Does Action Observation Training With Immediate Physical Practice Improve Hemiparetic Upper-Limb Function in Chronic Stroke?

BACKGROUND The mirror neuron network provides a neural mechanism to prime the motor system through action observation in stroke survivors. OBJECTIVE To examine whether action observation training with immediate physical practice improves upper-limb function in chronic stroke. METHODS In a within-subject design, 14 chronic stroke survivors were assessed at baseline, then participated in 2 weeks of relaxation-sham plus physical practice (control) and reassessed. Thereafter, they participated in 2 weeks of action observation training coupled with immediate physical practice (intervention), followed by a final assessment. Duration of each action observation video sequence (priming exposure) was 30 s followed immediately by practice of the observed motor skill. RESULTS There were significant improvements in control and intervention phases on primary outcome measures--Upper Extremity Fugl-Meyer Motor Assessment (FMA) and Functional Test of the Hemiparetic Upper Extremity (FTHUE)--as well as secondary outcome measures of self-perceptions of arm use. Gains in the primary outcomes were greater during the intervention phase (action observation + physical practice; FMA, 10.64; FTHUE level, 0.79, and tasks, 1.57) than during the control phase (relaxation-sham plus physical practice; FMA, 6.64; FTHUE level, 0.43, and tasks, 1.00). Interviews with participants highlighted the added value of watching an actor perform the movement before physically attempting to perform the action. CONCLUSIONS This study provides preliminary evidence of the additive value of action observation plus physical practice over relaxation-sham plus physical practice. There appears to be capacity for further recovery of upper-limb function in chronic stroke that persists at least in the short term.