Stroke patients with motor impairment and difficulties performing activities of daily living (ADL) require interventions to enhance the beneficial effects of physical training on motor rehabilitation. A crucial first step in the acquisition of complex motor skills, such as those used to perform ADL, is motor training, which results in the formation of motor memories. The ability to form motor memories is reduced in older adults, particularly if they are affected by stroke. Therefore, new strategies are required to compensate for this deficit. Action observation (AO), observing another individual perform motor training, is one such strategy since it enhances the effects of motor training in healthy older adults. However, the effects of action observation on motor memory formation and ADL are unknown in stroke patients. Here, we propose to test the hypothesis that AO will enhance the effects of motor training on motor memory formation and ADL in chronic stroke patients compared to motor training alone. To accomplish this we will conduct a cross over study with 3 interventions: motor training (MT), motor training combined with AO of movements performed in the training direction (MT+AO), and motor training combined with observation of training in the opposite direction to the physically practiced (MT-AO). To determine the effects of these interventions we will measure: a) the magnitude of motor memory formation using MRI-guided transcranial magnetic stimulation (TMS);b) cortical activation changes using functional MRI (fMRI);and c) changes in ADL performance after training with each intervention. This investigation will clarify the underlying mechanisms and potential use of a new scientifically sound strategy to enhance motor function after stroke. There is no universally accepted treatment to enhance training effects after stroke. In this setting, action observation could evolve into an economical and easily implemented strategy to help address a significant public health burden.
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