Video-based training for rehabilitation of upper limb functions after stroke: A new treatment exploiting the mirror neuron system
Final Report Abstract
The observation of purposeful actions is supposed to elicit a reenactment of similar actions stored in human brains. The underlying neural structure is the so-called mirror neuron system. Physiological studies demonstrate that observation of congruent actions significantly facilitates learning of basic movements in stroke patients. In this multicenter randomized clinical trial we tested the impact of action observation on rehabilitation of motor deficits after stroke. The hypothesis underlying the VIDEOTHERAPY study was that action observation and execution (observation combined with motor exercise, “video”) is superior over motor exercise alone (“nonvideo”) and standard rehabilitation (“standard”). This was tested by objective and subjective assessments of the motoric abilities of the individual patients' affected limb before and after the different treatments in comparison to each other. Patients meeting all the inclusion criteria and none of the exclusion criteria were randomized to receive one of the following above-mentioned treatments. Until the stop of the study due to limitation of funding to the initial appropriation period ca. 1200 patients were screened and 104 finally randomized into the study. Due to several problems only 61 patients entered the final statistical analysis. 24 patients completed the video, 16 the non-video and 21 the standard treatment. All groups were homogenous with respect to the primary and secondary endpoints. None of the tested hypotheses could be rejected at a nominal significance level of α = 0.05. The observed differences between groups were small, and the direction of the changes differed between the hypotheses tested. Therefore, no general effect of the treatment could be observed. Due to the low numbers of evaluated patients those results have rather explorative and not a confirmative character. The conduct of our study and the results match those of a recently published study by the influential group of Pomeroy. Also in this study there was a large disproportion between the screened numbers and the finally recruited numbers of patients. Despite the negative results of both studies the principle of action observation is still of high practical importance for the neurorehabilitation and should be tested in larger cohorts of patients. One distinguished feature in the results of VIDEOTHERAPY was the relatively high non-compliance with the “non-video” treatment. This aspect should be critically re-evaluated in future studies.
