Action observation combined with virtual reality improves paretic hand function in poststroke adults with hemiplegia
Photo by Beth Macdonald / Unsplash
Key Takeaway
Consider action observation combined with virtual reality for enhancing fine motor function of the paretic hand after stroke.
This randomized controlled trial enrolled poststroke adults with hemiplegia in inpatient rehabilitation centers in Italy. The study sample size was n=48. Participants were randomized to receive either action observation combined with virtual reality or virtual reality alone. The intervention involved observing goal-directed daily actions before replicating them in virtual reality. The comparator involved viewing nature scenes before performing the same virtual reality tasks without action observation. Follow-up evaluations occurred at baseline, postintervention, and at 6-month follow-up.
The primary outcome measured between-group differences in change in paretic hand scores using the Box and Block Test. The experimental group demonstrated a greater gain in paretic hand function compared to the control group. The effect size was 7.8 blocks at posttreatment and 10.8 blocks at 6-month follow-up. The 95% CI for the effect size was 7.1-7.9 at posttreatment and 10.6-10.9 at 6-month follow-up. Improvements in nonparetic hand function were comparable between groups. Secondary outcome measures including muscle strength, spasticity, global disability, functional independence, and nonparetic hand function showed similar improvements across both groups.
Safety and tolerability data were not reported. No adverse events, serious adverse events, discontinuations, or tolerability issues were documented in the provided data. A significant treatment by age by time-from-stroke interaction was observed for paretic hand dexterity, indicating that treatment effects varied according to these covariates. This interaction suggests that generalizability is limited and that treatment effects depend on specific patient characteristics.
More on Stroke
Exoskeleton-assisted robotic therapy improves upper limb motor scores versus conventional rehabilitation in poststroke inpatients
Robotic Therapy Helps Stroke Patients Regain Arm Function Faster
This multicenter, single-blind randomized controlled trial enrolled 94 inpatients with moderate-to-severe upper limb impairment within three…
A trial of 94 stroke patients found robotic arm therapy led to significantly better motor recovery than standard rehabilitation within five …
Post-hoc ATTEND trial analysis shows stroke severity and caregiver factors predict 6-month outcomes in India.
Stroke recovery in India depends heavily on age and caregiver support
This post-hoc analysis of a multicentre, prospective, randomised, open blinded endpoint trial evaluated 1,250 participants with acute stroke…
A look at 1,250 stroke patients in India shows that older age and certain caregivers predict worse long-term outcomes.
Systematic Review and Meta-Analysis: Non-Invasive Brain Stimulation for Visual Perception After Stroke
New brain stimulation helps stroke patients see better than before
This systematic review and meta-analysis examined non-invasive brain stimulation (NIBS) for visual perception after stroke. Pooled results s…
A new review shows brain stimulation helps stroke patients see better, offering hope for those struggling with vision loss after a stroke.
Meta-analysis shows semi-immersive VR improves hand function in post-stroke patients with over 12 hours of therapy
Virtual Reality Therapy Improves Hand Function After Stroke
This meta-analysis of randomized controlled trials evaluated virtual reality therapy for patients with hemiplegia after stroke. The pooled a…
A meta-analysis of trials shows virtual reality therapy significantly improves hand function in stroke patients, especially with longer trea…
View Original Abstract ↓
BACKGROUND: Action observation treatment and virtual reality are established approaches for upper limb rehabilitation after stroke. This study investigated whether combining action observation with virtual reality improves hand dexterity and upper limb motor recovery compared with virtual reality alone.
METHODS: In this multicenter, assessor-blinded randomized controlled trial conducted in inpatient rehabilitation centers in Italy between January 2022 and September 2024, poststroke adults with hemiplegia (n=48) were assigned to the experimental or to the control group. Both underwent 20 one-hour sessions over 5 weeks. Participants of the experimental group observed goal-directed daily actions before replicating them in virtual reality, whereas participants of the control group viewed nature scenes before performing the same virtual reality tasks without action observation. Motor function was evaluated at baseline, postintervention, and 6-month follow-up using the Box and Block Test, with the primary estimand defined as the between-group difference in change in paretic hand scores. Secondary outcomes included measures of muscle strength, spasticity, global disability, and functional independence.
