Postural and Balance Disorders in Patients with Parkinson's Disease: A Prospective Open-Label Feasibility Study with Two Months of Action Observation Treatment.

Andrea Santamato,Nicoletta Cinone,Maurizio Ranieri,Antonio Greco,Lucia Anna Stuppiello,Jula Laura De Sanctis,Vincenzo Solfrizzi,Davide Seripa,Francesco Panza,Francesca Fortunato,Giovanni Valeno

doi:10.1155/2015/902738

Abstract

Action observation treatment has been proposed as therapeutic option in rehabilitation of patients affected by Parkinson's disease (PD) to improve freezing of gait episodes. The purpose of this prospective open-label feasibility study was to evaluate the impact of 8-week action observation training (video-therapy) for the treatment of postural instability and balance impairment in PD patients. Fifteen PD patients aged under 80 years with scores of 1 to 3 on the Hoehn and Yahr staging and without evidence of freezing of gait were recruited. They underwent 24 sessions of video-therapy training based on carefully watching video clips on motor tasks linked to balance, subsequently performing the same observed movements. No statistically significant differences were observed in the identified outcome measures with the Berg Balance Scale and the Activities-Specific Balance Confidence Scale after two months of follow-up. In the present study, a short course of action observation treatment seems to be not effective in reducing balance impairments and postural instability in patients affected by mild to moderate PD. Further studies with larger samples, longer follow-up period, and standardized protocols of action observation treatment are needed to investigate the effects of this rehabilitation technique in the management of postural and balance disorders of PD patients.

Highlights

Postural instability is one of the cardinal manifestations of Parkinson’s disease (PD) and becomes a clinical concern in the middle-later stages, usually occurring after the onset of other clinical features [1]
In the present prospective open-label feasibility study, we aimed to demonstrate the effect of action observation treatment (AOT) for postural instability and balance disorders in PD patients, as well as occurring of freezing of gait in these patients [10]
Previous studies showed the detection of changes in local fields potentials (LFP) recorded from the subthalamic nucleus in PD patients during the observation of a movement performed by another person, whereas no LFP signals were detected during the observation of a static image

Summary

Introduction

Postural instability is one of the cardinal manifestations of Parkinson’s disease (PD) and becomes a clinical concern in the middle-later stages, usually occurring after the onset of other clinical features [1]. Observation of action performed by others may activate in an observer the same neural network as when he/she performs the same action [6] These observations suggest that there is a common thread between observation and execution of movement through internalization of temporal sequences by the observer and activation of the same cortical motor areas. This assumption represents the neurophysiological rationale for AOT in patients suffering from neurological diseases. The purpose of the present prospective open-label feasibility study was to evaluate the effectiveness of AOT in improving postural and balance disorders and secondly to assess whether AOT could have a positive impact on selfconfidence in activities of daily life and risk of falls

Objectives

Methods

Results

Discussion

Conclusion