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Original Article   Open accessopen access

European Journal of Physical and Rehabilitation Medicine 2022 Sep 01

DOI: 10.23736/S1973-9087.22.07313-0

Copyright © 2022 THE AUTHOR(s)

This is an open access article distributed under the terms of the CC BY-NC 4.0 license which allows users to distribute, remix, adapt and build upon the manuscript, as long as this is not done for commercial purposes, the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI), provides a link to the license and indicates if changes were made.

lingua: Inglese

Action observation and motor imagery have no effect on balance and freezing of gait in Parkinson’s disease: a randomized controlled trial

Paula T. BEZERRA 1, Lorenna M. SANTIAGO 1, 2, 3, 4, Isaíra A. SILVA 1, Aline A. SOUZA 1, Camila L. PEGADO 1, Clécia M. DAMASCENA 3, Tatiana S. RIBEIRO 1, Ana R. LINDQUIST 1

1 Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil; 2 Centro de Educação e Pesquisa em Saúde Anita Garibaldi, Instituto Santos Dumont, Macaíba, Rio Grande do Norte, Brazil; 3 Faculdade Estácio do Rio Grande do Norte (Fatern), Natal, Rio Grande do Norte, Brazil; 4 Faculdade Natalense de Ensino e Cultura, Natal, Rio Grande do Norte, Brazil


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BACKGROUND: Combining action observation (AO) and motor imagery (MI) training may induce greater brain activity in areas usually involved in Parkinson’s disease (PD) and lead to greater behavioral and neurophysiological effects than when used separately.
AIM: To determine the effects of combining AO, MI, and gait training on balance and freezing of gait in individuals with PD.
DESIGN: This is a single-blinded, randomized controlled clinical trial.
SETTING: Developed by the Laboratory of Intervention and Analysis of Movement (LIAM) from the Department of Physical Therapy of the Universidade Federal do Rio Grande do Norte (UFRN).
POPULATION: Study sample consisted of individuals diagnosed with idiopathic PD by a neurologist specialized in movement disorders.
METHODS: 39 individuals with PD were divided into experimental (EG = 21) and control groups (CG = 18). EG performed 12 sessions of AO, MI, and gait training, whereas CG watched PD-related educational videos and performed 12 sessions of gait training. Balance (measured using the Mini Balance Evaluation Systems Test [MiniBESTest]) and freezing of gait (measured using the Freezing of Gait Questionnaire) were reassessed one day after the end of the intervention.
RESULTS: We did not observe significant intra- and intergroup differences in freezing of gait. For the EG, we observed a significant intragroup difference in the total score of MiniBESTest (F = 5.2; p = 0.02), and sensory orientation (F = 4.5; p = 0.04) and dynamic gait (F = 3.6; p = 0.03) domains. MiniBESTest domains were not different between groups.
CONCLUSIONS: Combining AO, MI, and gait training was not more effective than isolated gait training for balance and freezing of gait in individuals with PD.
CLINICAL REHABILITATION IMPACT: MI training can moderate AO effects and enhance motor learning when both therapies are combined. Therefore, this approach may still have the potential to be included in the treatment of PD. New studies should investigate whether the factors that influence these results are related to the protocol's sensitivity in changing the evaluated parameters or to the time and intensity of AO and MI training.


KEY WORDS: Parkinson’s disease; Postural balance; Freezing; Gait; Motor imagery; Action observation

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