Dissertation/ Thesis
A Comparative Study of Action Observation Therapy and Mirror Therapy on Motor Function and Neural Mechanisms After Subacute Stroke: A Case Series
| العنوان: | A Comparative Study of Action Observation Therapy and Mirror Therapy on Motor Function and Neural Mechanisms After Subacute Stroke: A Case Series |
|---|---|
| Alternate Title: | 動作觀察治療與鏡像治療於亞急性中風患者動作功能與神經機制之對比性研究：個案系列報告 |
| المؤلفون: | Jun Ding Zhu, 朱俊鼎 |
| Thesis Advisors: | Y. W. Hsieh, 謝妤葳 |
| سنة النشر: | 2017 |
| المجموعة: | National Digital Library of Theses and Dissertations in Taiwan |
| الوصف: | 105 Introduction: Stroke is an important health issue worldwide. Patients with stroke commonly have unilateral upper-limb (UL) motor impairments which result in long-term dependence of patients. Action observation therapy (AOT) is a new rehabilitation approach based on the mechanism of mirror neuron system (MNS). During AOT, patients were asked to observe the actions performed by another healthy person in the videos and imitate the actions intentionally. Mirror therapy (MT) is another recent prominent rehabilitation intervention. MT required patients to look at the reflection of the unaffected hand in the mirror and imagine it as the affected one, which is known as mirror visual feedback. Both AOT and MT apply different patterns of visual feedback but involve motor observation and imagery and share some similar neural bases of MNS. However, their effectiveness in stroke rehabilitation is equivocal. Therefore, there were two purposes of this study. The first study aim was to investigate and compare treatment effects between AOT and MT on UL motor function measured by clinical scales in patients with subacute stroke. The second aim was to examine neural mechanisms between action observation related task and mirror related task by using the Magnetoencephalography (MEG). Methods: Eleven participants were recruited in this study to receive AOT or MT intervention for 60 minutes per day, 5days per week for 3 weeks. The clinical outcomes were selected based on the International Classification of Functioning, Disability and Health (ICF). Body functions level was assessed by the upper-limb subscale of Fugl-Meyer Assessment (FMA-UL), Box and Block Test (BBT) and revised Nottingham Sensory Assessment (rNSA). The Activity and Participation levels were assessed by the Wolf Motor Function Test (WMFT), Functional Independence Measure (FIM), Motor Activity Log (MAL) and physical function domains of Stroke Impact Scale (SIS). Mann-Whitney U test was applied to evaluate the treatment effects between the 2 groups. Wilcoxon Rank Sum Test was applied to examine within-group changes. In the MEG experiment, four participants were recruited to execute 6 conditions in action observation related task and mirror related task. Kruskal-Wallis test was used to examine the differences on the beta oscillation activity with different conditions of the 2 tasks. Mann-Whitney U test was used for the post hoc analysis. Results: There were 6 participants randomly assigned to the AOT group and 5 participants assigned to the MT group. The AOT group significant improved on the total score (p = .05) and distal part score (p = .04) of the FMA-UL and BBT (p = .05). Besides, the AOT also improved on the WMFT-Time (p = .03), the total score (p = .03) and motor subscale (p = .03) of FIM, MAL-AOU (p = .03), MAL-QOM (p = .03), and hand function subscale (p = .04) and physical domains (p = .05) of the SIS. MT could significantly enhance on the WMFT-FAS (p = .04), the total score (p = .04) and motor subscale (p = .04) of FIM, MAL-AOU (p = .04), MAL-QOM (p = .04), and hand function subscale (p = .04) of the SIS. In addition, the results of MEG recordings showed significant differences in different conditions of action observation related task (p = .03). The post hoc analysis showed that the beta oscillation activities of “combined video and action” (p = .03) and “action only” (p = .03) conditions had significant decline compared to the “resting” condition. The beta oscillation activity of “combined video and action” condition decreased more compared with the activity of “action only” and “video only” conditions, although no statistically significant differences were found between these conditions. The comparison of beta oscillation activity among in the conditions of mirror related task also showed significant difference (p = .04). In the comparison between “mirror” condition and “no mirror” condition, there was no significant difference (p = .69). Further, no significant difference of beta oscillation activity was found in “combined video and action” condition compared with “mirror” condition (p = .49). Conclusion: Both AOT and MT improved UL motor function and daily function in patients with subacute stroke. AOT have more improvement on UL motor function than MT. The findings of MEG suggested that both action observation and mirror conditions can facilitate activation of primary motor cortex in patients with subacute stroke. Further studies to enroll more participants and administer a follow-up assessment are suggested. |
| Original Identifier: | 105CGU05738009 |
| نوع الوثيقة: | 學位論文 ; thesis |
| وصف الملف: | 107 |
| الاتاحة: | http://ndltd.ncl.edu.tw/handle/7dwphm |
| رقم الانضمام: | edsndl.TW.105CGU05738009 |
| قاعدة البيانات: | Networked Digital Library of Theses & Dissertations |
| الوصف غير متاح. |