Ertelt Denis, Small Steven, Solodkin Ana, Dettmers Christian, McNamara Adam, Binkofski Ferdinand, Buccino Giovanni
Department of Neurology and Neuroimage Nord, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Neuroimage. 2007;36 Suppl 2:T164-73. doi: 10.1016/j.neuroimage.2007.03.043. Epub 2007 Mar 31.
Evidence exists that the observation of actions activates the same cortical motor areas that are involved in the performance of the observed actions. The neural substrate for this is the mirror neuron system. We harness this neuronal system and its ability to re-enact stored motor representations as a means for rehabilitating motor control. We combined observation of daily actions with concomitant physical training of the observed actions in a new neurorehabilitative program (action observation therapy). Eight stroke patients with moderate, chronic motor deficit of the upper limb as a consequence of medial artery infarction participated. A significant improvement of motor functions in the course of a 4-week treatment, as compared to the stable pre-treatment baseline, and compared with a control group have been found. The improvement lasted for at least 8 weeks after the end of the intervention. Additionally, the effects of action observation therapy on the reorganization of the motor system were investigated by functional magnetic resonance imaging (fMRI), using an independent sensorimotor task consisting of object manipulation. The direct comparison of neural activations between experimental and control groups after training with those elicited by the same task before training yielded a significant rise in activity in the bilateral ventral premotor cortex, bilateral superior temporal gyrus, the supplementary motor area (SMA) and the contralateral supramarginal gyrus. Our results provide pieces of evidence that action observation has a positive additional impact on recovery of motor functions after stroke by reactivation of motor areas, which contain the action observation/action execution matching system.
有证据表明，观察动作会激活与执行所观察动作相关的相同皮质运动区域。其神经基础是镜像神经元系统。我们利用这个神经元系统及其重新激活存储的运动表征的能力，作为恢复运动控制的一种手段。我们在一个新的神经康复计划（动作观察疗法）中将日常动作的观察与所观察动作的同步身体训练相结合。8名因大脑中动脉梗死导致上肢中度慢性运动功能障碍的中风患者参与了研究。与治疗前稳定的基线相比，以及与对照组相比，在为期4周的治疗过程中发现运动功能有显著改善。这种改善在干预结束后持续了至少8周。此外，使用由物体操作组成的独立感觉运动任务，通过功能磁共振成像（fMRI）研究了动作观察疗法对运动系统重组的影响。训练后实验组和对照组之间的神经激活与训练前同一任务引发的神经激活的直接比较显示，双侧腹侧运动前皮层、双侧颞上回、辅助运动区（SMA）和对侧缘上回的活动显著增加。我们的结果提供了证据，表明动作观察通过重新激活包含动作观察/动作执行匹配系统的运动区域，对中风后运动功能的恢复有积极的额外影响。
