Action Observation Treatment Improves Upper Limb Motor Functions in Children with Cerebral Palsy: A Combined Clinical and Brain Imaging Study

Giovanni Buccino, Anna Molinaro, Claudia Ambrosi, Daniele Arisi, Lorella Mascaro, Chiara Pinardi, Andrea Rossi, Roberto Gasparotti, Elisa Fazzi, Jessica Galli, Giovanni Buccino, Anna Molinaro, Claudia Ambrosi, Daniele Arisi, Lorella Mascaro, Chiara Pinardi, Andrea Rossi, Roberto Gasparotti, Elisa Fazzi, Jessica Galli

Abstract

The aim of the present study was to assess the role of action observation treatment (AOT) in the rehabilitation of upper limb motor functions in children with cerebral palsy. We carried out a two-group, parallel randomized controlled trial. Eighteen children (aged 5-11 yr) entered the study: 11 were treated children, and 7 served as controls. Outcome measures were scores on two functional scales: Melbourne Assessment of Unilateral Upper Limb Function Scale (MUUL) and the Assisting Hand Assessment (AHA). We collected functional scores before treatment (T1), at the end of treatment (T2), and at two months of follow-up (T3). As compared to controls, treated children improved significantly in both scales at T2 and this improvement persisted at T3. AOT has therefore the potential to become a routine rehabilitation practice in children with CP. Twelve out of 18 enrolled children also underwent a functional magnetic resonance study at T1 and T2. As compared to controls, at T2, treated children showed stronger activation in a parieto-premotor circuit for hand-object interactions. These findings support the notion that AOT contributes to reorganize brain circuits subserving the impaired function rather than activating supplementary or vicariating ones.

Figures

Figure 1
Figure 1
(a) Graphic representation of the fMRI experimental paradigm, alternating manipulation of a simple object (a sphere), and manipulation of complex objects. (b) Clusters of activations transposed on sections from standard pediatric brain (ANTS) before treatment (T1), when comparing manipulation of complex objects versus manipulation of a sphere. Cases and controls are taken as a whole group, p < 0.001. Note that at T1, no activation was present when directly comparing cases versus controls. (c) After treatment (T2), direct comparison between cases and controls shows increased activations in frontal and parietal areas known to be involved in hand-object interactions, p < 0.001. Clusters of activations transposed on sections from standard pediatric brain (ANTS), as in (b).
Figure 2
Figure 2
Scores obtained by cases (red line) and controls (blue line) at T1, T2, and T3 in two different functional scales (AHA, MUUL). Statistical analysis (see text for details) showed that only in case scores obtained at T2 differed significantly from scores at T1 in both scales. This was true also when comparing T3 with T2 in both scales (error bars: 95% CI). ∗∗refers to statistical significant effects.

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