Functional impairments in the upper extremities following a stroke significantly restrict individuals' activities of daily living and overall quality of life; in this context, Action Observation Training (AOT) has emerged in recent years as an effective rehabilitation method that promotes motor learning processes and cortical activity by activating the mirror neuron system. Although the literature acknowledges the positive effects on neural mechanisms of both unimanuel approaches, which focus on the paretic hand alone, and bimanual approaches, which involve the simultaneous use of both hands, there remains a gap regarding which method yields superior outcomes. This study aims to compare the effectiveness of AOT interventions consisting of exclusively unimanual versus exclusively bimanual activities on upper extremity functions, activities of daily living, and quality of life in chronic stroke patients, while investigating the potential differences between the outcomes of these two distinct approaches.
Being over 18 years of age,
Diagnosis of left hemiparetic stroke,
Having passed between 6 months since the onset of stroke,
Being in stage 4 or 5 of the hand and stage 4, 5 or 6 of the upper extremity --according to Brunnstrom staging,
Unwillingness to participate in the study,
Having spasticity that prevents grasping and releasing an object (levels 3 and 4 on the Modified Ashworth Scale),
Having a contracture in any of the affected upper extremity joints,
Having severe neglect disorder (scoring 21 or higher on the Catherine Bergego Scale),
Parallel
Action Observation Therapy(unimanuel activities)
Other interventionParticipants will receive 30 minutes of unimanual-only activities in each session AOT (at home via telerahabilitation) in addition to 45 minutes of conventional physiotherapy (stretching, strengthening, core mobility, balance, electrotherapy, and endurance exercises in the clinic). They will receive 3 sessions per week for 5 weeks.
Action Observation Therapy(bimanuel activities)
Other interventionParticipants will receive 30 minutes of bimanual-only activities in each session AOT(at home via telerahabilitation) in addition to 45 minutes of conventional physiotherapy (stretching, strengthening, core mobility, balance, electrotherapy, and endurance exercises in the clinic). They will receive 3 sessions per week for 5 weeks.
conventional physiotherapy
Other interventionParticipants will receive 45 minutes of conventional physiotherapy (stretching, strengthening, core mobility, balance, electrotherapy, and endurance exercises in the clinic). They will receive 3 sessions per week for 5 weeks.
Spasticity
Spasticity will assessed using the Modified Ashworth Scale. As the score increases, spasticity increases. The minimum score for this scale is 1 and the maximum score is 5.
Stage of hemiplegia
"Brunnstrom Hemiplegia Recovery Staging" will be used to determine the hemiplegic stage of the patients. This scale is scored between 1 and 6. As the score increases, the patient improves.
Dominant side
The Edinburgh Hand Preference Test will be used to determine which hand the patient uses more in daily life (Score range: -100 to +100; high positive scores indicate right-handedness, high negative scores indicate left-handedness).
Cognitif Function
Mini Mental Test will be used to evaluate cognitive functions. In the evaluation, 24-30 points indicate that cognitive functions are normal, 18-23 points indicate mild cognitive impairment, and 17 points and below indicate that cognitive status is severely affected.
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