Brain plasticity in Parkinson's disease with freezing of gait induced by action observation training
Brain plasticity in Parkinson's disease with freezing of gait induced by action observation training
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DOI：
10.1007/s00415-016-8309-7
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发表时间：
2017-01-01
影响因子：
6
通讯作者：
Filippi, Massimo
中科院分区：
文献类型：
--
作者：
Agosta, Federica;Gatti, Roberto;Filippi, Massimo
步态障碍是帕金森病 (PD) 的治疗挑战。本研究调查了为期 4 周的行动观察训练 (AOT) 对帕金森病严重程度、步态冻结和运动能力的疗效，并评估了与治疗相关的大脑功能变化。将 25 名出现冻结步态的 PD 患者随机分为两组：AOT（动作观察结合练习观察到的动作）和“景观”组（相同的体能训练结合景观视频观察）。在基线和第 4 周，患者接受临床评估和功能磁共振成像。在第 8 周重复临床评估。第 4 周时，两组患者的冻结步态严重程度有所减轻，步行速度和生活质量得到改善。此外，AOT 与运动功能障碍的减少和平衡能力的改善有关。与基线相比，AOT 组在第 8 周时对运动障碍、行走速度、平衡性和生活质量表现出持续的积极影响，与基线相比，AOT 组显示出额顶叶区域的募集增加，而景观组显示左侧中央后回和顶叶下回以及右侧罗兰盖和边缘上回的 fMRI 活动减少。与单独的物理治疗相比，AOT 与 4 周的临床改善相关，并且预测的 8 周的临床进展对改善 PD 患者的运动功能、步态和生活质量具有更持久的效果，与运动区域、额顶镜像神经元和注意力控制区域的募集增加有关。
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.