Abstract Details

Title Clinical and fMRI Effects of Action Observation and Motor Imagery Training on Dual-Task Performances in Parkinson’s Disease Patients With Postural Instability and Gait Disorders

Topic Neuro-rehabilitation

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-010

Objective To assess brain functional reorganization and gait changes performing dual-task after 6 weeks of action observation training (AOT) and motor imagery (MI) associated with gait/balance exercises in Parkinson’s disease patients with postural instability and gait disorders (PD-PIGD).

Background Dual-task is challenging for PD-PIGD patients and impacts on postural stability and gait safety.

Design/Methods

Twenty PD-PIGD patients were randomized into 2 groups: the AOT-MI-group performed a 6-week (W6) gait/balance training consisting of AOT-MI combined with practicing the observed-imagined exercises; LANDSCAPE-group performed the same exercises combined with watching landscape videos. Exercises were increasingly difficult, up to include dual-task. At baseline and W6, patients underwent: i) functional MRI (fMRI) dual-task (foot anti-phase movements while counting backwards by threes starting from 100) and ii) gait/balance evaluations including Timed-Up-and-Go-test (TUG) and TUG associated with dual-task, Mini-Balance-Evaluation-System-test (MiniBESTest) and Activities Balance Confidence questionnaire (ABC).

Results At W6 compared to baseline, both groups showed an improvement in TUG execution time, whereas only the AOT-MI group improved in TUG with dual-task, MiniBESTest and ABC. AOT-MI-group also showed improvements in gait speed during the turn phase of TUG and TUG with dual-task, ABC and MiniBESTest relative to LANDSCAPE-group. At W6 relative to baseline, during the fMRI dual-task, the AOT-MI-group showed reduced recruitment of frontal, occipital, insular areas and hippocampus and increased activity of parietal areas. The LANDSCAPE group presented decreased activity of occipital areas and increased recruitment of fronto-temporal areas. AOT-MI relative to LANDSCAPE group showed reduced recruitment of frontal, occipital, and temporal areas and of the right putamen.

Conclusions Our results suggest that increasingly difficult gait/balance exercises improve gait speed in PD-PIGD patients; however, only when exercises were preceded by a motor-learning facilitation strategy (AOT-MI), patients showed gait/balance improvements and increased brain efficiency during dual-task circumstances, which are among the most challenging for PD-PIGD patients.

Authors/Disclosures
Elisabetta Sarasso PRESENTER	Elisabetta Sarasso has nothing to disclose.
Federica Agosta (San Raffaele Scientific Institute)	Federica Agosta has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Philips. Federica Agosta has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier INC.
	No disclosure on file
Noemi Piramide, MSc (Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neu)	Noemi Piramide has nothing to disclose.
Elisa Canu (Ospedale San Raffaele)	The institution of Elisa Canu has received research support from Italian Ministry of Health .
	No disclosure on file
Sebastiano Galantucci (San Raffaele Scientific Institute)	Mr. Galantucci has nothing to disclose.
Andrea Tettamanti	No disclosure on file
	No disclosure on file
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit)	Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.

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