The Effect of Action Observation Therapy Including Unimanual and Bimanual Activities in Chronic Stroke

Condition(s) studied

Investigational drug(s) / intervention(s)

Action Observation Therapy(unimanuel activities): Participants will receive 30 minutes of unimanual-only activities in each session AOT (at home via telerahabilitation) in addition to 45 minutes of conventional physiotherapy (stretching, strengthening, core mobility, balance, electrotherapy, and endurance exercises in the clinic). They will receive 3 sessions per week for 5 weeks.

Action Observation Therapy(bimanuel activities): Participants will receive 30 minutes of bimanual-only activities in each session AOT(at home via telerahabilitation) in addition to 45 minutes of conventional physiotherapy (stretching, strengthening, core mobility, balance, electrotherapy, and endurance exercises in the clinic). They will receive 3 sessions per week for 5 weeks.

conventional physiotherapy: Participants will receive 45 minutes of conventional physiotherapy (stretching, strengthening, core mobility, balance, electrotherapy, and endurance exercises in the clinic). They will receive 3 sessions per week for 5 weeks.

Study summary

Functional impairments in the upper extremities following a stroke significantly restrict individuals' activities of daily living and overall quality of life; in this context, Action Observation Training (AOT) has emerged in recent years as an effective rehabilitation method that promotes motor learning processes and cortical activity by activating the mirror neuron system. Although the literature acknowledges the positive effects on neural mechanisms of both unimanuel approaches, which focus on the paretic hand alone, and bimanual approaches, which involve the simultaneous use of both hands, there remains a gap regarding which method yields superior outcomes. This study aims to compare the effectiveness of AOT interventions consisting of exclusively unimanual versus exclusively bimanual activities on upper extremity functions, activities of daily living, and quality of life in chronic stroke patients, while investigating the potential differences between the outcomes of these two distinct approaches.

Eligibility

Primary outcome measure(s)

• Spasticity — Baseline
  Spasticity will assessed using the Modified Ashworth Scale. As the score increases, spasticity increases. The minimum score for this scale is 1 and the maximum score is 5.
• Stage of hemiplegia — Baseline
  "Brunnstrom Hemiplegia Recovery Staging" will be used to determine the hemiplegic stage of the patients. This scale is scored between 1 and 6. As the score increases, the patient improves.
• Dominant side — Baseline
  The Edinburgh Hand Preference Test will be used to determine which hand the patient uses more in daily life (Score range: -100 to +100; high positive scores indicate right-handedness, high negative scores indicate left-handedness).
• Cognitif Function — Baseline
  Mini Mental Test will be used to evaluate cognitive functions. In the evaluation, 24-30 points indicate that cognitive functions are normal, 18-23 points indicate mild cognitive impairment, and 17 points and below indicate that cognitive status is severely affected.
• Neglect — Baseline
  The Catherine Bergego Scale will be used to assess the impact of unilateral neglect after stroke on activities of daily living. 1-10 indicates mild neglect, 11-20 indicates moderate neglect, and 21-30 indicates severe neglect.
• Motor function — Baseline, five week later (after intervention)
  The "Fugl-Meyer Upper Extremity Motor Assessment Scale" will be used to evaluate upper extremity motor functions. This scale ranges from 0 to 66 points. As the score increases, motor function improves.
• Upper extremity function — Baseline, five week later (after intervention)
  Evaluation of upper extremity functions (hand-arm) and motor speed will be done with the "Nine-Hole Peg Test".It is a widely used test in clinical practice that evaluates upper extremity function (hand and arm) and motor performance. The test consists of 9 wooden sticks with a diameter of 9 millimeters (mm) and a standard wooden block with 9 holes with a diameter of 10 mm. The patient inserts the nine sticks one by one into the nine holes as quickly as possible and then removes them one by one in the same manner. The timer is started when the first stick is inserted and stopped when the last stick is removed and released from the hand. The time elapsed for the patient to insert and remove the sticks is recorded.
• Functional Independence — Baseline, five week later (after intervention)
  Evaluation of upper extremity functions will be done with the "The Functional Independence Scale (FIS)". Function decreases as the time spent on the test increases. It is used to assess the change and development in ADL (Applications for Daily Living) depending on the degree of disability experienced by individuals and rehabilitation programs. Consisting of a total of 18 items, the FIS is divided into two main subcategories: motor domain (FIS-motor; 13 items) and cognitive domain (FIS-cognitive; 5 items). All activities are rated on a 7-point scale ranging from 1 (requires full assistance during activities) to 7 (performs the activity completely independently). The total FIS score ranges from 18 to 126 points. A decrease in the score indicates an increase in the individual's dependence during ADL.
• Life Quality — Baseline, five week later (after intervention)
  The Stroke Specific Quality of Life Scale will be used to assess the quality of life of individuals with stroke. The higher the total score, the better the quality of life of the individual with stroke. This scale is scored between 49-245.As the score increases, the quality of life increases.

Trial sites (1)

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