The use of action observation as a technique to retrain walking ability in post stroke patients will be evaluated. Action Observation is based on the mirror neuron system. The Mirror neuron (MN) system is a relatively simple neural mechanism that is activated when a patient observes an activity in the third person. The observation leads to recognition of the movement and of how the patient previously performed the activity. Action Observation Training involves a patient observing a movement like gait in order to active motor planning centers.
This study focuses on the use of Action Observation Training as an intervention when retraining gait of chronic post stroke patients.
All articles with regards to adult (18+ years of age) patients who suffered a stroke (after the age of 6 years - excluding damage to developing brain of a child) will be included.
Action Observation as used in this study is defined as the observation of gait or gait movement components in the third person in order to attempt activation of the Mirror Neuron System.
Action Observation used to improve gait training or any other form of lower limb mobility and or function on impairment, activity and/or participation level will be included.
Action Observation compared with the following interventions:
Traditional physical therapy/physiotherapy approaches.
In combination with other known interventions.
Patients treated in both rural and urban settings were included, private or public hospitals as well as developing and developed countries.
All articles where adult stroke patients were part of the study population will be included.
Bias and article grading. Descriptive analysis of the outcome measures used in the studies according to the International Classification of function and health in table format.
Bias will be determined using the Risk of Bias Table and grading will be done on the recommendations of the methods used, the effects and the outcomes given by the authors by using the GRADE system.
Data extraction, (selection and coding)
Data Collection Process:
• First phase of the data collection:
Data collection will be done by the researcher and an independent librarian in the medical library of the University of Pretoria. A set protocol for searching on each database was determined during the pilot study and will be implemented during the data extraction phase. The two sets of data will be compared and all the study titles from the two searches will be extracted and organized onto a title screening numbering sheet. Screening of all included study titles from all databases will be done by the researcher and an external examiner. The title screening numbering sheet will be used to mark the titles included/excluded for each of the keywords and each database individually. The researcher and the external researcher will evaluate the article titles based on the eligibility criteria provided by the main researcher. If in doubt about a specific title the researchers will “include” the title for revision in the abstract phase. The results of the included articles by the researcher as well as the external researcher will be compared. Where both parties agreed the studies will be included. The arbitration researcher will evaluate the titles of those on which the researcher and external researcher did not agree based on the abstracts and will include the relevant articles in the “post arbitration sample”.
• Second phase of data collection:
After arbitration, duplicate articles from different databases will be excluded. The abstracts of each of the articles will be reviewed by the researcher and exclusions will be made accordingly.
• Third phase of data collection:
The final post-abstract articles will be subject to further evaluation by the researcher on its relevance of the full text.
Data to be extracted:
Stroke and Action Observation.
• All articles with regards to adult (18+) patients who suffered a stroke six months or more prior to the study will be included.
• Patients treated in both rural and urban settings will lbe included, private or public hospitals as well as developing and developed countries.
• Articles on chronic stroke patient intervention will be included
• Articles pertaining to lower limb mobility and/or gait rehabilitation using Action Observation in any manner will be included.
• Articles comparing Action Observation with the following interventions will be included: Traditional physical therapy/physiotherapy approaches, no intervention , in combination with other interventions
Risk of bias (quality) assessment
The Risk of Bias table will be used for every individual study.
Strategy for data synthesis
The GRADE system will be used to guide the descriptive synthesis with regards to each of the different articles matching the criteria.
Analysis of subgroups or subsets
Contact details for further information
Organisational affiliation of the review
University of Pretoria
Mrs Aletta Kruger, Primary Researcher Dr Carina Eksteen, Study leader and researcher
Mrs Andorette van Wyk, Private Physiotherapist
Details of any existing review of the same topic by the same authors
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.