The Effects of Additional Action Observational Training for Functional Electrical Stimulation Treatment on Weight Bearing, Stability and Gait Velocity of Hemiplegic Patients Non-physical practice improves task performance in an unstable, perturbed environment: motor imagery and observational balance training Action Observation Therapy in the Subacute Phase Promotes Dexterity Recovery in Right-Hemisphere Stroke Patients Drinking Behavior Training for Stroke Patients Using Action Observation and Practice of Upper Limb Function Observation and execution of upper-limb movements as a tool for rehabilitation of motor deficits in paretic stroke patients: protocol of a randomized clinical trial Upper limb children action-observation training (UP-CAT): a randomised controlled trial in Hemiplegic Cerebral Palsy Clinical Relevance of Action Observation in Upper-Limb Stroke Rehabilitation Meaningful change and responsiveness in common physical performance measures in older adults. A Mirror Therapy–Based Action Observation Protocol to Improve Motor Learning After Stroke Encoding a motor memory in the older adult by action observation Action observation training for functional activities after stroke: a pilot randomized controlled trial. Randomized Trial of Observation and Execution of Upper Extremity Actions Versus Action Alone in Children With Unilateral Cerebral Palsy Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Action Observation Improves Freezing of Gait in Patients With Parkinson’s Disease The effects of action observational training on walking ability in chronic stroke patients: a double-blind randomized controlled trial Reduction of Bradykinesia of Finger Movements by a Single Session of Action Observation in Parkinson Disease Clinical feasibility of action observation training for walking function of patients with post-stroke hemiparesis: a randomized controlled trial Action observation treatment improves recovery of postsurgical orthopedic patients: evidence for a top-down effect? Improving upper limb motor functions through action observation treatment: a pilot study in children with cerebral palsy.
[ Purpose ] The purpose of this study was to evaluate the functional effects of additional action observational training for functional electrical stimulation treatment on weight bearing , stability and gait velocity of hemiplegic patients . [ Subjects and Methods ] Twenty subjects were r and omized into two groups . Subjects more than six months post-stroke participated .  Balance and gait velocity were measured at the baseline , and after six weeks of treatment . Both groups received functional electrical stimulation treatment . The experimental group additionally received action observational training . The paired t-test was used to analyze differences in the outcome measures between before and after the intervention . The difference between the groups was compared using the independent t-test . [ Results ] The experimental group showed significant increases in weight bearing ( anterior·posterior , right·left ) on the affected side , stability index and gait velocity . The control group showed only a significant increase in anterior·posterior weight bearing on the affected side . Moreover , according to the comparison of training effects between in the two groups , the variables of anterior·posterior weight bearing , stability index and gait velocity revealed a statistically significant difference . [ Conclusion ] Additional action observational training for functional electrical stimulation treatment should be considered as a therapeutic method in physical therapy for the improvement of weight bearing , stability index and gait velocity of hemiplegic patients For consciously performed motor tasks executed in a defined and constant way , both motor imagery ( MI ) and action observation ( AO ) have been shown to promote motor learning . It is not known whether these forms of non-physical training also improve motor actions when these actions have to be variably applied in an unstable and unpredictable environment . The present study therefore investigated the influence of MI balance training ( MI_BT ) and a balance training combining AO and MI ( AO+MI_BT ) on postural control of undisturbed and disturbed upright stance on unstable ground . As spinal reflex excitability after classical ( i.e. , physical ) balance training ( BT ) is generally decreased , we tested whether non-physical BT also has an impact on spinal reflex circuits . Thirty-six participants were r and omly allocated into an MI_BT group  , in which participants imagined postural exercises , an AO+MI_BT group , in which participants observed videos of other people performing balance exercises and imagined being the person in the video , and a non-active control group ( CON ) . Before and after 4 weeks