Effectiveness of action observation therapy based on virtual reality technology in the motor rehabilitation of paretic stroke patients: a randomized clinical trial

Background: The rehabilitation of paretic stroke patients uses a wide range of intervention programs to improve the function of impaired upper limb. A new rehabilitative approach, called action observation therapy (AOT) is based on the discovery of mirror neurons and has been used to improve the motor functions of adult stroke patients and children with cerebral palsy. Recently, virtual reality (VR) has provided the potential to increase the frequency and effectiveness of rehabilitation treatment by offering challenging and motivating tasks. Methods: The purpose of the present project is to design a randomized controlled six-month follow-up trial (RCT) to evaluate whether action observation (AO) added to standard VR (AO + VR) is effective in improving upper limb function in patients with stroke, compared with a control treatment consisting of observation of naturalistic scenes (CO) without any action content, followed by VR training (CO + VR). Discussion: AO + VR treatment may provide an addition to the rehabilitative interventions currently available for recovery after stroke and could be utilized within standard sensorimotor training or in individualized tele-rehabilitation. Trial registration: The trial has been prospectively registered on ClinicalTrials.gov. NC 105163210. 17 December 2021. Keywords: Action observation therapy, Virtual reality, Mirror neuron system, Stroke, Motor learning

Antonino Errante, Donatella Saviola, Matteo Cantoni, Katia Iannuzzelli, Settimio Ziccarelli, Fabrizio Togni, Marcello Simonini, Carolina Malchiodi, Debora Bertoni, Maria Grazia Inzaghi, Francesca Bozzetti, Roberto Menozzi, Annamaria Quarenghi, Paola Quarenghi, Daniele Bosone, Leonardo Fogassi, Gian Piero Salvi, Antonio De Tanti