مشاهده عمل و تصویرسازی حرکت: ابزارهای شناختی نوآورانه در توانبخشی بیماری پارکینسون Action Observation and Motor Imagery: Innovative Cognitive Tools in the Rehabilitation of Parkinson’s Disease

۱٫ Introduction Parkinson’s disease (PD) is a complex neurodegenerative disorder characterized by motor and nonmotor symptoms. Since no known cure exists, the management of PD is traditionally based on symptomatic treatment with drug therapy (levodopa being considered the “gold standard”) or with neurosurgical approaches (Deep Brain Stimulation, DBS). However, even with optimal medical or surgical management, patients with PD still experience a progressive deterioration of their autonomy with increasing difficulties in daily living activities and in various aspects of mobility such as gait, transfers, balance, and posture. For this reason, there has been increasing recourse to the inclusion of rehabilitation therapies as an adjuvant to pharmacological and neurosurgical treatment with the aim of maximizing functional ability and minimizing secondary complications. A recent meta-analysis of physiotherapy interventions [1] provided evidence of short-term, small but significant and clinically important benefits for walking speed and balance in PD patients. However, formal comparison of different techniques could not be performed and there was insufficient evidence to support one specific physiotherapy intervention [2]. The latter reviews pointed out the need for more adequate trials and for the development of innovative approaches demonstrating a longer-term efficacy and better cost-effectiveness of physiotherapy in PD. Traditionally, physiotherapy was based on physical practice to improve motor abilities (such as muscular strength, gait, or coordination); however, the new guidelines highlighted that physiotherapy for PD needs to maximise quality of movement and functional independence by means of a tailored intervention linked to the stage of the disease progression. With regard to physiotherapy interventions, several approaches aim to teach patients using compensatory attentional/cognitive strategies that may rely on the recruitment of alternative motor circuits. Indeed, it has been demonstrated that both cueing strategies (based on the use of external stimuli associated with the initiation and facilitation of a motor activity) and attentional strategies (such as instructions which rely on cognitive mechanisms of motor control and are internally generated) are able to improve walking performance by using alternative pathways unaffected by PD [3]. In this sense, motor imagery (MI) and action observation (AO) are two training techniques that have recently gained attention as a promising rehabilitation tool for patients with neurological disorders [4–۶]. The aim of this perspective review was to show that both motor imagery (MI) and action observation (AO) represent two innovative rehabilitation approaches that are feasible in Parkinson’s disease (PD) and potentially able to induce significant benefits. Here we briefly summarized the basic mechanisms underlying MI and AO, their role in motor learning, and possible abnormalities in patients with PD. Further, we reviewed the available evidences supporting the use of MI and AO in the rehabilitation of Parkinsonian subjects.