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Influence of Joint-Specific Action Observation Training on Ambulatory Function in Chronic Stroke Survivors

  • Jong-Su Lee (Department of Physical Therapy, Graduate School of Rehabilitation Science, Daegu University) ;
  • Young-Mi Kim (Department of Physical Therapy, Uiduk University)
  • Received : 2025.09.22
  • Accepted : 2025.10.23
  • Published : 2025.10.31

Abstract

Purpose: This study examined the effectiveness of joint-focused action observation training (AOT) in improving the gait of patients with chronic stroke. Methods: Twenty-two chronic stroke patients were assigned randomly to three groups: AOT group, Action Observation only (AO) group, and control (C) group. The AOT group underwent 15 minutes of action observation followed by 15 minutes of physical training three times per week for six weeks. The AO group received only action observation without physical practice, while the control group received neither. All participants also received conventional neurodevelopmental treatment. The gait and balance were assessed using the Timed Up and Go test (TUG), Modified Emory Functional Ambulation Profile (mEFAP), and 10-meter walking test (10MWT). Nonparametric statistical methods were used for analysis. Results: The AOT group showed significant improvements in the TUG, mEFAP, and 10MWT scores after the intervention (p<0.05), whereas the AO and control groups did not exhibit significant changes in TUG and mEFAP. Group comparisons revealed significant differences in outcome measures, with the AOT group showing superior improvements to the control group (p<0.05). Conclusion: AOT effectively improved the gait and balance of chronic stroke patients. These findings support the clinical utility of AOT as an adjunctive intervention in stroke rehabilitation, particularly when customized with joint-focused video content.

