Action Imagery and Observation in Neurorehabilitation for Parkinson's Disease (ACTION-PD): Development of a User-Informed Home Training Intervention to Improve Functional Hand Movements.

Judith Bek,Emma Gowen,Stefan Vogt,Paul S Holmes,Matthew Sullivan,Jordan Webb,Trevor J Crawford,Zoë C Franklin,Chesney E Craig,Ellen Poliakoff

doi:10.1155/2021/4559519

Judith Bek, Emma Gowen + Show 8 more

Open Access

https://doi.org/10.1155/2021/4559519

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Abstract

Background Parkinson's disease (PD) causes difficulties with hand movements, which few studies have addressed therapeutically. Training with action observation (AO) and motor imagery (MI) improves performance in healthy individuals, particularly when the techniques are applied simultaneously (AO + MI). Both AO and MI have shown promising effects in people with PD, but previous studies have only used these separately. Objective This article describes the development and pilot testing of an intervention combining AO + MI and physical practice to improve functional manual actions in people with PD. Methods The home-based intervention, delivered using a tablet computer app, was iteratively designed by an interdisciplinary team, including people with PD, and further developed through focus groups and initial field testing. Preliminary data on feasibility were obtained via a six-week pilot randomised controlled trial (ISRCTN 11184024) of 10 participants with mild to moderate PD (6 intervention; 4 treatment as usual). Usage and adherence data were recorded during training, and semistructured interviews were conducted with participants. Exploratory outcome measures included dexterity and timed action performance. Results Usage and qualitative data provided preliminary evidence of acceptability and usability. Exploratory outcomes also suggested that subjective and objective performance of manual actions should be tested in a larger trial. The importance of personalisation, choice, and motivation was highlighted, as well as the need to facilitate engagement in motor imagery. Conclusions The results indicate that a larger RCT is warranted, and the findings also have broader relevance for the feasibility and development of AO + MI interventions for PD and other conditions.

Highlights

Beyond the more widely recognised difficulties with gait, balance, and gross motor functioning, Parkinson’s disease (PD) impairs fine motor skills including hand dexterity, which are needed for the successful performance of activities of daily living [1, 2]
PD affects the internal generation of action [10], external cues such as visual stimuli and auditory stimuli can help to elicit or control movement; this may relate to the relative preservation of goal-directed movement pathways, which compensate for impaired habitual or automatic processes [11]
Given the overlap in content of the interviews, data from the initial testing phase and the pilot randomised controlled trial (RCT) were combined for analysis, which used an inductive thematic approach [59]. emes are summarised in Table 2, and a more detailed analysis with illustrative quotes is provided in Supplementary Materials S3

Summary

Introduction

Beyond the more widely recognised difficulties with gait, balance, and gross motor functioning, Parkinson’s disease (PD) impairs fine motor skills including hand dexterity, which are needed for the successful performance of activities of daily living [1, 2]. PD affects the internal generation of action [10], external cues such as visual stimuli (e.g., floor markers) and auditory stimuli (e.g., rhythmic music) can help to elicit or control movement; this may relate to the relative preservation of goal-directed movement pathways, which compensate for impaired habitual or automatic processes [11] While such cues may be effective in improving gait parameters [12, 13], they are less applicable to the fine hand movements required for everyday functional actions. Training with action observation (AO) and motor imagery (MI) improves performance in healthy individuals, when the techniques are applied simultaneously (AO + MI) Both AO and MI have shown promising effects in people with PD, but previous studies have only used these separately. Conclusions. e results indicate that a larger RCT is warranted, and the findings have broader relevance for the feasibility and development of AO + MI interventions for PD and other conditions

Methods

Results

Conclusion