RESULTS: Both groups showed improvement in Box and Block scores for both hands. However, the experimental group demonstrated a greater gain in paretic hand function, with a between-group difference in change of 7.8 blocks at posttreatment (95% CI, 7.1-7.9) and 10.8 blocks at 6-month follow-up (95% CI, 10.6-10.9). Improvements in the nonparetic hand were comparable between groups. Similar improvements across both groups were observed in secondary outcome measures. A significant treatment×age×time-from-stroke interaction was observed for paretic hand dexterity, indicating that treatment effects varied according to these covariates.
CONCLUSIONS: Action observation combined with virtual reality appears to be more effective than virtual reality alone for promoting upper limb motor recovery after stroke, particularly in enhancing fine motor function of the paretic hand.
REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT05163210.
Intravenous tenecteplase improves functional outcomes but increases hemorrhage risk in non-large vessel occlusion acute ischemic stroke.
Tenecteplase improves stroke recovery but increases bleeding risk in late treatment window
Related in Neurology
Aerobic and strength training reduce fatigue in multiple sclerosis patients
Aerobic or strength training eases MS fatigue, trial finds
This randomized effectiveness trial in 62 persons with multiple sclerosis and fatigue found that 8 weeks of aerobic training, strength train…
A small trial finds that aerobic and strength training each reduce fatigue in MS, with no clear winner among exercise types.
Modified CIMT with trunk restraint improves function in chronic stroke patients
Six weeks of tailored therapy improved function and quality of life for chronic stroke patients.
A single-blinded RCT in 34 chronic stroke patients found that adding patient-tailored modified constraint-induced movement therapy (mCIMT) w…
Thirty-four people with long-term stroke saw better movement and balance after six weeks of a specific therapy mix compared to standard care…
Laughter yoga reduced fatigue in people with multiple sclerosis in a randomized controlled trial
Laughter Yoga Cuts Fatigue And Improves Sleep For Multiple Sclerosis Patients
This randomized controlled trial enrolled 42 people with multiple sclerosis. Participants in the intervention group received 12 sessions of …
People with multiple sclerosis who practiced laughter yoga reported less tiredness and better sleep after just twelve sessions.
Exercise training improves cognition and fatigue in older adults with multiple sclerosis
Exercise boosts brain and cuts fatigue in older adults with MS
This Phase-Ib randomized controlled trial in 51 older adults with multiple sclerosis found that 16 weeks of home-based aerobic and resistanc…
A 16-week home exercise program improved thinking speed, executive function, fatigue, and quality of life in older adults with multiple scle…
From Other Specialties
SBRT plus atezolizumab shows activity in metastatic cervical cancer
Radiation plus immune therapy helps some patients with advanced cervical cancer survive longer
This prospective phase II trial evaluated SBRT followed by atezolizumab in 21 patients with metastatic, recurrent, or persistent cervical ca…
A small trial found that adding immune therapy to radiation helped some patients with advanced cervical cancer keep their disease stable for…
In-person group sessions boost fruit/vegetable intake in Latina breast cancer survivors
In-Person Sessions Boost Fruit and Vegetable Intake in Latina Breast Cancer Survivors
This randomized factorial trial in 167 Latina breast cancer survivors found that in-person group sessions increased daily fruit/vegetable in…
In-person group sessions helped Latina breast cancer survivors eat more fruits and vegetables, while the control group's intake dropped shar…
Capivasertib-paclitaxel fails to improve overall survival in metastatic TNBC
New drug combo did not extend life for metastatic triple-negative breast cancer patients in this trial
This phase III RCT in 812 patients with previously untreated metastatic triple-negative breast cancer found that adding capivasertib to pacl…
A large global trial found that adding capivasertib to paclitaxel did not improve overall survival for patients with metastatic triple-negat…
Contrast-enhanced mammography reduces costs per QALY in breast cancer screening recalls compared to conventional imaging
Contrast-enhanced mammography may cut costs for breast cancer screening
This RCT evaluated women recalled from breast cancer screening in a hospital setting. Contrast-enhanced mammography (CEM) as the primary too…
Using contrast-enhanced mammography as the first test for women recalled from screening could lower imaging costs without harming quality of…