The clinical impact of action observation (AO) on upper limb functional recovery in subacute stroke patients is recent evidence. We sought to test the hypothesis that training everyday life activities through AO coupled with task execution might activate the left hemisphere different from the right one. Sixty-seven first-ever ischemic stroke subjects were randomly assigned to receive upper limb training coupled with AO tasks or standard rehabilitation. The groups were matched by age and gender, Bamford category, and interval from stroke and lesion side. Fugl-Meyer (FM) and Box and Block Test (BBT) were used to measure hand function recovery at the end (T1) and 4 to 5 months after the treatment (T2). At T1, FM was increased by 31% (+/- 26%), of maximum achievable recovery, whereas BBT was increased by 17% (+/- 18%); at T2, FM had reached 43% (+/- 45%) of maximum recovery, while BBT had reached 25% (+/- 22%). Combining the effects of treatment to those of lesion side revealed significantly higher gains, in both FM and BBT scores, in left hemiparetic subjects when exposed to AO as compared to standard rehabilitation alone (p < 0.01). The findings lead to recommend the use of AO in addition to motor training in left hemiparetic patients.

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