurology, 2020. 2020: p. 6250524. [Google Scholar] [Crossref]

24. Kim, C.-H. and D.-H. Bang, Action observation training enhances upper extremity function in subacute stroke survivor with moderate impairment: a double-blind, 63 randomized controlled pilot trial. Korean Society of Physical Medicine, 2016. 11(1): p.133-140. [Google Scholar] [Crossref]

25. Zhu, M.-H., et al., Effect of action observation therapy on daily activities and motor recovery in stroke patients. International Journal of Nursing Sciences, 2015. 2(3): p. 279-282. [Google Scholar] [Crossref]

26. Mancuso, M., et al., Action Observation Therapy for Upper Limb Recovery in Patients with Stroke: A Randomized Controlled Pilot Study. 2021. 11(3). [Google Scholar] [Crossref]

27. Philip, K., et al., EFFECT OF ACTION OBSERVATION THERAPY ON RECOVERY IN UPPER EXTREMITY POST STROKE PATIENTS. INTERNATIONAL JOURNAL OF PHARMACEUTICAL SCIENCE AND HEALTH CARE, 2018. 4. [Google Scholar] [Crossref]

28. Melo, L.P.d., et al., Investigation of the effects of mirror therapy on the spasticity, motor function and functionality of impaired upper limbs in chronic stroke patients. International Journal of Therapy and Rehabilitation, 2019. 26(7): p. 1-9. [Google Scholar] [Crossref]

29. Roshini, R., et al., EFFECT OF MIRROR THERAPY ON HEMIPARETIC UPPER EXTREMITY IN SUBACUTE STROKE PATIENTS. International Journal of Physiotherapy, 2015. 2(6). [Google Scholar] [Crossref]

30. Michielsen, M.E., et al., Motor recovery and cortical reorganization after mirror therapy in chronic stroke patients: a phase II randomized controlled trial. Neurorehabil Neural Repair, 2011. 25(3): p. 223-33. [Google Scholar] [Crossref]

31. Ambron, E., White, N. C., Faseyitan, O., Kessler, S. K., Medina, J., & Coslett, H. B. (2018). Magnifying the View of the Hand Changes Its Cortical Representation. A Transcranial Magnetic Stimulation Study. Journal of Cognitive Neuroscience, *30*(8), 1098–1107 [Google Scholar] [Crossref]

• The Impact of Ownership Structure on Dividend Payout Policy of Listed Plantation Companies in Sri Lanka
• Urban Sustainability in North-East India: A Study through the lens of NER-SDG index
• Performance Assessment of Predictive Forecasting Techniques for Enhancing Hospital Supply Chain Efficiency in Healthcare Logistics
• The Fractured Self in Julian Barnes' Postmodern Fiction: Identity Crisis and Deflation in Metroland and the Sense of an Ending
• Impact of Flood on the Employment, Labour Productivity and Migration of Agricultural Labour in North Bihar