Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy.
Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Parkinsonism Relat Disord. 2023 Nov;116:105858. doi: 10.1016/j.parkreldis.2023.105858. Epub 2023 Sep 22.
Motor imagery (MI) skills can be affected in Parkinson's disease (PD). We aimed at assessing MI and brain functional changes after action observation and MI training (AOT-MI) associated with gait/balance exercises in PD patients with postural instability and gait disorders (PD-PIGD).
Twenty-five PD-PIGD patients were randomized into two groups: DUAL-TASK + AOT-MI group performed 6-week gait/balance training combined with AOT-MI; DUAL-TASK group performed the same exercises without AOT-MI. Before and after training, MI was assessed using Kinesthetic-and-Visual-Imagery Questionnaire (KVIQ) and a MI functional MRI (fMRI) task. During fMRI, subjects were asked to watch first-person perspective videos representing gait/balance tasks and mentally simulate their execution. At baseline patients were compared with 23 healthy controls.
PD groups did not differ in the MI scores. Both patient groups increased kinesthetic KVIQ score after training, while only DUAL-TASK + AOT-MI group improved visual and total KVIQ scores. At baseline, both PD groups showed reduced fMRI activity of sensorimotor, temporal and cerebellar areas relative to controls. After training, DUAL-TASK + AOT-MI patients increased activity of anterior cingulate, fronto-temporal and motor cerebellar areas, and reduced the recruitment of cognitive cerebellar regions. DUAL-TASK group showed increased recruitment of occipito-temporal areas and reduced activity of cerebellum crus-I. DUAL-TASK + AOT-MI relative to DUAL-TASK group had increased activity of cerebellum VIII-IX. In DUAL-TASK + AOT-MI group, KVIQ improvement correlated with increased activity of cerebellum IX and anterior cingulate, and with reduced activity of crus-I.
AOT-MI improves MI abilities in PD-PIGD patients, promoting the functional plasticity of brain areas involved in MI processes and gait/balance control.
运动想象（MI）技能可能会受到帕金森病（PD）的影响。我们旨在评估姿势不稳和步态障碍的 PD 患者（PD-PIGD）在进行步态/平衡练习时，结合动作观察和运动想象训练（AOT-MI）后 MI 及大脑功能的变化。
25 名 PD-PIGD 患者被随机分为两组：双重任务+AOT-MI 组进行 6 周的步态/平衡训练，同时进行 AOT-MI；双重任务组进行相同的运动，不进行 AOT-MI。在训练前后，使用运动想象问卷（KVIQ）和 MI 功能磁共振成像（fMRI）任务评估 MI。在 fMRI 期间，要求受试者观看第一人称视角的代表步态/平衡任务的视频，并在心理上模拟其执行。在基线时，将患者与 23 名健康对照进行比较。
两组 PD 患者的 MI 评分没有差异。两组患者在训练后均增加了动觉 KVIQ 评分，而只有双重任务+AOT-MI 组提高了视觉和总 KVIQ 评分。在基线时，两组 PD 患者相对于对照组，感觉运动、颞叶和小脑区域的 fMRI 活动均减少。训练后，双重任务+AOT-MI 患者增加了前扣带、额颞和运动小脑区域的活动，并减少了认知小脑区域的募集。双重任务组增加了枕颞区域的募集，减少了小脑脚 I 的活动。与双重任务组相比，双重任务+AOT-MI 组增加了小脑 VIII-IX 的活动。在双重任务+AOT-MI 组中，KVIQ 的改善与小脑 IX 和前扣带的活动增加以及小脑脚 I 的活动减少相关。
AOT-MI 可改善 PD-PIGD 患者的 MI 能力，促进 MI 过程和步态/平衡控制所涉及的大脑区域的功能可塑性。
