Action Observation Training Group Research Articles

The inertial-based gait normalcy index of dual task cost during turning quantifies gait automaticity improvement in early-stage Parkinson’s rehabilitation

BackgroundThe loss of gait automaticity is a key cause of motor deficits in Parkinson’s disease (PD) patients, even at the early stage of the disease. Action observation training (AOT) shows promise in enhancing gait automaticity. However, effective assessment methods are lacking. We aimed to propose a novel gait normalcy index based on dual task cost (NIDTC) and evaluate its validity and responsiveness for early-stage PD rehabilitation.MethodsThirty early-stage PD patients were recruited and randomly assigned to the AOT or active control (CON) group. The proposed NIDTC during straight walking and turning tasks and clinical scale scores were measured before and after 12 weeks of rehabilitation. The correlations between the NIDTCs and clinical scores were analyzed with Pearson correlation coefficient analysis to evaluate the construct validity. The rehabilitative changes were assessed using repeated-measures ANOVA, while the responsiveness of NIDTC was further compared by t tests.ResultsThe turning-based NIDTC was significantly correlated with multiple clinical scales. Significant group-time interactions were observed for the turning-based NIDTC (F = 4.669, p = 0.042), BBS (F = 6.050, p = 0.022) and PDQ-39 (F = 7.772, p = 0.011) tests. The turning-based NIDTC reflected different rehabilitation effects between the AOT and CON groups, with the largest effect size (p = 0.020, Cohen’s d = 0.933).ConclusionThe turning-based NIDTC exhibited the highest responsiveness for identifying gait automaticity improvement by providing a comprehensive representation of motor ability during dual tasks. It has great potential as a valid measure for early-stage PD diagnosis and rehabilitation assessment.Trial registration Chinese Clinical Trial Registry: ChiCTR2300067657

Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy.

This study presents the results of a randomized controlled trial utilizing a 2 x 2 factorial design, comparing the effects of repeated transcranial magnetic stimulation (rTMS) and action observation training (AOT) intervention methods on spasticity, balance function, and motor function in children with spastic cerebral palsy (SCP). The study aimed to investigate whether the combination of the two interventions produces greater improvement than either treatment alone or conventional treatment. Subject children in this study, in accordance with the random number table, were randomly divided into four groups: conventional group, rTMS group, AOT group, and combined intervention group. All the children in the four groups received conventional rehabilitation treatment, on the basis of which they were given different therapeutic programs of rehabilitation measures. The conventional group had no other treatment while the rTMS group received rTMS, the AOT group received AOT and the combined intervention group was given a combined intervention of rTMS and AOT. They were trained five days per week for 12 weeks. Changes in scores of spasticity, balance function, walking ability, and gross motor function were assessed at the onset of the training program and upon completion of 12 weeks of treatment. A total of 64 Children with SCP completed the study, and their results were analyzed. The total gross motor function efficiency of 87.50% in the experimental group was significantly higher than that of 25.00% in the conventional group, 62.50% in the rTMS group, and 68.75% in the AOT group. The preliminary results showed that combined intervention of rTMS and AOT could effectively improve the balance function and motor function of children, and the therapeutic effect of the combined intervention was better than that of conventional treatment, rTMS or AOT alone. Finally, clinical efficacy and optimal treatment parameters of the combined intervention were clarified to provide a clinical basis for therapists to conduct lower limb function rehabilitation for children with SCP.

Effect of Action Observation Training and Bimanual Arm Training on Hand Function for Children with Hemiparetic Cerebral Palsy

Background: The background of the study focuses on addressing the challenges in hand function that thesechildren face due to their condition. Action observation training aims to leverage the brain’s mirror neuronsystem to improve motor skills by observing and imitating actions. Bimanual arm training involves coordinatedmovement of both arms to enhance functional abilities.Purpose: The study compared the effects of action observation training and bimanual arm training on handfunction in children with hemiparetic cerebral palsy.Materials and Methods: A total of 30 children were chosen according to the inclusion and exclusion criteria. Thesubjects were separated into two groups: action observation training (AOT) and bimanual arm training (BAT). TheFugl Meyer assessment scale (FMA) and the Box and Block test (BBT) were used for evaluating the result.Results: Both groups were homogenous at baseline, with a p value of 0.7866 in FMA and 0.6002 in BBT. Theresult of this study demonstrated that the action observation training group showed a better improvement thanbimanual arm training with a p value of < 0.0001.Conclusion: This study concluded that AOT improved hand function in cerebral palsy children.