Keywords

References

  1. Duncan PW, Zorowitz R, Bates B et al. Management of adult stroke rehabilitation care: a clinical practice guideline. Stroke. 2005;36(9):e100-43. https://doi.org/10.1161/01.STR.0000180861.54180.FF
  2. Yao YY, Wei ZJ, Zhang YC et al. Functional disability after ischemic stroke: a community-based cross-sectional study in shanghai, china. Frontiers in Neurology. 2021;12:649088. https://doi.org/10.3389/fneur.2021.649088
  3. Alguren B, Lundgren-Nilsson Å, Sunnerhagen KS. Functioning of stroke survivors-a validation of the icf core set for stroke in sweden. Disabil Rehabil. 2010;32(7):551-9. https://doi.org/10.3109/09638280903186335
  4. Hyndman D, Ashburn A, Stack E. Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers. Arch Phys Med Rehabil. 2002;83(2):165-70. https://doi.org/10.1053/apmr.2002.28030
  5. Kim K, Kim YM, Kim EK. Correlation between the activities of daily living of stroke patients in a community setting and their quality of life. J Phys Ther Sci. 2014;26(3):417-9. https://doi.org/10.1589/jpts.26.417
  6. Lord SE, McPherson K, McNaughton HK et al. Community ambulation after stroke: how important and obtainable is it and what measures appear predictive? Arch Phys Med Rehabil. 2004;85(2):234-9. https://doi.org/10.1016/j.apmr.2003.05.002
  7. Johansson BB. Current trends in stroke rehabilitation. A review with focus on brain plasticity. Acta Neurol Scand. 2011;123(3):147-59. https://doi.org/10.1111/ane.2011.123.issue-3
  8. Urgesi C, Moro V, Candidi M et al. Mapping implied body actions in the human motor system. J Neurosci. 2006;26(30):7942-9. https://doi.org/10.1523/JNEUROSCI.1289-06.2006
  9. Iacoboni M, Molnar-Szakacs I, Gallese V et al. Grasping the intentions of others with one's own mirror neuron system. PLoS Biol. 2005;3(3):e79. https://doi.org/10.1371/journal.pbio.0030079
  10. Stefan K, Cohen LG, Duque J et al. Formation of a motor memory by action observation. J Neurosci. 2005;25(41):9339-46. https://doi.org/10.1523/JNEUROSCI.2282-05.2005
  11. Mulder T. Motor imagery and action observation: cognitive tools for rehabilitation. J Neural Transm (Vienna). 2007;114(10):1265-78. https://doi.org/10.1007/s00702-007-0763-z
  12. Pomeroy V, Aglioti SM, Mark VW et al. Neurological principles and rehabilitation of action disorders: rehabilitation interventions. Neurorehabil Neural Repair. 2011;25(5_suppl):33S-43S. https://doi.org/10.1177/1545968311410942
  13. Sarasso E, Gemma M, Agosta F et al. Action observation training to improve motor function recovery: a systematic review. Arch physiother. 2015;5:14. https://doi.org/10.1186/s40945-015-0013-x
  14. Picardi M, Temporiti F, Salamone C et al. Efficacy of action observation therapy on gait, balance and mobility impairments: a systematic review and meta-analysis. Physiother Res Int. 2025;30(1):e70006. https://doi.org/10.1002/pri.v30.1
  15. Thanaya SAP, Mardhika PE, Thomas N et al. Action observation training for improving walking ability and balance of stroke patients: a systematic review and meta-analysis. J Bodyw Mov Ther. 2024;40:127-40. https://doi.org/10.1016/j.jbmt.2024.04.018
  16. Shamsi F, Nami M, Aligholi H et al. The effects of action observation training as an add-on rehabilitation strategy on the walking ability of patients with chronic stroke. J Bodyw Mov Ther. 2022;29:33-9. https://doi.org/10.1016/j.jbmt.2021.09.029
  17. Causer J, McCormick SA, Holmes PS. Congruency of gaze metrics in action, imagery and action observation. Front Hum Neurosci. 2013;7:604. https://doi.org/10.3389/fnhum.2013.00604
  18. Choi YA, Kim JS, Lee DY. Effects of fast and slow squat exercises on the muscle activity of the paretic lower extremity in patients with chronic stroke. J Phys Ther Sci. 2015;27(8):2597-9. https://doi.org/10.1589/jpts.27.2597
  19. Park SD, Song HS, Kim JY. The effect of action observation training on knee joint function and gait ability in total knee replacement patients. J Exerc Rehabil. 2014;10(3):168-71. https://doi.org/10.12965/jer.140112
  20. Sütbeyaz S, Yavuzer G, Sezer N et al. Mirror therapy enhances lower-extremity motor recovery and motor functioning after stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2007;88(5):555-9. https://doi.org/10.1016/j.apmr.2007.02.034
  21. Jonsdottir J, Cattaneo D. Reliability and validity of the dynamic gait index in persons with chronic stroke. Arch Phys Med Rehabil. 2007;88(11):1410-5. https://doi.org/10.1016/j.apmr.2007.08.109
  22. Liaw LJ, Hsieh CL, Lo SK et al. Psychometric properties of the modified emory functional ambulation profile in stroke patients. Clin Rehabil. 2006;20(5):429-37. https://doi.org/10.1191/0269215506cr950oa
  23. Baer HR, Wolf SL. Modified emory functional ambulation profile: an outcome measure for the rehabilitation of poststroke gait dysfunction. Stroke. 2001; 32(4): 973-9. https://doi.org/10.1161/01.STR.32.4.973
  24. Cheng DK, Nelson M, Brooks D et al. Validation of stroke-specific protocols for the 10-meter walk test and 6-minute walk test conducted using 15-meter and 30-meter walkways. Top Stroke Rehabil. 2020;27(4):251-61. https://doi.org/10.1080/10749357.2019.1691815
  25. Moosabhoy, Mufadal A GARD, Steven A. Methodology for determining the sensitivity of swing leg toe clearance and leg length to swing leg joint angles during gait. Gait & Posture. 2006;24(4):493-501. https://doi.org/10.1016/j.gaitpost.2005.12.004
  26. Lee JH, Park SW, Kim DA et al. Gait analysis using accelerometer in stroke patients. ARM. 2004;28(5):488-93.
  27. Bach P, Peatfield NA, Tipper SP. Focusing on body sites: the role of spatial attention in action perception. Exp Brain Res. 2007;178(4):509-17. https://doi.org/10.1007/s00221-006-0756-4
  28. Tanabe J, Morishita M. Effects of Action Observation Therapy with Limited Visual Attention on Walking Ability in Stroke Patients. J Mot Behav. 2022;54(1):27-36. https://doi.org/10.1080/00222895.2021.1874861
  29. Sarasso E, Gemma M, Agosta F et al. Action observation training to improve motor function recovery: a systematic review. Arch Physiother. 2015;5:14. https://doi.org/10.1186/s40945-015-0013-x
  30. Keysers C, Gazzola V. Social neuroscience: mirror neurons recorded in humans. Curr Biol. 2010;20(8):R353-R4. https://doi.org/10.1016/j.cub.2010.03.013
  31. Martineau J, Andersson F, Barthélémy C et al. Atypical activation of the mirror neuron system during perception of hand motion in autism. Brain Res. 2010;1320:168-75. https://doi.org/10.1016/j.brainres.2010.01.035
  32. Cattaneo L, Rizzolatti G. The mirror neuron system. Arch Neurol. 2009 May;66(5):557-60. https://doi.org/10.1001/archneurol.2009.41
  33. Borel S, Schneider P, Newman C. Video analysis software increases the interrater reliability of video gait assessments in children with cerebral palsy. Gait Posture. 2011;33(4):727-9. https://doi.org/10.1016/j.gaitpost.2011.02.012
  34. De Quervain IA, Simon SR, Leurgans S et al. Gait pattern in the early recovery period after stroke. J Bone Joint Surg Am. 1996;78(10):1506-14. https://doi.org/10.2106/00004623-199610000-00008
  35. Mulroy S, Gronley J, Weiss W et al. Use of cluster analysis for gait pattern classification of patients in the early and late recovery phases following stroke. Gait posture. 2003;18(1):114-25. https://doi.org/10.1016/S0966-6362(02)00165-0
  36. Lee S. The effects of bilateral coordination training on cortical reorganization and upper-limb motor function recovery of chronic stroke patients. Seoul National University. Dissertation of Doctorate Degree. 2008.
  37. Choi HS, Nam KW. The effect of action observation training on balance in patients with chronic stroke. JKAIS. 2014;15(6):3759-65.
  38. Bang DH, Shin WS, Kim SY et al. The effects of action observational training on walking ability in chronic stroke patients: a double-blind randomized controlled trial. Clin Rehabil. 2013;27(12):1118-25. https://doi.org/10.1177/0269215513501528
  39. Noh HJ, Kuk EJ, Kim JM. The effect of action observation physical training on sit-to-stand and balance in chronic stroke patients. Kor J Neural Rehabil. 2011;1(2):11-20.
  40. Kang KY. Effects of observed action gait training on spatio-temporal parameter and motivation of rehabilitation in stroke patients. J Korean Soc Phys Med. 2013;8(3):351-60.
  41. McCormick SA, Causer J, Holmes PS. Active vision during action execution, observation and imagery: evidence for shared motor representations. PLoS One. 2013;8(6):e67761. https://doi.org/10.1371/journal.pone.0067761