Sarasso E1,2, Piramide N1, Ravani I1, Volontè MA3, Fichera M3, Galantucci S3, Gatti R4, Tettamanti A2, Agosta F1, Filippi M5
1San Raffaele Scientific Institute, Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Milano, Italy, 2San Raffaele Scientific Institute, Laboratory of Movement Analysis, Milano, Italy, 3San Raffaele Scientific Institute, Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, Milano, Italy, 4Hunimed University, Physiotherapy Degree Course, Rozzano, Milano, Italy, 5San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Milano, Italy

Background: Previous studies have suggested the efficacy of action observation training (AOT) and motor imagery (MI) in Parkinson's disease (PD) patients, especially in reducing bradykinesia, freezing of gait and improving autonomy in activities of daily living.

Purpose: The aim of this study was to evaluate the effect of an AOT-MI training including dual-task gait and balance exercises on gait parameters and postural stability in PD patients with postural instability and gait disorders (PIGD).

Methods: Twenty PD-PIGD subjects were randomized into 2 groups:
i) AOT-MI group performed a 6-week training (1-hour session 3 times a week,) consisting of AOT-MI combined with practicing the observed-imagined gait and balance exercises;
ii) LANDSCAPE-group performed the same exercises combined with watching landscape videos. Exercises were increasingly difficult up to include dual-task during complex gait and balance tasks.
At baseline (T0) and week 6 (W6) patients underwent timed-up-and-go (TUG) with and without dual-tasks, MiniBESTest, activities balance confidence (ABC) assessment, and were administered quality of life (PDQ-39) questionnaires. Gait analysis parameters of straight and turn phases during TUG at spontaneous speed, at maximum speed (TUG-FAST), associated to motor (TUG-MOT) and cognitive dual-tasks (TUG-COG) were obtained using a six-camera SMART DX7000 optoelectronic system.

Results: Both groups at W6 showed improvements of TUG and TUG-FAST total execution time and increased velocity during the straight phase of TUG. Only the AOT-MI group showed improvements of TUG-COG and TUG-MOT total execution time and an increased velocity during the turn phase of TUG, TUG FAST, TUG COG and TUG MOT. The AOT-MI group showed also an improvement at Mini-BESTest, ABC and PDQ-39. Improvements of gait speed during the turn phase of TUG and TUG-COG, of MiniBESTest, ABC and PDQ-39 were significantly higher in the AOT-MI group relative to the LANDSCAPE group.

Conclusion(s): At W6 both groups of PD patients showed improvements of motor performance during single-task TUG. Only the AOT-MI group showed statistically significant improvements of balance and of gait speed during TUG with dual-tasks particularly during the turn phase, which is one of the most challenging situation for PD-PIGD patients. We hypothesized that AOT and MI might facilitate dynamic balance training also during dual-task conditions.

Implications: A combined cognitive-motor rehabilitation approach is more effective than a pure motor training to improve gait velocity and balance in patients with PD-PIGD.

Keywords: Parkinson's disease, action observation and motor imagery, gait analysis and balance

Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Topic: Neurology: Parkinson's disease; Disability & rehabilitation; Human movement analysis

Ethics approval required: Yes
Institution: San Raffaele Scientific Institute
Ethics committee: Human Research Ethics Committee
Ethics number: 44-int-2017, AOT-MI in PD-PIGD

All authors, affiliations and abstracts have been published as submitted.

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