The capacity of action observation to drag the trainees' motor pattern toward the observed model

Action Observation Training (AOT) promotes the acquisition of motor abilities. However, while the cortical modulations associated with the AOT efficacy are well known, few studies investigated the AOT peripheral neural correlates and whether their dynamics move towards the observed model during the training. We administered seventy-two participants (randomized into AOT and Control groups) with training for learning to grasp marbles with chopsticks. Execution practice was preceded by an observation session, in which AOT participants observed an expert performing the task, whereas controls observed landscape videos. Behavioral indices were measured, and three hand muscles' electromyographic (EMG) activity was recorded and compared with the expert. Behaviorally, both groups improved during the training, with AOT outperforming controls. The EMG trainee-model similarity also increased during the training, but only for the AOT group. When combining behavioral and EMG similarity findings, no global relationship emerged; however, behavioral improvements were "locally" predicted by the similarity gain in muscles and action phases more related to the specific motor act. These findings reveal that AOT plays a magnetic role in motor learning, attracting the trainee's motor pattern toward the observed model and paving the way for developing online monitoring tools and neurofeedback protocols.

The value of corticospinal excitability and intracortical inhibition in predicting motor skill improvement driven by action observation

The observation of other's actions represents an essential element for the acquisition of motor skills. While action observation is known to induce changes in the excitability of the motor cortices, whether such modulations may explain the amount of motor improvement driven by action observation training (AOT) remains to be addressed. Using transcranial magnetic stimulation (TMS), we first assessed in 41 volunteers the effect of action observation on corticospinal excitability, intracortical inhibition, and transcallosal inhibition. Subsequently, half of the participants (AOT-group) were asked to observe and then execute a right-hand dexterity task, while the controls had to observe a no-action video before practicing the same task. AOT participants showed greater performance improvement relative to controls. More importantly, the amount of improvement in the AOT group was predicted by the amplitude of corticospinal modulation during action observation and, even more, by the amount of intracortical inhibition induced by action observation. These relations were specific for the AOT group, while the same patterns were not found in controls. Taken together, our findings demonstrate that the efficacy of AOT in promoting motor learning is rooted in the capacity of action observation to modulate the trainee's motor system excitability, especially its intracortical inhibition. Our study not only enriches the picture of the neurophysiological effects induced by action observation onto the observer's motor excitability, but linking them to the efficacy of AOT, it also paves the way for the development of models predicting the outcome of training procedures based on the observation of other's actions.

The effect of first-person perspective action observation training on upper extremity function and activity of daily living of chronic stroke patients.

The purpose of this study was to investigate the effects of First‐Person Perspective Action Observation training and Third‐Person Perspective Action Observation training on upper extremity function and activities of daily living of patients with stroke‐induced hemiplegia.This was a single‐blind randomized study of 20 stroke patients (more than 6 months after the incident stroke) with upper extremity disabilities. The subjects who satisfied the inclusion and exclusion criteria were randomly divided into two groups: First‐Person Perspective Action Observation training group and Third‐Person Perspective Action Observation training group. The measurements were performed using Action Research Arm Test (ARAT) and Korean Modified Barthel Index (K‐MBI) and Motor Activity Log (MAL).The results of this study showed statistically significant differences (p < .05) in the upper extremity function and activity of daily living after the intervention in all two groups. Upon comparison of the amount of change between the experimental group and the control group, there was significant difference in upper extremity function and activity of daily living (p < .05).Action Observation training was found to have an effect on the upper extremity function and activity of daily living on chronic stroke patients. First‐Person Perspective Action Observation training was more effective in improving upper limb function and activity of daily living than the Third‐Person Perspective Action Observation training.

