title: Brain plasticity in Parkinson's disease with freezing of gait induced by action observation training.
abstract: 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.
authors: Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy.
authors: Federica
authors: F
authors: Agosta
authors: Laboratory of Movement Analysis, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.|Physiotherapy Unit, Humanitas University and Humanitas Clinical and Research Center, Rozzano, Italy.
authors: Roberto
authors: R
authors: Gatti
authors: Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy.|Laboratory of Movement Analysis, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Elisabetta
authors: E
authors: Sarasso
authors: Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Maria Antonietta
authors: MA
authors: Volonté
authors: Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy.
authors: Elisa
authors: E
authors: Canu
authors: Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy.
authors: Alessandro
authors: A
authors: Meani
authors: Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy.|Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Lidia
authors: L
authors: Sarro
authors: Biostatistics Unit, IRCCS-Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Foggia, Italy.
authors: Massimiliano
authors: M
authors: Copetti
authors: Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Bruxelles, Belgium.
authors: Erik
authors: E
authors: Cattrysse
authors: Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Bruxelles, Belgium.
authors: Eric
authors: E
authors: Kerckhofs
authors: Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Giancarlo
authors: G
authors: Comi
authors: Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
authors: Andrea
authors: A
authors: Falini
authors: Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Via Olgettina, 60, 20132, Milan, Italy. filippi.massimo@hsr.it.|Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. filippi.massimo@hsr.it.
authors: Massimo
authors: http://orcid.org/0000-0002-5485-0479
authors: M
authors: Filippi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001931:Brain Mapping; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009039:Motion Perception / Q000502:physiology*; D009043:Motor Activity / Q000502:physiology; D009473:Neuronal Plasticity / Q000502:physiology*; D009483:Neuropsychological Tests; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D010775:Photic Stimulation / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Action observation; Freezing of gait; Functional MRI; Gait disorders; Parkinson’s disease