The Use of Action Observation and Imitation in the Treatment of Upper Limb Paresis Early After Stroke

Background: Evidence suggests that repetitive functional training might improve upper limb (UL) recovery following a stroke however, individuals with more severe paresis often find participating in such training difficult. There is therefore a need for new therapies that can “prime” the central nervous system for movement before commencing repetitive training. Primary Aim: To ascertain if a new therapy called “Observation with intent To Imitate” (OTI)+Motor Practice (MP) sufficiently enhanced UL recovery in individuals with moderate/severe paresis early after stroke to justify proceeding to subsequent dose finding (phase I) and efficacy (phase II) trials. Methods: Seventeen individuals with moderate/severe UL limb paresis 3 to 31 days following ischaemic/haemorrhagic stroke were recruited. Those who were able to imitate an action were randomly assigned to receive either OTI+MP in addition to conventional physical therapy (CPT) or CPT alone. Those appointed to the OTI+MP group received up to an hour of OTI+MP once a day, for 15 consecutive working days. The outcome measures used were the Motricity Index (MI) to ascertain the ability to voluntarily contract paretic muscle (strength), the Action Research Arm Test (ARAT) to assess function and adverse event monitoring. Results: Both groups significantly improved in UL strength and function but the addition of OTI+MP did not result in better outcomes than CPT alone (P=0.425, MI), (P=0.520, ARAT). No adverse events were recorded. Conclusion: The addition of OTI+MP to CPT did not significantly improve UL strength and function compared to CPT alone. There were however, more clinically important changes with a general trend to greater improvement witnessed within the OTI+MP group, indicating that some individuals may have benefited from the additional therapy. More studies are required to establish which stroke survivors are most likely to benefit from OTI+MP early after stroke before progressing to dose finding and efficacy trials