Effects of Action Observation Therapy Based on Virtual Reality for Upper Extremity Rehabilitation in Stroke

The rehabilitation of paretic stroke patients uses a wide range of intervention programsto improve the function of impaired upper limb. A new rehabilitative approach, calledaction observation therapy (AOT) is based on the discovery of mirror neurons and has beenused to improve the motor functions of adult stroke patients and children with cerebralpalsy. Recently, virtual reality (VR) has provided the potential to increase thefrequency and effectiveness of rehabilitation treatment by offering challenging andmotivating tasks. The purpose of the present project is to design a randomized controlledtrial (RCT) to evaluate whether action observation (AO) added to standard VR (AO+VR) iseffective in improving upper limb function in patients with stroke, compared with anaction observation therapy alone.Non‐probability sampling technique will be used. After signing the consent form, theparticipant who met the inclusion criteria will be allocated to this study. LotteryMethod will be used for the randomization of subjects in two groups. For the blindness ofthe accessor, the concealment process (Closed Envelope Method) will be maintained. GroupA (will be given Action Observation Therapy only), During each training session,participants will be asked to observe a specific object‐directed daily action presentedon a computer screen, and afterward they will perform what they have observed. Group B(will be given Action Observation Therapy combined with Virtual Reality), the participantwill sit in the center of the set zone and will be assisted to wear the VR glasses. Afterthe participant will confirm that the sight and sound is clear and comfortable, the taskswill be done using virtual reality videos. Data will be collected at baseline and after 6weeks using Box and Block Test (Measures unilateral gross manual dexterity), Timed Test(To check the time duration for each task), Modified Ashworth Scale (To assessspasticity), Rankin Scale (To categorize severity of symptoms) and Fugl‐Meyer Assessmentfor Upper Extremity (FMA‐UE): to assess motor functioning, balance, sensation and jointfunctioning. All participants will receive 18 sessions of intervention for 60 min/day, 3days/week for 6 weeks.