Date Presented 04/22/2023

Action observation has been documented as an evidence-based intervention for upper extremity motor recovery poststroke. The results from this Critically Appraised Topic demonstrate a lack of documentation regarding the skin tone displayed in the videos used for action observation intervention. Consideration should be given to displaying videos with concordant race, skin tone, and gender of the client. Such inclusivity may increase positive outcomes for participants.

Primary Author and Speaker: Krystal Robinson-Bert

PURPOSE: To investigate the documentation of race and skin tone in action observation intervention for upper extremity recovery post-stroke.

DESIGN: In this critically appraised topic, the researcher screened all action observation systematic reviews for the post-stroke population published within the last five years.

METHOD: The computerized databases searched included Academic Search Ultimate, CINAHL Complete and MEDLINE Complete. Database search terms included ‘systematic review’, ‘action observation’, ‘upper extremity or upper limb’ and ‘stroke’. After screening all 15 articles, the key term ‘action observation’ was altered to be a required term in the title of the systematic review. Seven articles met the above criteria. One article was eliminated due to the analysis of multiple variables and five remained due to duplication. Each Systematic Review was screened for the following key terms: ‘race’, ‘skin’, ‘tone’, ‘ethnicity’ and ‘color’.

RESULTS: No articles contained any key terms except for one instance of ‘muscle tone’. All articles in the most recently published systematic review were also screened. Ten of the 19 studies were focused on lower extremity function post-stroke, while nine studies focused on upper extremity function post-stroke. None of the nine studies contained any of the key terms except in reference to the ‘color’ television used in intervention.

CONCLUSION: A lack of documentation of race and skin tone in action observation intervention was found. This could have an effect on cortical excitability and outcomes if the skin tone displayed is discordant to that of the study participant. This severe lack of commentary regarding the consideration of race/skin tone could be a missing key piece for effective action observation intervention. Future action observation studies should identify the race/skin tone displayed in the video recordings and document the race/skin tone of study participants in order to comment on concordance. It may be beneficial for the video recordings used in the intervention to be individualized to study participants based on factors such as race, skin tone and even gender. Such inclusivity may increase positive outcomes for participants.


Borges, L. R., Fernandes, A. B., Melo, L. P., Guerra, R. O., & Campos, T. F. (2018). Action observation for upper limb rehabilitation after stroke. The Cochrane database of systematic reviews, 10(10), CD011887.

Fu, J., Zeng, M., Shen, F., Cui, Y., Zhu, M., Gu, X., & Sun, Y. (2017). Effects of action observation therapy on upper extremity function, daily activities and motion evoked potential in cerebral infarction patients. Medicine, 96(42), e8080.

Ryan, D., Fullen, B., Rio, E., Segurado, R., Stokes, D., & O'Sullivan, C. (2021). Effect of Action Observation Therapy in the Rehabilitation of Neurologic and Musculoskeletal Conditions: A Systematic Review. Archives of rehabilitation research and clinical translation, 3(1), 100106.