Post on 07-Apr-2020
Il sistema dei neuroni specchio e la neuroriabilitazione
GIOVANNI BUCCINODipartimento di Scienze Mediche e Chirurgiche,Università Magna Graecia,Catanzaro
Gallese et al, 1996
Umiltà et al, 2001
Kohler et al, 2002
Buccino et al, 2001
Buccino et al, 2004
Iacoboni et al, 2005
Buccino et al, 2007
Buccino et al, 2004
Vogt et al, 2007
Action observation treatment in
neurorehabilitation
Buccino et al, 2006
When does Action Observation Treatment work?
• Recovery of upper limb motor functions in chronic stroke patients (Ertelt et al., 2007; Franceschini et al., 2010)
• Recovery of daily living activities and freezing of gait in Parkinson’s disease patients (Pelosin et al, 2010, Buccino et al., 2011)
• Recovery of lower limb motor functions in orthopedic patients (Bellelli et al., 2010)
• Recovery of upper limb motor functions in children with cerebral palsy (Buccino et al., 2012)
Patients
Patient Sex AgeStroke onset
Localisation of lesion
Duration of former therapies
(days)
1 m 61 2/1992Left large fronto-parieto-temporal (media territory)
84
2 m 66 8/ 2000Right basal ganglia,
capsula112
3 f 38 8/2003
Right parieto-temporo-occipital,
going into the intraparietal sulcus
140
4 f 64 6/2000Right basal ganglia,
capsula142
5 m 55 1/ 2000Right frontal operculum
113
6 m 54 7/2002 Left basal ganglia 238
7 m 60 3/2002Right primary
sensorimotor cortex50
8 F 63 8/1999Right parietal
(media territory)74
Stable baseline – no statistical difference between the two baseline measurements
(3 weeks apart)
Wilcoxon
Signed Ranks
Test
FAT WMFT SIS
Z 0,000(a) -0,840(b) -0,339(b)
Asymp.Sig.
(2-tailed)1,000 0,401 0,735
FAT – Frenchay Arm TestWMFT – Wolf Motor Function TestSIS – Stroke Impairment Scale
Significant effect of treatment
FAT WMFT SIS
Z -3.252 -1.680 -2.684
Significance 0,0005 0,05 0,0025
FAT – Frenchay Arm TestWMFT – Wolf Motor Function TestSIS – Stroke Impairment Scale
Ertelt et al, 2007
Ertelt et al, 2007
Action observation treatment in Parkinson’s disease (1)
• Case- control study, two centers (Milan, Parma)
• Twenty video-clips each presenting a daily action (i.ewalking)
• Each action subdivided into four motor segments
• Each motor segment presented for 3 minutes
• Patients were required to actually execute the observedmotor segment for 2 minutes
Action observation treatment in Parkinson’s disease (2)
• In the control group observation of non action related video-
clips (videos related to scientific or geographical matters)
• Patients and controls were evaluated by means of functionalscales (UPDRS, FIM) at baseline and at the end oftreatment
• Patients with cognitive impairment were not enrolled
Case Group(EXG)
Control Group (CG)
EXG vs. CG
p p p
UPDRS -25.8±8.7 0.018 -11.1±7.3 0.042 0.002
FIM 11.1±4.2 0.043 3.8±3.6 0.043 0.004
Buccino et al, 2011
Groups
Experimental (n=30) Control (n=30) p
Age, years 71.9 8.4 71.8 6.9 .96
Sex female, n (%) 21 (70.0) 16 (53.3) .14
Type of orthopedic surgical intervention
Hip arthroplasty, n (%) 15 (50.0) 10 (33.3)
Knee arthroplasty, n (%) 12 (40.0) 18 (60.0) .30