The Effects of Video Modeling Training and Action Observation Training on Balance and Gait of Stroke Patients

The purpose of this study was to apply video self-modeling training and action observation training to stroke patients and to investigate the effectiveness of the two different trainings on balance and gait. After random arrangement of 12 people in the video self-modeling training group and 12 people in the action observation training group for stroke patients, each walking-related video was observed for 5 minutes and then 20 minutes of related physical training was performed 3 times a week for 4 weeks before and after the intervention. As a result, there was a statistically significant difference in the TUG of the video self-modeling training group before and after the intervention in the video self-modeling training group and the action observation training group, and there was no statistically significant difference between the groups. The result of this study is that video self-modeling training and action observation training are intervention methods that have a positive effect on the balance and gait of stroke patients. It is considered that various studies on video self-modeling training are needed in the future.

Efficacy of Action Observation for Upper Limb Motor Deficit in Acute Stroke Participants

Introduction: Action Observation (AO) is a multisensory approach encompassing motor, somatosensory and cognitive rehabilitation. Several Studies have proved the effects of action observation on recovery of motor functions in chronic stroke survivors. However, the effect of action observation strategy on acute stroke participants remains unclear. The objective of this study was to find out the effectiveness of action observation to improve upper limb function in acute stroke.&#x0D; Methods: 28 acute stoke participants were selected based on inclusion and exclusion criteria and randomly assigned into two groups based on computer generated randomization. Action observation training group (AO) received action observation training and conventional group received conventional physiotherapy. Both the groups received 45 minutes session per day for the total duration of 10 days.&#x0D; Results: Upper limb functions were measured using Fugl Myer upper limb component (FMA) and action research arm test (ARAT)at the baseline and after the intervention. Compared with the conventional training group, AO group showed significant improvement in ARAT but no significant difference between the groups in FMA.&#x0D; Conclusion: In conclusion Action observation treatment may become a useful strategy in rehabilitation of acute stroke participants.

Effect of Action Observation Training on Spasticity, Gross Motor Function, and Balance in Children with Diplegia Cerebral Palsy.

This study evaluated the effect of action observation training on spasticity, gross motor function, and balance in children with spastic diplegia cerebral palsy. Eighteen children with cerebral palsy participated in this study. The participants were randomized into the action observation training group (n = 9) and a control group (n = 9). The action observation training group repeatedly practiced the action with their motor skills, while the control group practiced conventional physical therapy. Both groups received 30 min sessions, 3 days a week, for 6 weeks. To confirm the effects of intervention, the spasticity, gross motor function measurement (GMFM), and pediatric reaching test (PRT) were evaluated. The results showed that in the plantar flexor contracture test of both sides, the Modified Tardieu Scale (MTS) of the right side of knee joints, GMFM-B, C, and D were significantly increased between pre- and post-intervention within both groups (p < 0.05). PRT was significantly increased between pre- and post-intervention within the both groups (p < 0.05), and there was a significant difference between the two groups (p < 0.05). These results suggest that action observation training is both feasible and beneficial for improving spasticity, gross motor function, and balance in children with spastic diplegia cerebral palsy.

Randomized controlled trial combining constraint-induced movement therapy and action-observation training in unilateral cerebral palsy: clinical effects and influencing factors of treatment response.

Introduction:Constraint-induced movement therapy (CIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). As these children also show motor planning deficits, action-observation training (AOT) might be of additional value. Here, we investigated the combined effect of AOT to CIMT and identified factors influencing treatment response.Methods:A total of 44 children with uCP (mean 9 years 6 months, SD 1 year 10 months) participated in a 9-day camp wearing a splint for 6 h/day and were allocated to the CIMT + AOT (n = 22) and the CIMT + placebo group (n = 22). The CIMT + AOT group received 15 h of AOT (i.e. video-observation) and executed the observed tasks, whilst the CIMT + AOT group watched videos free of biological motion and executed the same tasks. The primary outcome measure was bimanual performance. Secondary outcomes included measures of body function and activity level assessed before (T1), after the intervention (T2), and at 6 months follow-up (T3). Influencing factors included behavioural and neurological characteristics.Results:Although no between-groups differences were found (p > 0.05; η2 = 0–16), the addition of AOT led to higher gains in children with initially poorer bimanual performance (p = 0.02; η2 = 0.14). Both groups improved in all outcome measures after the intervention and retained the gains at follow up (p < 0.01; η2 = 0.02–0.71). Poor sensory function resulted in larger improvements in the total group (p = 0.03; η2 = 0.25) and high amounts of mirror movements tended to result in a better response to the additional AOT training (p = 0.06; η2 = 0.18). Improvements were similar irrespective of the type of brain lesion or corticospinal tract wiring pattern.Conclusions:Adding AOT to CIMT, resulted in a better outcome for children with poor motor function and high amounts of mirror movements. CIMT with or without AOT seems to be more beneficial for children with poor sensory function.Trial registration:Registered at ClinicalTrials.gov on 22nd August 2017 (ClinicalTrials.gov identifier: NCT03256357).

