ACTION OBSERVATION WITH SYNCHRONIZED PHYSICAL PRACTICE IMPROVES AFFECTED HAND FUNCTION OF CHRONIC STROKE PATIENTS
ResumoIntroduction: Action Observation (AO) with physical practice refers to observing an action and imitating the observed action. AO activates the same neural circuit responsible for planning and executing actions using a mirror neuron system, leading to increased excitability of motor cortex areas and enhancement of motor learning. Previous works described positive results on upper limb motor recovery, gait and balance of stroke patients. It is not clear if AO synchronized with physical practice could improve the hand function in patients with chronic stroke. Objective: To evaluate the effects of AO with synchronized physical practice on affected hand function recovery of chronic stroke patients and investigate the influence of time after stroke on recovery. Material and Methods: Thirteen patients with a single episode of ischemic or hemorrhagic stroke in middle cerebral artery territory, occurring for at least three months, who were participants of a controlled clinical trial to assess the effects of AO with synchronized physical practice on affected upper limb recovery were selected in a non-random way after giving informed consent. Jebsen-Taylor Hand Function Test was used to evaluate the performance of different hand daily activities, such as: writing a short sentence, turning cards, picking up small objects, simulating feeding, stacking pieces and moving light and heavy cans, and the time for the execution of the task was recorded. Patients were divided into two groups, before two years after the stroke and after two years after the stroke for an additional analysis. Three evaluations were performed, the first at the beginning, the second at three months and the third at the end of the treatment. The intervention consisted of AO using thirty-five videos of selective arm movements, including range of motion exercises and hand skills. The treatment ocurred in small groups of patients, under direct supervision and assistance, and lasted six months, two times a week. ANOVA of repeated measures, with Tukey post-test was used to compare the three evaluation moments and investigate the effect of time after stroke on recovery. Level of statistical significance (p <0,05). Results: In the first evaluation, patients completed the test in 109,17 ± 11,13 seconds, after three months in 91,48 ± 9,03 seconds and after six months in 74,31 ± 8,16 seconds (p <0,001). Analysis of the effect of time after the stroke: before two years and after two years after stroke, showed statistical significant difference for the moment factor (p<0,001, F=18,359, n2p=0,625, power 99,9%), indicating improvement in both groups. However, the absence of significant difference for group (p=0,865, F=0,030, n2p=0,003, power 5,3%) and group x moment interaction factors (p=0,126, F=2,279, n2p=0,172; power 41,3%) indicated that the time after the stroke did not influence hand function recovery. Conclusion: AO with synchronized physical practice improved affected hand function recovery after six months of treatment and the time after stroke did not seem to interfere on recovery.
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