Action Observation Treatment Research Articles

Action observation treatment in children with cerebral palsy: a combined clinical and functional MRI activation study

Action observation treatment in children with cerebral palsy: a combined clinical and functional MRI activation study

Action observation for upper limb function after stroke: evidence-based review of randomized controlled trials.

[Purpose] The purpose of this study was to suggest evidenced information about action observation to improve upper limb function after stroke. [Methods] A systematic review of randomized controlled trials involving adults aged 18 years or over and including descriptions of action observation for improving upper limb function was undertaken. Electronic databases were searched, including MEDLINE, CINAHL, and PEDro (the Physiotherapy Evidence Database), for articles published between 2000 to 2014. Following completion of the searches, two reviewers independently assessed the trials and extracted data using a data extraction form. The same two reviewers independently documented the methodological quality of the trials by using the PEDro scale. [Results] Five randomized controlled trials were ultimately included in this review, and four of them (80%) reported statistically significant effects for motor recovery of upper limb using action observation intervention in between groups. [Conclusion] This review of the literature presents evidence attesting to the benefits conferred on stroke patints resulting from participation in an action observation intervention. The body of literature in this field is growing steadily. Further work needs to be done to evaluate the evidence for different conditions after stroke and different duration of intervention.

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

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.

Action observation treatment: a novel tool in neurorehabilitation.

This review focuses on a novel rehabilitation approach known as action observation treatment (AOT). It is now a well-accepted notion in neurophysiology that the observation of actions performed by others activates in the perceiver the same neural structures responsible for the actual execution of those same actions. Areas endowed with this action observation-action execution matching mechanism are defined as the mirror neuron system. AOT exploits this neurophysiological mechanism for the recovery of motor impairment. During one typical session, patients observe a daily action and afterwards execute it in context. So far, this approach has been successfully applied in the rehabilitation of upper limb motor functions in chronic stroke patients, in motor recovery of Parkinson's disease patients, including those presenting with freezing of gait, and in children with cerebral palsy. Interestingly, this approach also improved lower limb motor functions in post-surgical orthopaedic patients. AOT is well grounded in basic neuroscience, thus representing a valid model of translational medicine in the field of neurorehabilitation. Moreover, the results concerning its effectiveness have been collected in randomized controlled studies, thus being an example of evidence-based clinical practice.

Brain repair after stroke--a novel neurological model.

Following stroke, patients are commonly left with debilitating motor and speech impairments. This article reviews the state of the art in neurological repair for stroke and proposes a new model for the future. We suggest that stroke treatment--from the time of the ictus itself to living with the consequences--must be fundamentally neurological, from limiting the extent of injury at the outset, to repairing the consequent damage. Our model links brain and behaviour by targeting brain circuits, and we illustrate the model though action observation treatment, which aims to enhance brain network connectivity. The model is based on the assumptions that the mechanisms of neural repair inherently involve cellular and circuit plasticity, that brain plasticity is a synaptic phenomenon that is largely stimulus-dependent, and that brain repair required both physical and behavioural interventions that are tailored to reorganize specific brain circuits. We review current approaches to brain repair after stroke and present our new model, and discuss the biological foundations, rationales, and data to support our novel approach to upper-extremity and language rehabilitation. We believe that by enhancing plasticity at the level of brain network interactions, this neurological model for brain repair could ultimately lead to a cure for stroke.

Effectiveness of an interactive robot for the rehabilitation of the upper limb in children with cerebral palsy: A randomised single-blind controlled trial