Influence of Transcranial Direct Current Stimulation on Lower Limb Muscle Activation and Balance Ability in Soccer Player

Purpose: This study is to investigate influence of tDCS on lower limb muscle activity and balance ability in soccer player. Methods: Sessions were conducted with 15 subjects in tDCS group and 15 in action observation training group for 20 minutes, 5 sessions a week, for 8 weeks. All soccer players underwent 30 minutes of plyometric training before main exercise. To evaluate lower limb muscle activation, rectus femoris and biceps femoris were taken measure using surface electromyogram system and to evaluate balance ability, surface area, whole path length, limited of stability were measured using biorescue. Results: Regarding balance shown in surface area, whole path length, limited of stability and muscle activation in rectus femoris and biceps femoris, tDCS group showed more significant change than action bservation training group. Conclusion: Therefore, intervention using tDCS is more effective in improving lower limb muscle activation and balance ability than action observation training.

Functional and structural plasticity following action observation training in multiple sclerosis

Background: Hand motor deficits contribute to multiple sclerosis (MS)-related disability. Action observation training (AOT) is promising to improve upper limb function in neurologic patients. Objectives: In this preliminary study, we investigated AOT effects on dominant-hand motor performance in MS patients with upper limb motor impairment and performed an explorative analysis of their anatomical and functional magnetic resonance imaging (MRI) substrates. Methods: In total, 46 healthy controls (HC) and 41 MS patients with dominant-hand motor impairment were randomized to AOT (HC-AOT = 23; MS-AOT = 20; watching daily-life action videos and execution) or control-training (HC-Control = 23; MS-Control = 21; watching landscapes videos and execution). Behavioral, structural, and functional (at rest and during object manipulation) MRI scans were acquired before and after a 2-week training. Results: After training, MS groups improved in right upper limb functions, mainly in AOT group (p from 0.02 to 0.0001). All groups showed regional increased and decreased gray matter volume, with specific AOT effects in fronto-temporal areas in MS-AOT (p < 0.001), without white matter (WM) integrity modifications. Increased and reduced recruitments of the action observation matching system and its connections in MS-AOT were found (p < 0.001). Motor improvements were correlated with volumetric and functional MRI modifications (r from −0.78 to 0.77, p < 0.001). Conclusion: The 10-day AOT promotes clinical improvements in MS patients through structural and functional modifications of the action observation matching system.

Effect of Group-Based Rehabilitation Combining Action Observation with Physiotherapy on Freezing of Gait in Parkinson's Disease.

Freezing of gait (FoG) is among the most disabling symptoms of Parkinson's disease (PD) patients. Recent studies showed that action observation training (AOT) with repetitive practice of the observed actions represents a strategy to induce longer-lasting effects compared with standard physiotherapy. We investigated whether AOT may improve FoG and mobility in PD, when AOT is applied in a group-based setting. Sixty-four participants with PD and FoG were assigned to the experimental (AO) or control groups and underwent a 45-minute training session, twice a week, for 5 weeks. AOT consisted in physical training combined with action observation whereas the control group executed the same physical training combined with landscape-videos observation. Outcome measures (FoG questionnaire, Timed Up and Go test, 10-meter walking test, and Berg balance scale) were evaluated before training, at the end of training, and 4 weeks later (FU-4w). Both groups showed positive changes in all outcome measures at posttraining assessment. Improvements in FoG questionnaire, Timed Up and Go test, and Berg balance scale were retained at FU-4w evaluation only in the AOT group. AOT group-based training is feasible and effective on FoG and motor performance in PD patients and may be introduced as an adjunctive option in PD rehabilitation program.