of non-physical training , balance performance was assessed on a free-moving platform during stance without perturbation and during perturbed stance . Soleus H-reflexes were recorded during stable and unstable stance . The post-measurement revealed significantly decreased postural sway during undisturbed and disturbed stance after both MI_BT and AO+MI_BT . Spinal reflex excitability remained unchanged . This is the first study showing that non-physical training ( MI_BT and AO+MI_BT ) not only promotes motor learning of “ rigid ” postural tasks but also improves performance of highly variable and unpredictable balance actions . These findings may be relevant to improve postural control and thus reduce the risk of falls in temporarily immobilized patients The clinical impact of action observation ( AO ) on upper limb functional recovery in subacute stroke patients is recent evidence . We sought to test the hypothesis that training everyday life activities through AO coupled with task execution might activate the left hemisphere different from the right one . Sixty-seven first-ever ischemic stroke subjects were r and omly assigned to receive upper limb training coupled with AO tasks or st and ard rehabilitation . The groups were matched by age and gender , Bamford category , and interval from stroke and lesion side . Fugl-Meyer ( FM ) and Box and Block Test ( BBT ) were used to measure h and function recovery at the end ( T1 ) and 4 - 5 months after the treatment ( T2 ) . At T1 , FM was increased by 31 % ( ±26 % ) , of maximum achievable recovery , whereas BBT was increased by 17 % ( ±18 % ) ; at T2 , FM had reached 43 % ( ±45 % ) of maximum recovery , while BBT had reached 25 % ( ±22 % ) . Combining the effects of treatment to those of lesion side revealed significantly higher gains , in both FM and BBT scores , in left hemiparetic subjects when exposed to AO as compared to st and ard rehabilitation alone ( P < .01 ) . The findings lead to recommend the use of AO in addition to motor training in left hemiparetic patients [ Purpose ] This study examined the effects of action observation and action practice on stroke patients ’ upper limb function .  [ Subjects and Methods ] The subjects were 33 chronic stroke patients who were r and omly assigned to four groups . The action observation group ( 5 males , 3 females ) watched a video of the task , the action practice group ( 5 males , 4 females ) performed the action , the combined action observation-action practice group ( 5 males , 4 females ) watched the video of the task and practice d the action , and the control group ( 4 males , 3 females ) did not perform either action observation or action practice . The video used in the action observational physical training comprised a scene of an adult male picking up a cup , bringing it to his mouth in order to touch his mouth , and then returning the cup to its initial position . [ Results ] Improvements in drinking behavior functions were observed immediately after the experiment and one week later . After the intervention , the number of drinking motions had increased the most in the combination group . One week after the experiment , there were increases in the action observation , action training , and combination groups . [ Conclusion ] A combination of action observation and action training is the most effective treatment method , and action training is a desirable second to combined therapy Background Evidence exist that motor observation activates the same cortical motor areas that are involved in the performance of the observed actions . The so called “ mirror neuron system ” has been proposed to be responsible for this phenomenon . We employ this neural system and its capability to re-enact stored motor representations as a tool for rehabilitating motor control . In our new neurorehabilitative schema ( videotherapy ) we combine observation of daily actions with concomitant physical training of the observed actions focusing on the upper limbs . Following a pilot study in chronic patients in an ambulatory setting , we currently design ed a new multicenter clinical study dedicated to patients in the sub-acute state after stroke using a home-based self-induced training .  Within our protocol we assess 1 ) the capability of action observation to elicit rehabilitational effects in the motor system , and 2 ) the capacity of this schema to be performed by patients without assistance from a physiotherapist . The results of this study would be of high health and economical relevance . Methods / design A controlled , r and omized , multicenter , paralleled , 6 month follow-up study will be conducted on three groups of patients : one group will be given the experimental treatment whereas the other two will participate in control treatments .  