movement. Method.– Eighteen patients with clinical HCP (fourteen males, mean age 14 years and 2 months, aged 6 years 10 months to 20 years 10 months) participated in the study. Using fMRI block design, brain activation following passive simple opening-closing hand movement of either the paretic or nonparetic hand with simultaneous observation of a similar movement performed by either the left or right hand of an actor was examined. Results.– Passive movement of the paretic hand performed simultaneously to the observation of congruent movement (‘‘anatomic imitation’’) activated more ‘‘higher motor areas’’, including contralesional pre-supplementary motor area, superior frontal gyrus (extending to premotor cortex), and superior and inferior parietal regions than non video-guided passive movement of the paretic hand. Passive movement of the paretic hand recruited more ipsilesional sensorimotor areas compared to passive movement of the non paretic hand. Conclusion.– Our study showed in HCP that the combination of observation of congruent hand movement simultaneously to actual passive movement of the paretic hand recruits more higher motor areas than nonvideo-guided passive movement of the paretic hand. Our study gives neuronal findings to propose video-guided passive movement of paretic hand in CP. Further Reading Ertelt, D et al. Observation and execution of upper-limb movements as a tool for rehabilitation of motor deficits in paretic stroke patients: protocol of a randomized clinical trial. BioMed Central Neurol 2012;12;42. Buccino, G. et al. Improving upper limb motor functions through action observation treatment: a pilot study in children with cerebral palsy. Dev Med Child Neurol 2012;54(9),822-828.

P 91. Physiologic mechanism of motor learning induced by action observation

Our previous report ( Nojima et al., 2012 ) indicated that repetitive training with mirror visual feedback can improve the motor performance of the non-moving hand and facilitate the primary motor cortex (M1) function. However, that experiment could not rule out the influence of the intermanual transfer from the training hand on motor learning of the non-moving hand. Therefore, we executed the present study to elucidate how a visual feedback itself works on the motor performance and cortical excitability. We used transcranial magnetic stimulation (TMS) to evaluate the plastic changes of the excitability of the right M1 by action observation (AO). Twenty-one neurologically healthy subjects were participated in this experiment. Each subject was asked to rotate two cork-balls in a counter-clockwise direction with the left hand as fast as possible before and after the intervention, and the number of ball-rotation was counted for 30 s. Subjects were assigned to the AO group (n = 11) and the control group (n = 10), respectively. AO intervention was executed placing PC monitor over subject’s left hand. For the control cocndition, subjects watch the stationary hand picture instead of motion picture. To measure the effect of the intervention on the excitability of M1, motor evoked potentials (MEP) and short intracortical inhibition (SICI), intracortical facilitation (ICF) were obtained from the left first dorsal interosseous (FDI) muscle. The pre/post ratio of the number of ball rotation in the AO group was significantly larger than that of the control group. With regard to functional changes of M1, the mean MEP amplitude and the ICF for the left FDI revealed significant increase after intervention in the AO group but not in the control group. In addition, there was a significant positive correlation between behavioral improvement and the subjective strength of kinesthetic illusion. The present results showed that the visual image of the moving hand significantly improved the motor performance of the left hand and increased the excitability of M1 regardless of actual movement of target hand. Especially, it was suggested that this behavioral improvement was associated with the facilitation of the excitatory function of corticospinal pathway since ICF was significantly increased by AO intervention. This plastic change in M1 might be associated with the subjective kinesthetic illusion. This approach may be a promising tool to improve motor performance as rehabilitation.

Improving upper limb motor functions through action observation treatment: a pilot study in children with cerebral palsy

The aim of this randomized controlled trial was to assess whether action observation treatment may improve upper limb motor functions in children with cerebral palsy (CP). All children with CP admitted to our unit for rehabilitation from May 2009 to May 2010 were eligible. Inclusion criteria were age between 6 years and 11 years, an IQ of at least 70, and no major visual and/or auditory deficits. Fifteen children were enrolled and randomly assigned to either a case group (n=8; four males, four females; median age 7 y 6 mo) or control group (n=7; five males, two females; median age 8 y). Six participants had left-sided hemiplegia, six right-sided hemiplegia, and three had tetraplegia; 10 were independent walkers. Those in the case group were asked to observe video clips showing daily age-appropriate actions, and afterwards to imitate them. Participants in the control group were asked to observe video clips with no motor content and afterwards to execute the same actions as cases. The primary outcome measure was the Melbourne Assessment Scale. Children were scored twice at baseline (2 wks apart), and at the end of treatment, by a physician blind to group assignment. At baseline groups did not differ on functional evaluation. After treatment, the functional score gain (Δ) was significantly different in the case and control groups (p=0.026). The present results support the notion that action observation treatment can be an effective part of the rehabilitation programme in children with CP.

The role of inhibition in action observation treatment

This commentary is on the original article by Buccino et al. on pages 822‐828 of this issue.

