title: Clinical relevance of action observation in upper-limb stroke rehabilitation: a possible role in recovery of functional dexterity. A randomized clinical trial.
abstract: OBJECTIVE
  A randomized controlled observer-blind trial was designed to evaluate the effectiveness of action observation as an add-on treatment to the standard rehabilitation of upper-limb function, early after stroke.
  
  
  METHODS
  Stroke survivors (N = 102) were consecutively recruited from 13 centers 30 days (±7) after a first-ever stroke and randomly assigned to the experimental (EG) or control group (CG). EG participants watched video footage of daily routine tasks (actions) carried out with the upper limb in order to prepare to imitate the presented action. At the end of each sequence, a therapist prompted the patient to perform the same movement for 2 minutes, providing help when needed. Static images without animals or human beings were shown to the CG. At the end of each sequence, the CG executed movements that simulated the shoulder and elbow joint mobilization activities performed by the EG.
  
  
  RESULTS
  for the Fugl-Meyer test, Frenchay Arm test, Box and Block test (BBT), Modified Ashworth Scale, and Functional Independence Measure Motor items were recorded before treatment (T0), after 4 weeks of treatment (T1), and at the follow-up visit 4 to 5 months after the conclusion of treatment (T2). Results. An improvement over time was appreciated on all measures of impairment and functional ability with both treatment programs. A Time × Treatment interaction emerged from the generalized estimating equations analysis of BBT, showing significant T0-T1 and T0-T2 differences in favor of EG.
  
  
  CONCLUSIONS
  This multicenter trial endorses the use of action observation in upper-extremity rehabilitation, along with a role for the mirror neuron system in poststroke recovery.
authors.affiliation: Unit of Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy. marco.franceschini@sanraffaele.it
authors.forename: Marco
authors.initials: M
authors.lastname: Franceschini
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Ceravolo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Agosti
authors.forename: Paola
authors.initials: P
authors.lastname: Cavallini
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonassi
authors.forename: Valentina
authors.initials: V
authors.lastname: Dall'Armi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Massucci
authors.forename: Francesca
authors.initials: F
authors.lastname: Schifini
authors.forename: Patrizio
authors.initials: P
authors.lastname: Sale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D019370:Observation; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D016037:Single-Blind Method; D000071939:Stroke Rehabilitation; D034941:Upper Extremity / Q000503:physiopathology