All patients will undergo their usual rehabilitative treatment beside participation in the study . The experimental condition consists in the observation and immediate imitation of common daily h and and arm actions . The two parallel control groups are a placebo group and a group receiving usual rehabilitation without any trial-related treatment . Trial r and omization is provided via external data management . The primary efficacy endpoint is the improvement of the experimental group in a st and ardized motor function test ( Wolf Motor Function Test ) relative to control groups . Further assessment s refer to subjective and qualitative rehabilitational scores . This study has been review ed and approved by the ethics committee of Aachen University . Discussion This therapy provides an extension of therapeutic procedures for recovery after stroke and emphasizes the importance of action perception in neurorehabilitation The results of the study could become implemented into the wide physiotherapeutic practice , for example as an ad on and individualized therapy Background Rehabilitation for children with hemiplegic cerebral palsy ( HCP ) aim ed to improve function of the impaired upper limb ( UL ) uses a wide range of intervention programs . A new rehabilitative approach , called Action-Observation Therapy , based on the recent discovery of mirror neurons , has been used in adult stroke but not in children . The purpose of the present study is to design a r and omised controlled trial ( RCT ) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP . Methods / Design The trial is design ed according to CONSORT Statement . It is a r and omised , evaluator-blinded , match-pair group trial . Children with HCP will be r and omised within pairs to either experimental or control group . The experimental group will perform an Action-Observation Therapy , called UP-CAT ( Upper Limb-Children Action-Observation Training ) in which they will watch video sequences showing goal -directed actions , chosen according to children UL functional level , combined with motor training with their hemiplegic UL . The control group will perform the same tailored actions after watching computer games . A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed . Assisting H and Assessment was chosen as primary measure and , based on its calculation power , a sample size of 12 matched pairs was established . Moreover , Melbourne and ABILH AND -Kids were included as secondary measures . The time line of assessment s will be T0 ( in the week preceding the onset of the treatment ) , T1 and T2 ( in the week after the end of the treatment and 8 weeks later , respectively ) . A further assessment will be performed at T3 ( 24 weeks after T1 ) , to evaluate the retention of effects . In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging , exploring the mirror system and sensory-motor function , will be performed at T0 , T1 and T2 . Discussion The paper aims to describe the methodology of a RCT for evaluating the efficacy of  Action-Observation Therapy  in improving UL activity in children with hemiplegia . This study will be the first to test this new type of treatment in childhood . The paper presents the theoretical background , study hypotheses , outcome measures and trial methodology .Trial Registration Objective . A r and omized controlled observer-blind trial was design ed to evaluate the effectiveness of action observation as an add-on treatment to the st and ard rehabilitation of upper-limb function , early after stroke . Methods . Stroke survivors ( N = 102 ) were consecutively recruited from 13 centers 30 days ( ±7 ) after a first-ever stroke and r and omly assigned to the  experimental ( EG )  or  control group (  CG ) . EG participants watched video footage of daily routine tasks ( actions ) carried out with the upper limb in order to prepare to imitate the presented action . At the end of each sequence , a therapist prompted the patient to perform the same movement for 2 minutes , providing help when needed . Static images without animals or human beings were shown to the CG . At the end of each sequence , the CG executed movements that simulated the shoulder and elbow joint mobilization activities performed by the EG . Results for the Fugl-Meyer test , Frenchay Arm test , Box and Block test ( BBT ) , Modified Ashworth Scale , and Functional Independence Measure Motor items were recorded before treatment ( T0 ) , after 4 weeks of treatment ( T1 ) , and at the follow-up visit 4 to 5 months after the conclusion of treatment ( T2 ) . Results . An improvement over time was appreciated on all measures of impairment and functional ability with both treatment programs . A Time × Treatment interaction emerged from the generalized estimating equations analysis of BBT , showing significant T0–T1 and T0–T2 differences in favor of