A Systematic Investigation of the Effect of Action Observation Training and Motor Imagery Training on the Development of Mental Representation Structure and Skill Performance.

Action observation training and motor imagery training have independently been studied and considered as an effective training strategy for improving motor skill learning. However, comparative studies of the two training strategies are relatively few. The purpose of this study was to investigate the effects of action observation training and motor imagery training on the development of mental representation structure and golf putting performance as well as the relation between the changes in mental representation structure and skill performance during the early learning stage. Forty novices were randomly assigned to one of four groups: action observation training, motor imagery training, physical practice and no practice. The mental representation structure and putting performance were measured before and after 3 days of training, then after a 2-day retention period. The results showed that mental representation structure and the accuracy of the putting performance were improved over time through the two types of cognitive training (i.e., action observation training and motor imagery training). In addition, we found a significant positive correlation between changes in mental representation structure and skill performance for the action observation training group only. Taken together, these results suggest that both cognitive adaptations and skill improvement occur through the training of the two simulation states of action, and that perceptual-cognitive changes are associated with the change of skill performance for action observation training.

The effects of action observation training and mirror therapy on gait and balance in stroke patients.

[Purpose] The aim of this study was to evaluate the effects of action observation training and mirror therapy to improve on balance and gait function of stroke patients. [Subjects and Methods] The participants were randomly allocated to one of three groups: The action observation training with activity group practiced additional action observation training with activity for three 30-minute session for six weeks (n=12). The mirror therapy with activity group practiced additional mirror therapy with activity for three 30-minute sessions for six weeks (n=11). The only action observation training group practiced additional action observation training for three 30-minute sessions for weeks (n=12). All groups received conventional therapy for five 60-minute sessions over a six-week period. [Results] There were significant improvements in balance and gait function. The action observation training with activity group significantly improved subjects’ static balance. The action observation training with activity group and the mirror therapy with activity group significantly improved subjects’ gait ability. [Conclusion] The activation of mirror neurons combined with a conventional stroke physiotherapy program enhances lower-extremity motor recovery and motor functioning in stroke patients.

Brain plasticity in Parkinson's disease with freezing of gait induced by action observation training.

Gait disorders represent a therapeutic challenge in Parkinson's disease (PD). This study investigated the efficacy of 4-week action observation training (AOT) on disease severity, freezing of gait and motor abilities in PD, and evaluated treatment-related brain functional changes. 25 PD patients with freezing of gait were randomized into two groups: AOT (action observation combined with practicing the observed actions) and "Landscape" (same physical training combined with landscape-videos observation). At baseline and 4-week, patients underwent clinical evaluation and fMRI. Clinical assessment was repeated at 8-week. At 4-week, both groups showed reduced freezing of gait severity, improved walking speed and quality of life. Moreover, AOT was associated with reduced motor disability and improved balance. AOT group showed a sustained positive effect on motor disability, walking speed, balance and quality of life at 8-week, with a trend toward a persisting reduced freezing of gait severity. At 4-week vs. baseline, AOT group showed increased recruitment of fronto-parietal areas during fMRI tasks, while the Landscape group showed a reduced fMRI activity of the left postcentral and inferior parietal gyri and right rolandic operculum and supramarginal gyrus. In AOT group, functional brain changes were associated with clinical improvements at 4-week and predicted clinical evolution at 8-week. AOT has a more lasting effect in improving motor function, gait and quality of life in PD patients relative to physical therapy alone. AOT-related performance gains are associated with an increased recruitment of motor regions and fronto-parietal mirror neuron and attentional control areas.

