The specific study aims will be:
1. To investigate the short- and long-term treatment effects of action observation, imagery, and execution therapy (AOIE) compared with an action observation therapy (AO) group and a customary rehabilitation group as controls on different aspects of outcomes in patients with stroke.
2. To examine the neural mechanisms and changes in cortical neural activity after the interventions in stroke patients.
3. To examine the correlations between AOIE-induced brain activation changes and the clinical efficacy of AOIE.
4. To identify who are the possible good responders to the therapy based on baseline motor function and motor imagery ability of the participants.
The investigators propose a 3-year randomized controlled trial to (1) investigate the short- and long-term treatment efficacy of AOIE, action observation alone, versus customary rehabilitation on clinical outcomes of patients with subacute stroke, (2) examine the neural mechanisms and activation changes after the 3 interventions by using an advanced brain imaging technique, magnetoencephalography (MEG), (3) determine the correlations between neural activation changes and clinical outcomes, and (4) identify who are the good responders to the AOIE therapy. An estimated total of 96 patients with subacute stroke will be recruited in this study. All participants will be randomly assigned to receive 1 of the 3 interventions for 3 weeks (a total of 15 sessions). Clinical outcome measures will be conducted at baseline, immediately after treatment (3 weeks), and at 3 months follow-up. The MEG assessment will be conducted at baseline and immediately after treatment (3 weeks). For the MEG study, The investigators anticipate to enroll 12 to 15 patients in each group to complete neuroimaging evaluation because of the specific eligibility criteria and high costs of MEG. The patients can still participate in the study, receiving rehabilitation therapy and clinical evaluations, even if the participants will not be included in the MEG study.
- Action observation, imagery & execution Behavioral
Intervention Desc: The participants will be asked to observe movements through a video clip, practice motor imagery, and executing the movements that the participants observed. ARM 1: Kind: Experimental Label: Action observation, imagery & execution
- Action observation Behavioral
Intervention Desc: The participants will be asked to observe videos and then practice what the participants observed. ARM 1: Kind: Experimental Label: Action observation
- Customary upper-extremity rehabilitation Behavioral
Intervention Desc: The participants will receive UE training without watching videos or imagining movements/tasks. ARM 1: Kind: Experimental Label: Customary upper-extremity rehabilitation
|Type||Measure||Time Frame||Safety Issue|
|Primary||Change scores of Modified Rankin Scale||baseline, 3 weeks , 3 months|
|Primary||Change scores of Fugl-Meyer Assessment||baseline, 3 weeks , 3 months|
|Secondary||Change scores of Box and Block Test||baseline, 3 weeks , 3 months|
|Secondary||Change scores of ABILHAND questionnaire||baseline, 3 weeks , 3 months|
|Secondary||Change scores of Movement Imagery Questionnaire, revised second version||baseline, 3 weeks , 3 months|
|Secondary||Change scores of Functional Independence Measure||baseline, 3 weeks , 3 months|
|Secondary||Change scores of physical intensity measured by activity monitors||baseline, 3 weeks , 3 months|
|Secondary||Change scores of energy expenditure measured by activity monitors||baseline, 3 weeks , 3 months|
|Secondary||Change scores of Stroke Impact Scale (SIS) Version 3.0||baseline, 3 weeks , 3 months|
|Secondary||Magnetoencephalography (MEG)||baseline, 3 weeks|