Mirror neurons: action observation treatment as a tool in stroke rehabilitation

Abstract

Background: The observation of actions performed by others activate in an observer the same neural structures (including mirror neurons) as when he/she actually performs the same actions.

Aim: The aim of the present study was to assess whether action observation treatment may improve upper limb motor impairment in chronic stroke patients.

Design: This was an observational study.

Setting: Patients were recruited by three Italian Centres for Neurorehabilitation between 2006 and 2008.

Population: Twenty-eight chronic stroke patients with upper limb impairment have undergone for four weeks, five days a week, a rehabilitation treatment based on observation of video-clips presenting hand daily actions, followed by the imitation of those same actions with the affected limb.

Methods: Functional evaluation by means of Modified Barthel Index (MBI), Frenchay Arm Test (FAT) and Fugl Meyer (FM) was carried out twice before treatment (BT1 and BT2), at an interval of 15 days, then after treatment (AT1) and finally at a two-month follow-up (AT2). Wilcoxon Signed Rank test was applied to test differences between scores obtained from functional scales before and after treatment (BT1 vs. BT2; BT2 vs. AT1; AT1 vs. AT2).

Results: In all scales, scores did not differ when comparing BT1 with BT2. Scores improved significantly in all scales at AT1 as compared to BT2 (MBI, P=0.026; FAT, P=0.005; FM, P=0.001). This improvement was still present at the two-month follow-up as testified by no score difference between AT1 and AT2.

Conclusion: Action Observation Treatment may become a useful strategy in the rehabilitation of stroke patients.

Clinical rehabilitation impact: The present preliminary study suggests that stimulation of neural structures (including mirror neurons), activated when the patients actually perform the same actions as those observed could constitute a good alternative rehabilitative approach in chronic stroke patients.