EG . Conclusion . This multicenter trial endorses the use of action observation in upper-extremity rehabilitation , along with a role for the mirror neuron system in poststroke recovery OBJECTIVES To estimate the magnitude of small meaningful and substantial individual change in physical performance measures and evaluate their responsiveness . DESIGN Secondary data analyses using distribution- and anchor-based methods to determine meaningful change . SETTING Secondary analysis of data from an observational study and clinical trials of community-dwelling older people and subacute stroke survivors . PARTICIPANTS Older adults with mobility disabilities in a strength training trial ( n=100 ) , subacute stroke survivors in an intervention trial ( n=100 ) , and a prospect i ve cohort of community-dwelling older people ( n=492 ) . MEASUREMENTS  Gait speed , Short Physical Performance Battery ( SPPB ) , 6-minute-walk distance ( 6MWD ) , and self-reported mobility . RESULTS Most small meaningful change estimates ranged from 0.04 to 0.06 m/s for gait speed , 0.27 to 0.55 points for SPPB , and 19 to 22 m for 6MWD . Most substantial change estimates ranged from 0.08 to 0.14 m/s for gait speed , 0.99 to 1.34 points for SPPB , and 47 to 49 m for 6MWD . Based on responsiveness indices , per-group sample sizes for clinical trials ranged from 13 to 42 for substantial change and 71 to 161 for small meaningful change . CONCLUSION Best initial estimates of small meaningful change are near 0.05 m/s for gait speed , 0.5 points for SPPB , and 20 m for 6MWD and of substantial change are near 0.10 m/s for gait speed , 1.0 point for SPPB , and 50 m for 6MWD . For clinical use , substantial change in these measures and small change in gait speed and 6MWD , but not SPPB , are detectable . For research use , these measures yield feasible sample sizes for detecting meaningful change Background . Mirror therapy is a priming technique to improve motor function of the affected arm after stroke . Objective . To investigate whether a mirror therapy – based action observation ( AO ) protocol contributes to motor learning of the affected arm after stroke . Methods . A total of 37 participants in the chronic stage after stroke were r and omly allocated to the AO or control observation ( CO ) group . Participants were instructed to perform an upper-arm reaching task as fast and as fluently as possible . All participants trained the upper-arm reaching task with their affected arm alternated with either AO or CO . Participants in the AO group observed mirrored video tapes of reaching movements performed by their unaffected arm , whereas participants in the CO group observed static photographs of l and scapes . The experimental condition effect was investigated by evaluating the primary outcome measure : movement time ( in seconds ) of the reaching movement , measured by accelerometry . Results . Movement time decreased significantly in both groups : 18.3 % in the AO and 9.1 % in the CO group . Decrease in movement time was significantly more in the AO compared with the CO group ( mean difference = 0.14 s ; 95 % confidence interval = 0.02 , 0.26 ; P = .026 ) . Conclusion . The present study showed that a mirror therapy – based AO protocol contributes to motor learning after stroke The ability of motor training to encode a motor memory is reduced in older adults . Here , we tested the hypothesis that training-dependent memory encoding , an issue of relevance in neurorehabilitation , is enhanced in elder individuals by action observation which alone can contribute to learning processes . A group of 11 healthy older adults participated in this study , which consisted of three r and omized counterbalanced sessions on different days testing the effects of motor training ( MT ) alone , action observation ( AO ) alone , and a combination of both ( MT + AO ) on motor memory encoding . The combination of MT + AO formed a motor memory in the primary motor cortex and differentially modulated motor cortical excitability in muscles that were agonist and antagonist with respect to the training task , but MT or AO alone did not . These results suggest that action observation can enhance the effects of motor training on memory encoding protocol s in the older adult , possibly through Hebbian modulation of intracortical excitatory mechanisms OBJECTIVE The objective of this study was to compare the effects of action observation training and motor imagery training on recovery from  chronic stroke .  