The Effect of Action Observation Training using Point-Light Technique on Muscle Activity, Muscle Coordination, Upper Extremity Function, and Activities of Daily Living in Stroke Patients: A Randomized Controlled Study

Experimental group (PL-AOT)
We selected 5 tasks that are frequently performed by the inpatients in their current environment: wiping a table, folding towels, pouring water into a cup, stamping, and using a fork, included in the 20 tasks proposed by Franceschini et al. (2010), [44](Table 2).
With reference to the study finding that watching videos in a first-person view is more effective than in a third-person view in improving the upper extremity function and ADL, we structured the videos such that the first-person view was longer (≤ 70 seconds) than the third-person view (front, lateral, anterior diagonal, posterior diagonal) (≤ 60 seconds)[45]. For the visual cues in videos that applied the point-light technique, we applied colour marks on the major joints for each movement to enhance participants’ understanding and visual attention to the movements and applied arrows to indicate the direction of the movement[27, 28]. Each task video was edited to a total length of 6 min. In each AOT session, participants were seated, facing a 15-inch laptop screen placed 30 cm in front, in a quiet and isolated space, and watched the edited 6-min video task, followed by 9 min of imitating the observed action, allowing for two repetitions per session. The participants observed the videos. The therapist verbally explained the task and its features to maintain the participants’ focus. After watching the video, participants were instructed to imitate the actions using the objects seen in the video.

Control group (AOT)
The same videos used for the experimental group were also used for the control group; however, the visual cues were removed. As with the experimental group, the control group watched a task video for 6 min, followed by 9 min of imitating the observed action, allowing for two repetitions per session, making a total of 30-min training. The participants observed the videos seated, facing a 15.6-inch laptop screen placed 30 cm in front of a quiet and isolated space. The therapist verbally explained the task and its features to maintain the participants’ focus. After watching the video, participants were instructed to imitate the actions using the objects seen in the video.

2023-05-10

2023-10-02

Changes in the upper extremity function, ADL, muscle activation, and muscle coordination Comparison of the upper extremity function scores before and after the intervention in each group
In terms of the FMA-UE, ARAT, and BBT scores, the experimental group showed a significant improvement in the upper extremity function for all measured parameters (FMA-UE, ARAT, BBT) after the intervention (p<.05). The control group only showed a significant improvement in U/E, Coordination, and summation (p<.05) of FMA-UE; however, not in the wrist and hand (p>.05). In the ARAT, the control group showed significant improvements in the grasp, pinch, gross motor, and total scores (p<.05); however, not in the grip score (p>.05). In BBT, the control group showed a significant improvement in the upper extremity function (p<.05).

Comparison of ADL scores before and after the intervention in each group
For the K-MBI scores, the experimental group showed a significant improvement of ADL in seven items (personal hygiene, feeding, stair climbing, dressing, bowel control, ambulation, total score) after the intervention (p<.05); however, not in four items (Bathing, Toileting, Bladder Control, Transfer) (p>.05). Conversely, the control group showed significant improvements in four items (bathing, dressing, bladder control, total score) (p<.05); however, not in seven items (personal hygiene, feeding, toileting, stair climbing, Bowel Control, Ambulation, Transfer) (p>.05). For the MAL score, both groups showed significant improvements in the ADL in both the AOU and QOM after the intervention.

Comparison of muscle activation before and after the intervention in each group
Both groups showed significantly improved muscle activation of the anterior deltoid and triceps brachii after the intervention (p<.05).

Comparison of the changes in the Upper extremity function scores after the intervention between the two groups
After the intervention, the experimental group showed a significantly greater improvement in the total FMA-UE score and in all sub-category scores compared to that of the control group (p<.05). Similarly, the experimental group had a significantly greater improvement in the total ARAT score and in all sub-category scores compared to that of the control group (p<.05). The mean amount of change in the BBT score was also significantly greater in the experimental group than in the control group (p<.05).

Comparison of changes in the ADL scores after the intervention between the two groups
After the intervention, the experimental group showed a significantly greater improvement in the total K-MBI score (p<.05). The mean amount of change was significantly greater in the experimental group for four items (personal hygiene, feeding, dressing, total score) compared to that of the control group (p<.05). The experimental group also had a significantly greater improvement of the AOU and QOM of MAL compared to that of the control group (p<.05).

Comparison of changes in muscle activation after the intervention between the two groups
After the intervention, the mean amount of change in the activation of the anterior deltoid and triceps brachii was significantly greater in the experimental group than in the control group (p<.05).

Comparison of muscle coordination before and after the intervention in each group
We compared the mean amount of change in CCR during reach after the intervention between the groups. The experimental group showed a negative value for the change in shoulder flexion and elbow extension during reach after the intervention. In contrast, the control group showed a positive value for the change in shoulder flexion and elbow extension during reach after the intervention. These indicated that the experimental group had more positive shoulder and elbow joint changes than the control group.

Study procedure
We used a two-group pre-test–post-test experimental design. Participants were randomly assigned to either the experimental or control groups (n=16 each) by drawing lots. The therapists thoroughly explained how the interventions would be provided and conducted screening assessments to select suitable candidates (n=32) based on the inclusion and exclusion criteria. To ensure consistency, the principal researcher conducted pre- and post-assessments of muscle activation and coordination, upper extremity function, and ADL in both groups. The intervention was carried out by two occupational therapists (including the principal researcher) who had > 6 years of clinical experience. The Fugl–Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), and Box and Block Test (BBT) were used to evaluate the upper extremity function. The Korean Modified Barthel Index (K-MBI) and the Motor Activity Log (MAL) were used to assess the ADL. Surface Electromyography (sEMG) was used to assess muscle activation and coordination. Before commencing the intervention, the principal researcher educated and trained other therapists on the PL-AOT. The interventions were designed as a five 30-minute/week for 4 weeks (a total of 20 sessions). Further, the participants continued their conventional occupational and physical therapy regimens with the experimental intervention.

randomization done in office by a compute

We used a two-group pre-test–post-test experimental design. Participants were randomly assigned to either the experimental or control groups (n=16 each) by drawing lots.

Yes

The therapists thoroughly explained how the interventions would be provided and conducted screening assessments to select suitable candidates (n=32) based on the inclusion and exclusion criteria.

The intervention was carried out by two occupational therapists (including the principal researcher) who had > 6 years of clinical experience.

Participants were randomly assigned to either the experimental or control groups (n=16 each) by drawing lots.