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

Parkinson’s disease (PD) causes difficulties with hand movements, which few studies have 48 addressed therapeutically. Training with action observation (AO) and motor imagery (MI) improves performance in healthy individuals, particularly when the techniques are applied 50 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 was 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 semi-structured interviews were conducted with participants. Exploratory outcome measures including dexterity and timed action performance were tested. 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 have broader relevance 69 for the feasibility and development of AO+MI interventions for people with PD and in other populations

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

From Hindawi via Jisc Publications RouterHistory: publication-year 2021, received 2021-05-01, rev-recd 2021-06-28, accepted 2021-07-12, pub-print 2021-07-23, archival-date 2021-07-23Publication status: PublishedFunder: Economic and Social Research Council; doi: http://dx.doi.org/10.13039/501100000269; Grant(s): ES/K013564/1Funder: Wellcome Trust; doi: http://dx.doi.org/10.13039/100004440; Grant(s): 209741/Z/17/ZFunder: Medical Research Council; doi: http://dx.doi.org/10.13039/501100000265Funder: University Of Manchester; doi: http://dx.doi.org/10.13039/501100000770Funder: Manchester Metropolitan University; doi: http://dx.doi.org/10.13039/100010014Background. 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

Sample means and standard deviations (in parentheses).

<p>Sample means and standard deviations (in parentheses).</p

Electrode positions for M1 and cerebellar tDCS.

<p>(A) During M1 stimulation, the anode was placed on the leg area motor hotspot, as identified during single-pulse TMS, and reference was placed on the inion. (B) During cerebellar stimulation, the anode was placed on the median line 2cm below the inion and reference was placed on the right buccinator muscle.</p

Mean power frequency (MPF).

<p>MPF for young (A & B) and older adults (C & D) during each visual condition respectively as a function of stimulation condition (sham, cerebellar, M1), testing block (pre, DC, post0 and post30) and first and last 30s of each testing block.</p

AP peak-to-peak sway amplitude.

<p>AP peak-to-peak sway amplitude for young (A & B) and older adults (C & D) during both visual conditions respectively as a function of stimulation condition (sham, cerebellar, M1) and testing block (pre-stimulation, during (DC), after (post0) and 30 minutes after (post30)).</p

Session schematic.

<p>Schematic representation of how the postural control task blocks are separated during each session.</p

MEP area under the recruitment curve (AURC).

<p>AURC averaged across both legs for (A) young and (B) older adults as a function of stimulation condition and testing block.</p

AP path length.

<p>AP path length across each testing block and each stimulatory condition for young (A & B) and older adults (C & D) during eyes open and eyes closed respectively. Note the different scale in B and D due to greater sway in Eyes Closed conditions.</p