METHODS Thirty patients who were more than six months post stroke participated in this study and were r and omly allocated to three groups . The action observation training group practice d additional action observation training for five 30-minute sessions over a four-week period . The motor imagery training group practice d additional motor imagery training for five 30-minute sessions over a four-week period . The following clinical measures were used for assessment of dynamic balance and gait abilities : Timed Up and Go Test , Functional Reaching Test , Walking Ability Question naire , and Functional Ambulation Category . Spatiotemporal gait parameters were also collected using a GAITRite system . RESULT Compared with the physical training group , the action observation training group showed significant improvement in the Timed Up and Go test , gait speed , cadence , and single limb support of the affected side . No significant differences in any of the outcome measures were observed between the action observation training group and the motor imagery training group . CONCLUSION Action observation training and motor imagery training results in improvement of dynamic balance and gait ability . These results suggest the feasibility and suitability of action observation training for patients with chronic stroke Background . The properties of the mirror neuron system suggest a new type of upper limb ( UL ) rehabilitation in children with unilateral cerebral palsy ( UCP ) , based on observation of action therapy followed by execution of a variety of observed movements ( AOT ) . Objective . We tested the effects of AOT in the Upper Limb Children Action Observation Training ( UP-CAT ) trial . Methods . In a r and omized , evaluator-blinded , block- design ed trial , 24 UCP children with mild to moderate h and impairment were assigned to 2 groups . The experimental group observed , 1 hour per day for 3 consecutive weeks , video sequences of unimanual or bimanual goal -directed actions and subsequently executed observed actions with the hemiparetic UL or both ULs . The control group performed the same actions in the same order as the experimental sample , but had watched computer games . The Assisting H and Assessment ( AHA ) scale was the primary outcome measure ; the Melbourne assessment and ABILH AND -Kids were secondary ones . Outcomes were assessed at 1 week ( T1 ) , 8 weeks ( T2 ) , and 24 weeks ( T3 ) after the end of the training . Results . The experimental group improved more ( P = .008 ) in score changes for the AHA at the primary endpoints T1 ( P = .008 ) , T2 ( P = .019 ) , and T3 ( P = .049 ) . No between-group significant changes were found for ABILH AND -Kids or Melbourne assessment . Conclusions . UP-CAT improved daily UL activities in UCP children , suggesting a new rehabilitation approach based on a neurophysiological model of motor learning OBJECTIVE To define the minimal clinical ly important difference ( MCID ) for the FIM instrument in patients poststroke . DESIGN Prospect i ve case series discharged over a 9-month period . SETTING Long-term acute care hospital . PARTICIPANTS Patients with stroke ( N=113 ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Admission , discharge , and change scores were calculated for the total FIM , motor FIM , and cognitive FIM .  Assessment s of clinical change were rated at discharge on a 15-point ( -7 to + 7 ) Likert scale by attending physicians , with MCID defined at a cutoff score of 3 . The FIM change scores associated with MCID were identified from receiver operating characteristic curves . Bayesian analysis was used to determine the probability of individual patients achieving MCID . RESULTS FIM change scores associated with MCID were 22 , 17 , and 3 for the total FIM , motor FIM , and cognitive FIM , respectively . The accuracy of the  MCID  was greater when subjects were categorized based on admission FIM scores than when considering the sample as a whole . Larger FIM change scores were related to MCID in subjects with lower admission FIM scores . CONCLUSIONS These findings will assist in the interpretation of FIM change scores relative to physicians ' assessment s of important clinical change Background . Freezing of gait ( FOG ) is a disabling impairment for people with Parkinson ’s disease ( PD ) and may not respond to medications . The effectiveness of physical therapy for FOG is debatable . Action observation strategies to overcome FOG may enhance physical training . Objective . To assess whether action observation , combined with practicing the observed actions , may reduce FOG episodes . Methods . Twenty patients with PD entered a single-blind trial and were r and omly assigned to the experimental ( Action ) or control ( L and scape ) groups . Those in the Action group watched video clips showing specific movements and strategies to circumvent FOG episodes , whereas those in the L and scape group watched video clips of static pictures showing different l and scapes . All patients underwent identical physical therapy training , 3 sessions a week for 4 weeks . Results . The FOG Question naire score and the number of FOG episodes