Hip fracture repair, n (%) 3 (10.0) 2 (6.7)
Time from surgery to randomization (days) 7.7+2.2 7.3+2.4 .49
Mini Mental State Examination (0-30) 26.4 3.0 26.3 3.3 .94
Geriatric Depression Scale (0-15) 3.0 3.1 3.1 2.8 .92
BMI (Kg/cm2) 24.9 6.8 24.7 4.4 .87
CIRS severity 1.3 0.3 1.3 0.4 .61
CIRS comorbidity 1.7 1.1 1.6 0.9 .67
Albumin serum levels (gr/dl) 3.2 0.4 3.2 0.3 .95
Transferrin serum levels (mg/dl) 189.6 47.4 180.1 32.5 .38
Length of stay, days 20.1 2.9 21.0 3.6 .29
Groups
Experimental (n=30) Control (n=30)
Functional status
FIM total score on admission (0-126) 86.7 16.6 93.6 11.8 .07
FIM total score at discharge (0-126) 109.1 11.9 109.6 6.8 .85
FIM –AFG 22.4 11.9 16.0 9.3 .02
FIM – AFE 1.0 0.5 0.7 0.4 .01
FIM – RFG 57.7 21.5 47.7 14.7 .04
Motor FIM* subscore on admission (13-91) 14.7 5.6 17.9 3.5 .01
Motor FIM* subscore at discharge (13-91) 26.6 3.4 25.4 2.0 .09
Motor FIM* subscores – AFG 11.9 5.6 7.5 3.4 .001
Tinetti (gait and balance) on admission (0-28) 12.7 6.9 15.7 4.7 .06
Tinetti (gait and balance) at discharge (0-28) 22.4 4.0 23.2 1.6 .32
Tinetti AFG 9.6 4.2 7.4 4.2 .04
Walking aids on admission
Two crutches 18 (60.0) 24 (80.0).08
Walker 12 (40.0) 6 (20.0)
Walking aids at discharge
One crutch 29 (96.7) 22 (73.3)
Two crutches 1 (3.3) 8 (26.7) .01
• Case-control study
• Fifteen video-clips each showing upper limb daily actions within the motor repertoire of children
• Each action divided into three motor segments
• Children in the case group look carefully at the video sequences and imitate the observed action
Action observation treatment in children with cerebral palsy (1)
• Children in the control group look at video-clips on geographical, scientific or historical topics suitable for children
• All children evaluated by means of Melbourne Assessment of Upper Limb Function before and at the end of the treatment.
• Long term follow-up at two months.
Action observation treatment in children with cerebral palsy (2)
Inclusion criteria:
Children with cerebral palsyAged 5-10IQ>/= 70No visual and/or auditory deficits
Exclusion criteria:
Drug treatmentEpilepsy
Buccino et al, 2012
Actionobservation(AO)
Motorimagery(MI)
Controlgroup(CO)
p
Time error 3.3±7.6 20.1±14.5 16.9±14.6 0.002
Frequency right hand (Hz) 1.00±0.00 0.93±0.00 0.79±0.27 0.008
Frequency right foot (Hz) 0.99±0.00 0.94±0.00 0.88±0.14 0.011
Frequency left hand (Hz) 0.96±0.00 0.97±0.15 0.76±0.27 0.009
Frequency left foot (Hz) 0.96±0.00 0.94±0.13 0.89±0.18 NS
Range of motion right hand(degree)
58.0±10.9 57.2±11.3 59.5±12.5 NS
Range of motion right foot(degree)
49.1±10.3 45.4±13.2 31.8±12.9 0.002
Range of motion left hand(degree)
61.1±7.0 51.9±15.2 59.9±17.7 NS
Range of motion left foot(degree)
39.9±10.0 38.4±17.2 25.4±11.0 0.031
Absolute error (degree) 20.9±12.8 23.5±12.1 29.6±14.2 NS
Gatti et al, 2013
Thanks to
Milan group: Stefano Cappa,Roberto Gatti, Maria Cristina Giusti
Parma group: Stefano Calzetti,Anna Negrotti
Cremona group: Giuseppe Bellelli, DanieleArisi
Brescia group: Marco Trabucchi, AlessandroPadovani, Elisa Fazzi