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