were significantly reduced in both groups after the training period . At follow-up examination ( 4 weeks after the end of the intervention ) , a significant reduction in the number of FOG episodes was observed only in the Action group . Motor performance ( walking and balance ) and quality -of-life assessment s were significantly improved in both groups at the end of training and at follow-up . Conclusions . Our results suggest that action observation has a positive additional effect on recovery of walking ability in PD patients with FOG . Further studies on the combination of observation and imitation to supplement a physical training program may result in an innovative rehabilitative approach for FOG Objective : To investigate the effect of action observational training on walking ability  with chronic stroke patients . Design : A double-blind r and omized controlled trial . Setting : Inpatient rehabilitation hospital . Participants : Thirty chronic stroke patients . Interventions : Patients in both groups underwent treadmill training for 30 minutes . The action observational training group ( n = 15 ) watched a video of treadmill walking actions taken at various speeds before treadmill training for 10 minutes . The control group ( n = 15 ) watched a nature video unrelated to gait training for the same amount of time . All participants received training five times a week for a period of four weeks . Main measures : Timed up and go test , 10-metre walk test , 6-minute walk test and maximal flexed knee angle in the swing phase during walking . Results : There were significant improvements in timed up and go test ( –4.47 vs. –2.47 seconds ) , 10-m walk test ( 0.35 vs. 0.16 m/s ) , 6-minute walk test ( 93.13 vs. 32.53 m ) and maximal flexed knee angle in the swing phase during walking ( 7.11 vs. 4.58 degrees ) in the action observational training group compared with the control group ( P < 0.05 ) . Small to huge effect sizes of 1.27 , 0.57 , 2.34 and 0.37 were observed for timed up and go test , 10-m walk test , 6-minute walk test , and maximal flexed knee angle in the swing phase during walking , respectively . Conclusion : These results suggest that action observational training is an effective method for improvement of the walking ability in chronic stroke patients Background . Action observation influences motor performance in healthy subjects and persons with motor impairments . Objective . To underst and the effects of action observation on the spontaneous rate of finger movements in patients with Parkinson disease ( PD ) . Methods . Participants , 20 with PD and 14 healthy controls , were r and omly divided into 2 groups . Those in the VIDEO group watched video clips showing repetitive finger movements paced at 3 Hz , whereas those in the ACOUSTIC group listened to an acoustic cue paced at 3 Hz . All participants performed a finger sequence at their spontaneous pace at different intervals ( before , at the end of , 45 minutes after , and 2 days after training ) ; 8 participants with PD were recruited for a sham intervention , watching a 6-minute video representing a static h and . Finally , 10 patients participated in the same protocol used for the VIDEO group but were tested in the on and off medication states . Results . Both VIDEO and ACOUSTIC training increased the spontaneous rate in all participants . VIDEO intervention showed a greater effect over time , improving the spontaneous rate and reducing the intertapping interval to a larger extent than ACOUSTIC 45 minutes and 2 days after training . Action observation significantly influenced movement rate in on and off conditions , but 45 minutes after training , the effect was still present only in the on condition . No effect was observed after sham intervention . Conclusions . These findings suggest that the dopaminergic state contributes to the effects of action observation , and this training may be a promising approach in the rehabilitation of bradykinesia in PD Objective : To identify the effects of action observation training ( AOT ) on the walking ability of subjects with post-stroke hemiparesis . Design : R and omized , single-blind , controlled pilot study . Setting : Inpatient rehabilitation hospital . Subjects : Twenty-one subjects with post-stroke hemiparesis were r and omly allocated to either the experimental group ( EG ) or the control group ( CG ) , with 11 and 10 patients , respectively . Interventions : The subjects in the EG and CG watched video clips demonstrating four functional walking tasks and showing different l and scape images , respectively . All subjects subsequently performed the walking tasks ( a total of 30 min , once a day , 3 times weekly for a 4-week period ) . Main measures : 10-m walk test , figure-of-8 walk test ( time and steps ) , dynamic gait index ( DGI ) , and gait