The Effect of Treadmill Training Applied Simultaneously with Action Observation on Walking Ability in Chronic Stroke Patients

Purpose: To investigate the effect of treadmill training applied simultaneously with gait related action observation on walking ability in chronic stroke patients. Methods: Sixteen chronic stroke patients participated in this study. Participants were randomly allocated into either the treadmill applied simultaneously with action observation training group (TAG) or treadmill applied simultaneously with landscape observation training group (TLG). The participants in both group underwent treadmill training for four weeks (a total of twelve minute, once a day, three times weekly for a four week period). All participants were measured to gait speed (10 m walking test, 10 MWT), gait endurance (6 minute walk distance, 6 MWD), dynamic gait index (DGI). In order to assure the statistical significance of the results, we used for SPSS 15.0 for windows. The Wilcoxon signed ranks test was used to compare pre-test and post-test result, and the Mann-Whitney U-test was employed for comparison between groups. Results: The 10 MWT, 6 MWD, DGI was significantly different between the TAG and the TLG group. Conclusion: According the results of this study, treadmill applied simultaneously with action observation (TAG) is effective intervention for improvement of walking ability in chronic stroke patient.

The Effect of Action Observation Training on Sit to Walk with Chronic Stroke Patients

Purpose: This study was performed to examine the effect of action observation training on sit to-walk times in chronic stroke patients. Methods: Twelve stroke patients were randomly allocated to two groups, as follows: an action observation training (AOT) group and a scenery picture observation (SPO) group. The AOT group was engaged in video observation for 2 minutes 30 seconds with 12 ADL functional activities related to the sit-to–walk task: physical training was carried out in two repetitions lasting 2 minutes 30 seconds. The landscape imagery control group observed landscape picture for 2 minutes 30 seconds and then carried out the same physical training. The intervention involved a total of 12 sessions over 4 weeks, and each session lasted 30 minutes. The pre and post-tests measured the timed up and go test (TUG), Sit to stand test (STS), and Dynamic gait index (DGI). The Wilcoxon signed ranks test was used to compare pre-test and post-test result, and the Mann-Whitney U test was employed for comparison between groups. Results: The TUG time was significantly different between the AOT group and the SPO group. According to the findings, the experimental group’s TUG was significantly decreased (p<0.05). In comparison of the two groups, there was no significant in STS or DGI between the AOT group and SPO group. Conclusion: This study showed that the intervention can be used to decrease TUG time. Our research suggests that action observation training has a positive effect on sit-to-walk times in patients with chronic stroke.

The effect of action observation training on knee joint function and gait ability in total knee replacement patients.

The purpose of this study is to investigate that effect of action observation training (AOT) on knee joint function and balance in total knee replacement (TKR) patients. The subjects consisted of eighteen post-TKR patients. All participants underwent conventional physical therapy. In addition, patients in the AOT group (n= 9) were asked to observe video clips showing daily actions and to imitate them afterward. Patients in the control group (n= 9) were asked to execute the same actions as patients in the AOT group. Outcome measures Western Ontario and Mc-Master Universities Osteoarthritis Index (WOMAC) included pain, stiffness, function and Timed Up and Go (TUG) test. After intervention, patients in the AOT group score better than patients in the control group. After TUG test, patients in the AOT group and control group were no significant difference between two groups. In addition to conventional physical therapy, AOT is effective in the rehabilitation of post-TKR patients. Action observation training is considered conducive to improving knee functions and ameliorating pain and stiffness, of patients who underwent TKR.

Action observation training for functional activities after stroke: A pilot randomized controlled trial

The objective of this study was to compare the effects of action observation training and motor imagery training on recovery from chronic stroke. Thirty patients who were more than six months post stroke participated in this study and were randomly allocated to three groups. The action observation training group practiced additional action observation training for five 30-minute sessions over a four-week period. The motor imagery training group practiced additional motor imagery training for five 30-minute sessions over a four-week period. The following clinical measures were used for assessment of dynamic balance and gait abilities: Timed Up and Go Test, Functional Reaching Test, Walking Ability Questionnaire, and Functional Ambulation Category. Spatiotemporal gait parameters were also collected using a GAITRite system. Compared with the physical training group, the action observation training group showed significant improvement in the Timed Up and Go test, gait speed, cadence, and single limb support of the affected side. No significant differences in any of the outcome measures were observed between the action observation training group and the motor imagery training group. Action observation training and motor imagery training results in improvement of dynamic balance and gait ability. These results suggest the feasibility and suitability of action observation training for patients with chronic stroke.