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      Action observation combined with gait training to improve gait and cognition in elderly with mild cognitive impairment A randomized controlled trial Translated title: Observação da ação e treinamento da marcha para melhorar a marcha e a cognição em idosos com comprometimento cognitivo leve: um estudo controlado randomizado


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          Owing to advancement of medical technology and current knowledge, the population has a longer life expectancy, leading to an increase in the proportion of elderly.


          The study aimed to investigate the effect of action observation (AO) combined with gait training on gait and cognition in elderly with mild cognitive impairment (MCI).


          Thirty-three participants were randomly allocated to action observation with gait training (AOGT), gait training (GT), and control (CT) groups. The AOGT and GT groups received a program of observation and gait training protocol with the same total duration of 65 min for 12 sessions. For the observation, the AGOT group watched a video of normal gait movement, while the GT group watched an abstract picture and the CT group received no training program. All participants were assessed for gait parameters during single- and dual-tasks using an electronic gait mat system and were assessed for cognitive level using the Montreal Cognitive Assessment (MoCA) at baseline, after training and at 1-month follow-up.


          The results showed that the AOGT group had significant improvements in gait speeds during single- and dual-tasks, as well as better MoCA score, while the GT group had significant improvement only in gait speed.


          The adjunct treatment of AO with gait training provides greater benefits for both gait and cognitive performances in elderly with MCI.


          Com o avanço da tecnologia médica e do conhecimento atual, a população tem uma expectativa de vida mais longa, levando a um aumento na proporção de idosos.


          O estudo teve como objetivo investigar o efeito da observação de ação (AO) combinada com o treinamento da marcha na marcha e cognição em idosos com comprometimento cognitivo leve (CCL).


          Trinta e três participantes foram alocados aleatoriamente para observação de ação com grupos de treinamento de marcha (AOGT), treinamento de marcha (GT) e controle (CT). Os grupos AOGT e GT receberam um programa de observação e protocolo de treinamento de marcha com a mesma duração total de 65 minutos por 12 sessões. Na observação, o grupo AGOT assistiu a um vídeo de movimento normal da marcha, enquanto o grupo GT assistiu a uma figura abstrata e o grupo CT não recebeu nenhum programa de treinamento. Todos os participantes foram avaliados quanto aos parâmetros da marcha durante tarefas simples e duplas, utilizando um sistema eletrônico de esteira da marcha e avaliados quanto ao nível cognitivo, utilizando a Avaliação Cognitiva de Montreal (MoCA) na linha de base, após o treinamento e 1 mês de acompanhamento.


          Os resultados mostraram que o grupo AOGT apresentou melhorias significativas nas velocidades da marcha durante tarefas simples e duplas, além do escore MoCA, enquanto o grupo GT teve melhora significativa apenas na velocidade da marcha.


          O tratamento adjunto da AO com o treinamento da marcha proporciona maiores benefícios tanto do desempenho da marcha quanto do desempenho cognitivo em idosos com CCL.

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          Most cited references26

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          The diagnosis and management of mild cognitive impairment: a clinical review.

          Cognitive decline is a common and feared aspect of aging. Mild cognitive impairment (MCI) is defined as the symptomatic predementia stage on the continuum of cognitive decline, characterized by objective impairment in cognition that is not severe enough to require help with usual activities of daily living.
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            Action observation treatment: a novel tool in neurorehabilitation.

            This review focuses on a novel rehabilitation approach known as action observation treatment (AOT). It is now a well-accepted notion in neurophysiology that the observation of actions performed by others activates in the perceiver the same neural structures responsible for the actual execution of those same actions. Areas endowed with this action observation-action execution matching mechanism are defined as the mirror neuron system. AOT exploits this neurophysiological mechanism for the recovery of motor impairment. During one typical session, patients observe a daily action and afterwards execute it in context. So far, this approach has been successfully applied in the rehabilitation of upper limb motor functions in chronic stroke patients, in motor recovery of Parkinson's disease patients, including those presenting with freezing of gait, and in children with cerebral palsy. Interestingly, this approach also improved lower limb motor functions in post-surgical orthopaedic patients. AOT is well grounded in basic neuroscience, thus representing a valid model of translational medicine in the field of neurorehabilitation. Moreover, the results concerning its effectiveness have been collected in randomized controlled studies, thus being an example of evidence-based clinical practice.
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              Hebbian learning and predictive mirror neurons for actions, sensations and emotions.

              Spike-timing-dependent plasticity is considered the neurophysiological basis of Hebbian learning and has been shown to be sensitive to both contingency and contiguity between pre- and postsynaptic activity. Here, we will examine how applying this Hebbian learning rule to a system of interconnected neurons in the presence of direct or indirect re-afference (e.g. seeing/hearing one's own actions) predicts the emergence of mirror neurons with predictive properties. In this framework, we analyse how mirror neurons become a dynamic system that performs active inferences about the actions of others and allows joint actions despite sensorimotor delays. We explore how this system performs a projection of the self onto others, with egocentric biases to contribute to mind-reading. Finally, we argue that Hebbian learning predicts mirror-like neurons for sensations and emotions and review evidence for the presence of such vicarious activations outside the motor system.

                Author and article information

                Dement Neuropsychol
                Dement Neuropsychol
                Dementia & Neuropsychologia
                Associação de Neurologia Cognitiva e do Comportamento
                Apr-Jun 2020
                Apr-Jun 2020
                : 14
                : 2
                : 118-127
                [1 ]Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.
                [2 ]Gait and Balance Group, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand.
                [3 ]Division of Neurology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
                Author notes
                Sunee Bovonsunthonchai. Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Rd., Salaya, Phuttamonthon, Nakhon Pathom, 73170, Thailand. E-mail. sunee.bov@ 123456mahidol.edu

                Disclosure: The authors report no conflicts of interest.

                Author contributions. Rommanee Rojasavastera: data collection, data analysis and interpretation, manuscript drafting. Sunee Bovonsunthonchai: conception and design of the study, data analysis and interpretation, manuscript drafting and revising, correspondence. Vimonwan Hiengkaew: conception and design of the study. Vorapun Senanarong: conception and design of the study.


                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Original Article

                action observation,cognition,gait,gait training,mild cognitive impairment,observação da ação,cognição,treinamento da marcha,marcha,comprometimento cognitivo leve


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