Temporiti Federico, Adamo Paola, Cavalli Emanuele, Gatti Roberto
Physiotherapy Unit, Humanitas Clinical and Research Center-IRCCS, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Front Neurol. 2020 Aug 13;11:808. doi: 10.3389/fneur.2020.00808. eCollection 2020.
The discovery of the Mirror Neuron System has promoted the development of Action Observation Therapy (AOT) to improve motor and functional abilities in patients with Parkinson's disease (PD). This innovative approach involves observing video-clips showing motor contents, which may vary across the studies influencing AOT efficacy. To date, no studies have systematically summarized the effects of AOT in patients with PD on motor and functional outcomes, underlining the characteristics of visual stimuli in relation to their efficacy. To describe the potential benefits of AOT in patients with PD and discuss the characteristics of visual stimuli used in clinical studies in relation to their efficacy. A systematic literature search was carried out using MEDLINE via PubMed, EMBASE, Scopus, and PEDro, from inception until March 2020. Randomized controlled trials that investigated the effects of AOT on motor and functional recovery in patients with PD were included. Two independent reviewers appraised the records for inclusion, assessed the methodological quality, and extracted the following data: number and characteristics of participants, features and posology of the treatments, outcome measures at each follow-up, and main results. Findings were aggregated into a quantitative synthesis (mean difference and 95% confidence interval) for each time point. Overall, 7 studies (189 participants) with a mean PEDro score of 6.1 (range: 4-8) points were selected. Included studies revealed AOT as effective in improving walking ability and typical motor signs (i.e., freezing of gait and bradykinesia) in patients with PD. Moreover, when this approach incorporated ecological auditory stimuli, changes to functional abilities and quality of life were also induced, which persisted up to 3 months after treatment. However, included studies adopted AOT stimuli with heterogeneous posology (from a single session to 8 weeks) and characteristics of motor contents might be responsible for different motor and functional recovery (person-related and viewing perspectives, transitive or intransitive actions, healthy subjects or patients, and association or not with imitation). AOT leads to improvements in motor and functional abilities in patients with PD and the characteristics of visual stimuli may play a role in determining AOT effects, deserving further investigations.
镜像神经元系统的发现推动了动作观察疗法（AOT）的发展，以改善帕金森病（PD）患者的运动和功能能力。这种创新方法包括观看展示运动内容的视频片段，不同研究中这些视频片段可能有所不同，从而影响AOT的疗效。迄今为止，尚无研究系统总结AOT对PD患者运动和功能结局的影响，以及视觉刺激与其疗效相关的特征。为了描述AOT对PD患者的潜在益处，并讨论临床研究中使用的视觉刺激与其疗效相关的特征。通过PubMed、EMBASE、Scopus和PEDro对MEDLINE进行了系统的文献检索，检索时间从数据库建立至2020年3月。纳入了调查AOT对PD患者运动和功能恢复影响的随机对照试验。两名独立的评审员评估记录以确定是否纳入，评估方法学质量，并提取以下数据：参与者的数量和特征、治疗的特点和剂量、每次随访的结局指标以及主要结果。将每个时间点的研究结果汇总为定量合成（平均差和95%置信区间）。总体而言，选择了7项研究（189名参与者），平均PEDro评分为6.1分（范围：4 - 8分）。纳入的研究表明，AOT对改善PD患者的步行能力和典型运动体征（即步态冻结和运动迟缓）有效。此外，当这种方法结合生态听觉刺激时，还会引起功能能力和生活质量的变化，这种变化在治疗后可持续长达3个月。然而，纳入的研究采用了剂量各异的AOT刺激（从单次治疗到8周），运动内容的特征可能是导致不同运动和功能恢复情况的原因（与个体相关和观看视角、及物或不及物动作、健康受试者或患者，以及是否与模仿相关）。AOT可改善PD患者的运动和功能能力，视觉刺激的特征可能在决定AOT效果方面发挥作用，值得进一步研究。
