Action observation and motor imagery for rehabilitation in Parkinson's disease: A systematic review and an integrative hypothesis

This article discusses recent evidence supporting the use of action observation therapy and motor imagery practice for rehabilitation of Parkinson's disease. A main question that emerges from the review regards the different effectiveness of these approaches and the possibility of integrating them into a single method to enhance motor behaviour in subjects with Parkinson’s disease. In particular, the reviewed studies suggest that action observation therapy can have a positive effect on motor facilitation of patients and that a long-term rehabilitation program based on action observation therapy or motor imagery practice can bring some benefit on their motor recovery. Moreover, the paper discusses how the research on the combined use of action observation and motor imagery for motor improvements in healthy subjects may encourage the combined use of action observation therapy and motor imagery practice for therapeutic aims in Parkinson's disease. To date, this hypothesis has never been experimented

Motor inhibition to dangerous objects: Electrophysiological evidence for task-dependent aversive affordances

Previous work suggests that perception of an object automatically facilitates actions related to object grasping and manipulation. Recently, the notion of automaticity has been challenged by behavioral studies suggesting that dangerous objects elicit aversive affordances that interfere with encoding of an object’s motor properties; however, related electrophysiological studies have provided little support for these claims. We sought EEG evidence that would support the operation of an inhibitory mechanism that interferes with the motor encoding of dangerous objects and we investigated whether such mechanism would be modulated by the perceived distance of an object and the goal of a given task. Electroencephalograms were recorded by 24 participants who passively perceived dangerous and neutral objects in their peripersonal, boundary or extrapersonal space and performed either a reachability judgment task or a categorization task. Our results showed that greater attention, reflected in the visual P1 potential, was drawn by dangerous and reachable objects. Crucially, a frontal N2 potential, associated with motor inhibition, was larger for dangerous objects only when participants performed a reachability judgment task. Furthermore, a larger parietal P3b potential for dangerous objects indicated the greater difficulty in linking a dangerous object to the appropriate response, especially when it was located in the participants’ extrapersonal space. Taken together, our results show that perception of dangerous objects elicits aversive affordances in a task-dependent way and provides evidence for the operation of a neural mechanism that does not code affordances of dangerous objects automatically, but rather on the basis of contextual information

Action Observation With Dual Task for Improving Cognitive Abilities in Parkinson's Disease: A Pilot Study

Action observation therapy (AOT) has been recently proposed as a new rehabilitation approach for treatment of motor deficits in Parkinson's disease. To date, this approach has never been used to deal with cognitive deficits (e.g., deficits in working memory, attention), which are impairments that are increasingly recognized in Parkinsonian patients. Typically, patients affected by these dysfunctions have difficulty filtering out irrelevant information and tend to lose track of the task goal. In this paper, we propose that AOT may also be used to improve cognitive abilities of Parkinsonian patients if it is used within a dual task framework. We articulate our hypothesis by pivoting on recent findings and on preliminary results that were obtained through a pilot study that was designed to test the efficacy of a long-term rehabilitation program that, for the first time, uses AOT within a dual task framework for treating cognitive deficits in patients with Parkinson's disease. Ten Parkinson's disease patients underwent a 45-min treatment that consisted in watching a video of an actor performing a daily-life activity and then executing it while performing distractive tasks (AOT with dual task). The treatment was repeated three times per week for a total of 4 weeks. Patients' cognitive/motor features were evaluated through standard tests four times: 1 month before treatment, the first and the last day of treatment and 1 month after treatment. The results show that this approach may provide relevant improvements in cognitive aspects related to working memory (verbal and visuospatial memory) and attention. We discuss these results by pivoting on literature on action observation and recent literature demonstrating that the dual task method can be used to stimulate cognition and concentration. In particular, we propose that using AOT together with a dual task may train the brain systems supporting executive functions through two mechanisms: (i) stimulation of goal setting within the mirror neuron system through action observation and (ii) working memory and persistent goal maintenance through dual task stimuli

The neural response is heightened when watching a person approaching compared to walking away: Evidence for dynamic social neuroscience

The action observation network has been proposed to play a key role in predicting the action intentions (or goals) of others, thereby facilitating social interaction. Key information when interacting with others is whether someone (an agent) is moving towards or away from us, indicating whether we are likely to interact with the person. In addition, to determine the nature of a social interaction, we also need to take into consideration the distance of the agent relative to us as the observer. How this kind of information is processed within the brain is unknown, at least in part because prior studies have not involved live whole-body motion. Consequently, here we recorded mobile EEG in 18 healthy participants, assessing the neural response to the modulation of direction (walking towards or away) and distance (near vs. far distance) during the observation of an agent walking. We evaluated whether cortical alpha and beta oscillations were modulated differently by direction and distance during action observation. We found that alpha was only modulated by distance, with a stronger decrease of power when the agent was further away from the observer, regardless of direction. Critically, by contrast, beta was found to be modulated by both distance and direction, with a stronger decrease of power when the agent was near and facing the participant (walking towards) compared to when they were near but viewed from the back (walking away). Analysis revealed differences in both the timing and distribution of alpha and beta oscillations. We argue that these data suggest a full understanding of action observation requires a new dynamic neuroscience, investigating actual interactions between real people, in real world environments

