Observation of others' actions during limb immobilization prevents the subsequent decay of motor performance

Augmented action observation: Theory and practical applications in sensorimotor rehabilitation

Sensory feedback is a fundamental aspect of effective motor learning in sport and clinical contexts. One way to provide this is through sensory augmentation, where extrinsic sensory information are associated with, and modulated by, movement. Traditionally, sensory augmentation has been used as an online strategy, where feedback is provided during physical execution of an action. In this article, we argue that action observation can be an additional effective channel to provide augmented feedback, which would be complementary to other, more traditional, motor learning and sensory augmentation strategies. Given these similarities between observing and executing an action, action observation could be used when physical training is difficult or not feasible, for example during immobilization or during the initial stages of a rehabilitation protocol when peripheral fatigue is a common issue. We review the benefits of observational learning and preliminary evidence for the effectiveness of using augmented action observation to improve learning. We also highlight current knowledge gaps which make the transition from laboratory to practical contexts difficult. Finally, we highlight the key areas of focus for future research.

Changes in brain functional connectivity and muscle strength independent of elbow flexor atrophy following upper limb immobilization in young females

Muscle disuse induces a decline in muscle strength that exceeds the rate and magnitude of muscle atrophy, suggesting that factors beyond the muscle contribute to strength loss. The purpose of this study was to characterize changes in the brain and neuromuscular system in addition to muscle size following upper limb immobilization in young females. Using a within-participant, unilateral design, 12 females (age: 20.6 ± 2.1 years) underwent 14 days of upper arm immobilization using an elbow brace and sling. Bilateral measures of muscle strength (isometric and isokinetic dynamometry), muscle size (magnetic resonance imaging), voluntary muscle activation capacity, corticospinal excitability, cortical thickness and resting-state functional connectivity were collected before and after immobilization. Immobilization induced a significant decline in isometric elbow flexion (-21.3 ± 19.2%, interaction: P = 0.0440) and extension (-19.9 ± 15.7%, interaction: P = 0.0317) strength in the immobilized arm only. There was no significant effect of immobilization on elbow flexor cross-sectional area (CSA) (-1.2 ± 2.4%, interaction: P = 0.466), whereas elbow extensor CSA decreased (-2.9 ± 2.9%, interaction: P = 0.0177) in the immobilized arm. Immobilization did not differentially alter voluntary activation capacity, corticospinal excitability, or cortical thickness (P > 0.05); however, there were significant changes in the functional connectivity of brain regions related to movement planning and error detection (P < 0.05). This study reveals that elbow flexor strength loss can occur in the absence of significant elbow flexor muscle atrophy, and that the brain represents a site of functional adaptation in response to upper limb immobilization in young females.

Reorganization of Brain Resting-state Functional Connectivity Following 14 Days of Elbow Immobilization in Young Females

Limb immobilization is known to cause significant decreases in muscle strength and muscle mass as early as two days following the onset of immobilization. However, the decline in strength surpasses the decline in muscle mass, suggesting that factors in addition to muscle loss, such as neuroplasticity, contribute to the decrease in force production. However, little is known regarding immobilization-induced neural changes, although sensorimotor regions seem to be the most affected. The present study aimed to determine whether brain functional organization is altered following 14 days of unilateral elbow immobilization. Functional organization was quantified using resting-state functional connectivity, a measure of the synchronicity of the spontaneous discharge of different brain regions at rest. Data was obtained from twelve healthy young females before and after completing the immobilization period. A seed-to-voxel analysis was performed using seeds associated with cortical, subcortical, and cerebellar sensorimotor regions of the brain. The results showed changes predominantly involving cerebellar connectivity. For example, the immobilization period caused a decrease in connectivity between the motor cerebellar region of the immobilized arm and the left temporal lobe, and an increase between the same cerebellar region and the supplementary motor area. Overall, changes in connectivity occurred in regions typically associated with error detection and motor learning, suggesting a potential functional reorganization of the brain within 14 days of elbow immobilization.

