Comparative Efficacy Study of Action Observation Therapy and Mirror Therapy after Stroke: Rehabilitation Outcomes and Neural Mechanisms by Meg

Stroke is the leading cause of long-term adult disability with increasing prevalence worldwide. Loss of upper-extremity (UE) motor function is one of the most debilitating deficits following stroke. More than two-thirds of patients with stroke experience different degrees of UE motor deficits and subsequently impact on their daily life. To develop novel and effective interventions to promote nervous system recovery and to optimize treatment outcomes is one major priority in stroke rehabilitation. However, despite recent advances in stroke rehabilitation research, translation of knowledge and advancement from basic neurosciences and mechanisms to produce new treatment opinions for patients is still a challenge. Over the last few years, action observation therapy (AOT) and mirror therapy (MT) have gained great attention in stroke rehabilitation. These two current promising rehabilitation approaches have been developed based on neuroscience and neurophysiology. AOT and MT aim to enhance motor learning and promote neural reorganization of patients through different afferent inputs and patterns of visual feedback. In AOT, patients are asked to observe the actions performed by another person and to execute the same actions, whereas MT emphasizes to observe the mirror reflection of non-affected UE movement as if it were the affected one. Both approaches involve different patterns of motor observation, imitation, and execution but share some similar neural bases of mirror neuron system. Despite recent reports of the 2 approaches, very limited studies have investigated the changes in brain activity after AOT or MT in patients with stroke. Further research on examining treatment outcomes of AOT and MT is also warranted since no conclusive results have been drawn at this stage. We propose a 3-year comparative, randomized controlled trial study to (1) investigate the treatment efficacy of AOT, MT versus a control intervention on motor and functional outcomes of patients with stroke, (2) compare the mechanisms and changes in cortical neural activity after AOT, MT, and control intervention by using magnetoencephalography (MEG), (3) determine the correlations between neural activation changes and clinical outcomes after treatments, and (4) identify who are the potential good responders to AOT and MT. An estimated total of 90 patients with subacute stroke will be recruited in this study. All participants will be randomly assigned to receive AOT, MT, or control intervention for 3 weeks (a total of 15 sessions). Outcome measures will be conducted at baseline, immediately after treatment, and at 3 months follow-up. For the MEG study, we anticipate to enroll 12 to 15 patients in each group to complete neuroimaging evaluation because of the specific eligibility criteria and high costs of MEG. The participants can still receive clinical evaluation and therapy even if they are not included in the MEG study. This proposed study will provide scientific evidence of treatment efficacy on motor, functional outcomes, and neural mechanisms after AOT and MT in patients with subacute stroke. The overall results will contribute to the development of best practice in stroke rehabilitation, further advance in translational neurorehabilitation, and benefit patients with stroke.

Project ID:PC10507-0261
External Project ID:MOST105-2314-B182-018