Action Observation Therapy

Original Editor - Redisha jakibanjar

Top Contributors - Redisha Jakibanjar  

Introduction

Action Observation (AO) is a dynamic state during which the observer can understand what the other is doing by simulating the actions and outcomes that are likely to follow from the observed motor act.[1]

Action Observation Therapy (AOT) is a top down approach and is grounded in basic neuroscience and the recent discovery of the mirror neuron system (MNS)[2][3]. AOT commonly includes action observation and action execution and allows patients to safely practice movements and motor tasks.[3]

illustration of human mirror neuron sysytem

Purpose

  • To recover damaged cerebral networks and take advantage to rebuild motor function despite impairments, as an alternative or complement to physiotherapy.[4]
  • Promote functional reorganization within the brain via activation of mirror neurons in order to promote motor function recovery.[5]

Technique

There are not such specific rules for performing the therapy but still the general process is:

During each rehabilitation session, patients are required to observe a specific object-directed daily action presented through a video clip on a computer screen, and afterwards to execute what they have observed. Only one action is practiced during each rehabilitation session. The presented action can be divided into three to four motor tasks. The presented task can be shown from different perspective for the better outcome[6]

Phases:

  1. Observation phase : during this phase, patient is asked to carefully observe the given video.
  2. Execution phase: during this phase, patient is asked to perform the observed motor task at the best of his/her ability.[6]

Time duration:

There is not such a rule for performing the task but typically, AOT rehabilitation session takes half an hour. A few minutes are needed by the physiotherapist to explain the task to the patient (carefully looking at the movie, paying attention also to the details of presented actions) and to motivate him to the task, then 12 min of observation (3 min for each of the motor acts into which the action is divided) and finally 8 min of execution (2 min for each motor act). There is not any evidence available regarding whether a more intensive practice, for example 1 h per session, is better than half an hour.[6]

Actions used:

  1. Transitive actions : Actions with object interaction, e.g., using a pencil
  2. Intransitive actions : Actions without object interaction, e.g., the opposition of the index finger and the thumb as the pantomime of a precision grasping) [7]

Measuring results

Evaluation of the result while performing the AOT is the vital thing to be considered. The use of an appropriate outcome measure or index is a basic requisite to analyze the efficacy of any rehabilitative therapy.[7]

Neurophysiological basis

AOT is based on mirror neurons in various regions of the macaque cerebral cortex. Mirror neurons discharge both during the execution of goal-directed actions performed with different biological effectors and during the observation of another individual performing the same or a similar action. Areas containing mirror neurons are often referred to as the MNS. various non invasive procedure has shown experimental evidence in humans confirming the existence of an action observation–action execution matching mechanism in specific regions of the frontal and parietal lobes.[6]

AOT in Parkinson's disease and Stroke

  • A systematic review on efficacy of action observation and motor imagery among Parkinson's disease(PD) concluded that AOT and Motor Imagery Prcatice (MIP) used as therapeutic programs can improve or slow the deterioration of motor capabilities in PD patients.[8]
  • Study was done among stroke patients (total included number=70 ) who had cerebral infarction diagnostic criteria formulated by Chinese Society of Neurology, Chinese Medical Association; unilateral hemiplegia; first-episode of cerebral infarction determined by CT and MRI; stable vital signs; disease course of 2 to 6 months; age of 40 to 75 years; mini-mental state examination (MME) score ≥27 and treatment instructions can be performed; Fugl-Meyer assessment (FMA) score ≥20 for upper extremity motor function; binocular vision or corrected visual acuity ≥1.0; everyday treatment can be tolerant; and providing informed consent. this study concluded that motion observation and traditional upper limb rehabilitation treatment technology can significantly elevate the movement function of cerebral infarction patients in sub acute seizure phase with upper limb dysfunction, which expanded the application range of motion observation therapy and provided an effective therapy strategy for upper extremities hemiplegia in stroke patients.[9]
  • RCT among 67 patients with purely ischemic stroke showed that action observation can stimulate and enhance the beneficial effects of motor training on motor memory formation, especially in left hemiparetic patients following an acute ischemic stroke.[1]

AOT IN Total Hip Arthroplasty

A prospective study conducted among 24 patients to investigate the effectiveness of AOT compared with written information in patients submitted to a physical therapy program after primary total hip arthroplasty (THA) showed that both treatments were effective at improving pain, functional status, quality of life, and gait features i patients with primary THA. In addition to conventional physical therapy, AOT improved perceived physical function more than written information.[10]

References

  1. 1.0 1.1 CERAVOLO MG. Action Observation as a Tool for Upper Limb Recovery. Fizikalna i rehabilitacijska medicina. 2016 Apr 3;28(1-2):144-50.
  2. Shih TY, Wu CY, Lin KC, Cheng CH, Hsieh YW, Chen CL, Lai CJ, Chen CC. Effects of action observation therapy and mirror therapy after stroke on rehabilitation outcomes and neural mechanisms by MEG: study protocol for a randomized controlled trial. Trials. 2017 Dec;18(1):459.
  3. 3.0 3.1 Ertelt D, Binkofski F. Action observation as a tool for neurorehabilitation to moderate motor deficits and aphasia following stroke. Neural regeneration research. 2012 Sep 15;7(26):2063.
  4. Sarasso E, Gemma M, Agosta F, Filippi M, Gatti R. Action observation training to improve motor function recovery: a systematic review. Archives of physiotherapy. 2015 Dec;5(1):14.
  5. Zhu MH, Wang J, Gu XD, Shi MF, Zeng M, Wang CY, Chen QY, Fu JM. Effect of action observation therapy on daily activities and motor recovery in stroke patients. International Journal of Nursing Sciences. 2015 Sep 1;2(3):279-82.
  6. 6.0 6.1 6.2 6.3 Buccino G. Action observation treatment: a novel tool in neurorehabilitation. Phil. Trans. R. Soc. B. 2014 Jun 5;369(1644):20130185.
  7. 7.0 7.1 Plata-Bello J. The Study of Action Observation Therapy in Neurological Diseases: A Few Technical Considerations. InNeurological Physical Therapy 2017. InTech.
  8. Caligiore D, Mustile M, Spalletta G, Baldassarre G. Action observation and motor imagery for rehabilitation in Parkinson's disease: A systematic review and an integrative hypothesis. Neuroscience & Biobehavioral Reviews. 2017 Jan 1;72:210-22.
  9. Fu J, Zeng M, Shen F, Cui Y, Zhu M, Gu X, Sun Y. Effects of action observation therapy on upper extremity function, daily activities and motion evoked potential in cerebral infarction patients. Medicine. 2017 Oct;96(42).
  10. Villafañe JH, Pirali C, Isgrò M, Vanti C, Buraschi R, Negrini S. Effects of Action Observation Therapy in Patients Recovering From Total Hip Arthroplasty Arthroplasty: A Prospective Clinical Trial. Journal of chiropractic medicine. 2016 Dec 1;15(4):229-34.