Walking but not barking improves verb recovery: implications for action observation treatment in aphasia rehabilitation.

Recent studies have shown that action observation treatment without concomitant verbal cue has a positive impact on the recovery of verb retrieval deficits in aphasic patients. In agreement with an embodied cognition viewpoint, a hypothesis has been advanced that gestures and language form a single communication system and words whose retrieval is facilitated by gestures are semantically represented through sensory-motor features. However, it is still an open question as to what extent this treatment approach works. Results from the recovery of motor deficits have suggested that action observation promotes motor recovery only for actions that are part of the motor repertoire of the observer. The aim of the present experiment was to further investigate the role of action observation treatment in verb recovery. In particular, we contrasted the effects induced by observing human actions (e.g. dancing, kicking, pointing, eating) versus non human actions (e.g. barking, printing). Seven chronic aphasic patients with a selective deficit in verb retrieval underwent an intensive rehabilitation training that included five daily sessions over two consecutive weeks. Each subject was asked to carefully observe 115 video-clips of actions, one at a time and, after observing them, they had to produce the corresponding verb. Two groups of actions were randomly presented: humans versus nonhuman actions. In all patients, significant improvement in verb retrieval was found only by observing video-clips of human actions. Moreover, follow-up testing revealed long-term verb recovery that was still present two months after the two treatments had ended. In support of the multimodal concept representation's proposal, we suggest that just the observation of actions pertaining to the human motor repertoire is an effective rehabilitation approach for verb recovery.

동작관찰이 뇌졸중 환자의 환측 상지 기민성에 미치는 영향 : 단일사례연구

Purpose : The purpose of present study was to determine effects of action observation training on upper limb function after stroke. Training was progressed to imitation and intensive training after observation to required action in ADL. Methods : Among the single case study was used to ABA design. pre base line(A) was only collected participant information without intervention in 5 times. action observation intervention(B) was carried out 10 times and 5 times to base lime(A) after intervention. Results : Results indicated that 10-second test, box and block test, manual function test was increased when compared action observation intervention(B) to pre base line(A). Conclusion : To stroke action observation training was evaluated gross manipulation, dexterity and upper limb function in related with ADL. action observation training benefits were maintained after intervention(B) and showed improvement on upper limb function of stroke.

Action observation treatment improves autonomy in daily activities in Parkinson's disease patients: Results from a pilot study

Action observation treatment improves autonomy in daily activities in Parkinson's disease patients: Results from a pilot study

Action Observation Treatment Improves Recovery of Postsurgical Orthopedic Patients: Evidence for a Top-Down Effect?

Bellelli G, Buccino G, Bernardini B, Padovani A, Trabucchi M. Action observation treatment improves recovery of postsurgical orthopedic patients: evidence for a top-down effect? Objective To assess whether action observation treatment (AOT) may also improve motor recovery in postsurgical orthopedic patients, in addition to conventional physiotherapy. Design Randomized controlled trial. Setting Department of rehabilitation. Participants Patients (N=60) admitted to our department postorthopedic surgery were randomly assigned to either a case (n=30) or control (n=30) group. Exclusion criteria were age 18 years or younger and 90 years or older, Mini-Mental State Examination score of 21 of 30 or lower, no ambulating order, advanced vision impairment, malignancy, pneumonia, or heart failure. Interventions All participants underwent conventional physiotherapy. In addition, patients in the case group were asked to observe video clips showing daily actions and to imitate them afterward. Patients in the control group were asked to observe video clips with no motor content and to execute the same actions as patients in the case group afterward. Participants were scored on functional scales at baseline and after treatment by a physician blinded to group assignment. Main Outcomes Measures Changes in FIM and Tinetti scale scores, and dependence on walking aids. Results At baseline, groups did not differ in clinical and functional scale scores. After treatment, patients in the case group scored better than patients in the control group (FIM total score, P=.02; FIM motor subscore, P=.001; Tinetti scale score, P=.04); patients in the case group were assigned more frequently to 1 crutch ( P=.01). Conclusions In addition to conventional physiotherapy, AOT is effective in the rehabilitation of postsurgical orthopedic patients. The present results strongly support top-down effects of this treatment in motor recovery, even in nonneurologic patients.