Action Observation and Motor Imagery: Innovative Cognitive Tools in the Rehabilitation of Parkinson’s Disease

Abstract

Parkinson's disease (PD) is characterized by a progressive impairment of motor skills with deterioration of autonomy in daily living activities. Physiotherapy is regarded as an adjuvant to pharmacological and neurosurgical treatment and may provide small and short-lasting clinical benefits in PD patients. However, the development of innovative rehabilitation approaches with greater long-term efficacy is a major unmet need. Motor imagery (MI) and action observation (AO) have been recently proposed as a promising rehabilitation tool. MI is the ability to imagine a movement without actual performance (or muscle activation). The same cortical-subcortical network active during motor execution is engaged in MI. The physiological basis of AO is represented by the activation of the “mirror neuron system.” Both MI and AO are involved in motor learning and can induce improvements of motor performance, possibly mediated by the development of plastic changes in the motor cortex. The review of available evidences indicated that MI ability and AO feasibility are substantially preserved in PD subjects. A few preliminary studies suggested the possibility of using MI and AO as parts of rehabilitation protocols for PD patients.

Action observation produces motor resonance in Parkinson's disease

“…Our findings are also consistent with evidence indicating that people with PD can effectively use motor imagery, such as when judging the weight of objects after viewing a lifting action (Poliakoff, Galpin, Dick, & Tipper, 2010), or in the production of appropriate gestures when communicating action-related information (Humphries et al, 2016). Moreover, the present findings provide a clear rationale for therapies that capitalize on intact motor resonance, consistent with emerging evidence supporting the application of action observation training in PD (for recent reviews see Abbruzzese, Avanzino, Marchese, & Pelosin, 2015;Caligiore, Mustile, Spalletta, & Baldassarre, 2017). Nonetheless, as described above, people with PD may engage compensatory visual processes during motor imagery (Helmich et al, 2007;van Nuenen et al, 2012;Wai et al, 2012) as well as showing reduced corticomotor facilitation when observing actions (Tremblay et al, 2008).…”

Motor Imagery and Action Observation as Effective Tools for Physical Therapy

“…Motor imagery is a cognitive process in which a subject only imagines completing a movement, without tensing any muscles (Figure 1(a)) [2]. While motor imagery alone can improve motor performance [3], it is particularly effective when associated with physical practice [4] as compared to physical practice alone.…”

“…When a subject observes a specific action being performed, activation of the same neural structures used for the movement pattern is also repeated in the subject (Figure 1(b)) [2]. The neurophysiological basis of action observation is represented by the discovery of mirror neurons in the cerebral cortex of monkeys [6,7].…”

Psychometric properties of clock and pelvic drawings in Parkinson's disease: A validity and cross‐sectional study

“…The MDS‐UPDRS also serves as a common reference scale in studies of instrument development for rating specific aspects of PD (Hogan et al, ). Scores range 0–52 (Part I), 0–52 (Part II), 0–132 (Part III), 0–24 (Part IV), and 0–260 (Total Score), with a higher score indicating greater disease severity. The Montreal Cognitive Assessment (MoCA; Abbruzzese, Avanzino, Marchese, & Pelosin, )—a 30‐point test providing a measure of global cognitive status based on assessing a range of executive functions (e.g., orientation, memory recall, visuospatial function, attention/concentration, and language). The MoCA exhibits high sensitivity and specificity for detecting mild cognitive dysfunction (Nasreddine et al, ) and is valid and reliable in people with PD (De Pandis et al, ).…”

“…Participants with fewer than 12 years of education received an additional point. “Clock Drawing” test (Hubbard et al, )—a qualitative neurological drawing test commonly used as a screening test for assessing cognitive level in people with PD (De Pandis et al, ). This test is an integral component of the MoCA test protocol (Abbruzzese et al, ) with scores range from 0 to 3, based on one point assigned for each of the three criteria (contour, numbers, and hands). For the current study, a “pen and sheet” modality with “verbal command” condition was used: no computerized methods were employed, and the raters visually did the evaluation and scoring (De Pandis et al, ).…”