Intrinsic Motivations Drive Learning of Eye Movements: An Experiment with Human Adults

Intrinsic motivations drive the acquisition of knowledge and skills on the basis of novel or surprising stimuli or the pleasure to learn new skills. In so doing, they are different from extrinsic motivations that are mainly linked to drives that promote survival and reproduction. Intrinsic motivations have been implicitly exploited in several psychological experiments but, due to the lack of proper paradigms, they are rarely a direct subject of investigation. This article investigates how different intrinsic motivation mechanisms can support the learning of visual skills, such as “foveate a particular object in space”, using a gaze contingency paradigm. In the experiment participants could freely foveate objects shown in a computer screen. Foveating each of two “button” pictures caused different effects: one caused the appearance of a simple image (blue rectangle) in unexpected positions, while the other evoked the appearance of an always-novel picture (objects or animals). The experiment studied how two possible intrinsic motivation mechanisms might guide learning to foveate one or the other button picture. One mechanism is based on the sudden, surprising appearance of a familiar image at unpredicted locations, and a second one is based on the content novelty of the images. The results show the comparative effectiveness of the mechanism based on image novelty, whereas they do not support the operation of the mechanism based on the surprising location of the image appearance. Interestingly, these results were also obtained with participants that, according to a post experiment questionnaire, had not understood the functions of the different buttons suggesting that novelty-based intrinsic motivation mechanisms might operate even at an unconscious level

The Neural Correlates of Action Representation in the Real World

This thesis is about action representations and their neural correlates. Action representations serve as internal models of our behaviour, constructed through dynamic interaction between body and environment, shaped by knowledge and experience. We rely on action representations in order to act in an everchanging environment. Considering that much of our real world behaviour involves dynamic movements with degrees of freedom that are not tolerated by traditional brain imaging techniques, we have long been constrained in examining how actions are represented in the brain. In this thesis, limitations of traditional brain imagining techniques are overcome by employing a novel mobile EEG approach, which allows the identification of the neural markers of the action representations underlying real world locomotor behaviour

Characterizing neurocognitive impairments in Parkinson’s with mobile EEG when walking and stepping over obstacles

The neural correlates that help us understand the challenges that Parkinson’s patients face when negotiating their environment remain under-researched. This deficit in knowledge reflects the methodological constraints of traditional neuroimaging techniques, which include the need to remain still. As a result, much of our understanding of motor disorders is still based on animal models. Daily-life challenges such as tripping and falling over obstacles represent one of the main causes of hospitalisation for individuals with Parkinson’s disease. Here, we report the neural correlates of naturalistic ambulatory obstacle avoidance in Parkinson’s disease patients using mobile EEG. We examined 14 medicated patients with Parkinson’s disease and 17 neurotypical control participants. Brain activity was recorded while participants walked freely, and while they walked and adjusted their gait to step over expected obstacles (preset adjustment) or unexpected obstacles (online adjustment) displayed on the floor. EEG analysis revealed attenuated cortical activity in Parkinson’s patients compared to neurotypical participants in theta (4-7 Hz) and beta (13-35 Hz) frequency bands. The theta power increase when planning an online adjustment to step over unexpected obstacles was reduced in Parkinson’s patients compared to neurotypical participants, indicating impaired proactive cognitive control of walking that updates the online action plan when unexpected changes occur in the environment. Impaired action planning processes were further evident in Parkinson’s disease patients’ diminished beta power suppression when preparing motor adaptation to step over obstacles, regardless of the expectation manipulation, compared to when walking freely. In addition, deficits in reactive control mechanisms in Parkinson’s disease compared to neurotypical participants were evident from an attenuated beta rebound signal after crossing an obstacle. Reduced modulation in the theta frequency band in the resetting phase across conditions also suggests a deficit in the evaluation of action outcomes in Parkinson’s disease. Taken together the neural markers of cognitive control of walking observed in Parkinson’s disease reveal a pervasive deficit of motor-cognitive control, involving impairments in the proactive and reactive strategies used to avoid obstacles while walking. As such, this study identified neural markers of the motor deficits in Parkinson’s disease, and revealed patients’ difficulties in adapting movements both before and after avoiding obstacles in their path

Average rate of “clicks” of the two buttons for the SUR-NOV condition.

<p>The label “Random rectangle” on the x-axes indicates the number of clicks (and standard error) for the button causing the appearance of the blue rectangle in a random position whereas the label “Fixed picture” refers to the data for the button which triggered the appearance of the picture in a fixed position. Data for 15 comprehenders are indicated with a solid line whereas data for 9 non-comprehenders are indicated with a dashed line.</p