symmetry score ( swing and stance phases , and stride length ) before and after the intervention . Results : The changes between the pre- and post-test values of the 10-m walk test ( median [ interquartile range ] , -5.10 [ -15.80–-1.60 ] versus 0.00 [ -6.60–4.06 ] ) , figure-of-8 walk test ( time : -3.50 [ -12.60–-2.00 ] versus -1.25 [ -4.98–0.25 ] ; steps:-5.00 [ -8.00–-2.00 ] versus 0.00 [ -3.25–0.25 ] ) , and DGI ( 4.00 [ 3.00–6.00 ] versus 1.00 [ -4.00–3.00 ] ) showed significant differences between the EG and CG ( p < 0.05 ) . In the EG , the 10-m walk test , time and steps of figure-of-8 walk test , DGI , and gait symmetry score in the stance phase showed significant differences between pre- and post-test ( p < 0.05 ) . Conclusions : The findings suggest that AOT can be beneficial in enhancing walking ability of patients with post-stroke hemiparesis , and may be clinical ly feasible as a practical adjunct to routine rehabilitation therapy . A power calculation on our data showed that 20 subjects in each group were required for further definitive studies OBJECTIVE To assess whether action observation treatment ( AOT ) may also improve motor recovery in postsurgical orthopedic patients , in addition to conventional physiotherapy . DESIGN R and omized controlled trial . SETTING Department of rehabilitation . PARTICIPANTS Patients ( N=60 ) admitted to our department postorthopedic surgery were r and omly assigned to either a case ( n=30 ) or control ( n=30 ) group . Exclusion criteria were age 18 years or younger and 90 years or older , Mini-Mental State Examination score of 21 of 30 or lower , no ambulating order , advanced vision impairment , malignancy , pneumonia , or heart failure . INTERVENTIONS All participants underwent conventional physiotherapy . In addition , patients in the case group were asked to observe video clips showing daily actions and to imitate them afterward . Patients in the control group were asked to observe video clips with no motor content and to execute the same actions as patients in the case group afterward . Participants were scored on functional scales at baseline and after treatment by a physician blinded to group assignment . MAIN OUTCOMES MEASURES Changes in FIM and Tinetti scale scores , and dependence on walking aids . RESULTS At baseline , groups did not differ in clinical and functional scale scores . After treatment , patients in the case group scored better than patients in the control group ( FIM total score , P=.02 ; FIM motor subscore , P=.001 ; Tinetti scale score , P=.04 ) ; patients in the case group were assigned more frequently to 1 crutch ( P=.01 ) . CONCLUSIONS In addition to conventional physiotherapy , AOT is effective in the rehabilitation of postsurgical orthopedic patients . The present results strongly support top-down effects of this treatment in motor recovery , even in nonneurologic patients AIM The aim of this r and omized controlled trial was to assess whether action observation treatment may improve upper limb motor functions in children with cerebral palsy ( CP ) . METHOD All children with CP admitted to our unit for rehabilitation from May 2009 to May 2010 were eligible . Inclusion criteria were age between 6 years and 11 years , an IQ of at least 70 , and no major visual and /or auditory deficits . Fifteen children were enrolled and r and omly assigned to either a case group ( n=8 ; four males , four females ; median age 7 y 6 mo ) or control group ( n=7 ; five males , two females ; median age 8 y ) . Six participants had left-sided hemiplegia , six right-sided hemiplegia , and three had tetraplegia ; 10 were independent walkers . Those in the case group were asked to observe video clips showing daily age-appropriate actions , and afterwards to imitate them . Participants in the control group were asked to observe video clips with no motor content and afterwards to execute the same actions as cases . The primary outcome measure was the Melbourne Assessment Scale . Children were scored twice at baseline ( 2 wks apart ) , and at the end of treatment , by a physician blind to group assignment . RESULTS At baseline groups did not differ on functional evaluation . After treatment , the functional score gain ( Δ ) was significantly different in the case and control groups ( p=0.026 ) . INTERPRETATION The present results support the notion that action observation treatment can be an effective part of the rehabilitation programme in children with CP
Following the discovery of Mirror Neuron System ( MNS ) , Action Observation Training ( AOT ) has become an emerging rehabilitation tool to improve motor functions both in neurologic and orthopedic pathologies .
The aim of this study is to present the state of the art on the use of AOT in experimental studies to improve motor function recovery in any disease .