Identification of movement phenotypes from occupational gesture kinematics: Advancing individual ergonomic exposure classification and personalized training

The identification of personalized preventive strategies plays a major role in contrasting the occurrence of work-related musculoskeletal disorders. This requires the identification of distinct movement patterns within large samples and the attribution of a proper risk level to each identified movement phenotype. We assessed the feasibility of this approach by exploiting wearable inertial measurement units to estimate the whole-body kinematics of 43 healthy participants performing 18 reach-to-manipulate movements, which differed based on the object's position in the space and the type of manipulation required. Through unsupervised clustering, we identified multiple movement phenotypes graded by ergonomic performance. Furthermore, we determined which joints mostly contributed to instantiating the ergonomic differences across clusters, emphasizing the importance of monitoring this aspect during occupational gestures. Overall, our analysis suggests that movement phenotypes can be identified within occupational motor repertoires. Assigning individual performance to specific phenotypes has the potential to inform the development of more effective and tailored interventions.

The capacity of action observation to drag the trainees' motor pattern toward the observed model

Action Observation Training (AOT) promotes the acquisition of motor abilities. However, while the cortical modulations associated with the AOT efficacy are well known, few studies investigated the AOT peripheral neural correlates and whether their dynamics move towards the observed model during the training. We administered seventy-two participants (randomized into AOT and Control groups) with training for learning to grasp marbles with chopsticks. Execution practice was preceded by an observation session, in which AOT participants observed an expert performing the task, whereas controls observed landscape videos. Behavioral indices were measured, and three hand muscles' electromyographic (EMG) activity was recorded and compared with the expert. Behaviorally, both groups improved during the training, with AOT outperforming controls. The EMG trainee-model similarity also increased during the training, but only for the AOT group. When combining behavioral and EMG similarity findings, no global relationship emerged; however, behavioral improvements were "locally" predicted by the similarity gain in muscles and action phases more related to the specific motor act. These findings reveal that AOT plays a magnetic role in motor learning, attracting the trainee's motor pattern toward the observed model and paving the way for developing online monitoring tools and neurofeedback protocols.

Effects of the social context on the neurophysiological correlates of observed error monitoring

Monitoring the motor performance of others, including the correctness of their actions, is crucial for the human behavior. However, while performance (and error) monitoring of the own actions has been studied extensively at the neurophysiological level, the corresponding studies on monitoring of others' errors are scarce, especially for ecological actions. Moreover, the role of the context of the observed action has not been sufficiently explored. To fill this gap, the present study investigated electroencephalographic (EEG) indices of error monitoring during observation of images of interrupted reach-to-grasp actions in social (an object held in another person's hand) and non-social (an object placed on a table) contexts. Analysis in time- and time-frequency domain showed that, at the level of conscious error awareness, there were no effects of the social context (observed error positivity was present for erroneous actions in both contexts). However, the effects of the context were present at the level of hand image processing: observing erroneous actions in the non-social context was related to larger occipito-temporal N1 and theta activity, while in the social context this pattern was reversed, i.e., larger N1 and theta activity were present for the correct actions. These results suggest that, in case of easily predictable ecological actions, action correctness is processed as early as at the level of hand image perception, since the hand posture conveys information about the action (e.g., motor intention). The social context of actions might make the correct actions more salient, possibly through the saliency of the correctly achieved common goal.

Early sleep after action observation and motor imagery training boosts improvements in manual dexterity

The systematic observation and imagination of actions promotes acquisition of motor skills. Furthermore, studies demonstrated that early sleep after practice enhances motor learning through an offline stabilization process. Here, we investigated behavioral effects and neurodynamical correlates of early sleep after action observation and motor imagery training (AO + MI-training) on motor learning in terms of manual dexterity. Forty-five healthy participants were randomized into three groups receiving a 3 week intervention consisting of AO + MI-training immediately before sleeping or AO + MI-training at least 12 h before sleeping or a control stimulation. AO + MI-training implied the observation and motor imagery of transitive manual dexterity tasks, whereas the control stimulation consisted of landscape video-clips observation. Manual dexterity was assessed using functional tests, kinematic and neurophysiological outcomes before and after the training and at 1-month follow-up. AO + MI-training improved manual dexterity, but subjects performing AO + MI-training followed by early sleep had significantly larger improvements than those undergoing the same training at least 12 h before sleeping. Behavioral findings were supported by neurodynamical correlates during motor performance and additional sleep-dependent benefits were also detected at 1 month follow-up. These findings introduce a new approach to enhance the acquisition of new motor skills or facilitate recovery in patients with motor impairments.

The value of corticospinal excitability and intracortical inhibition in predicting motor skill improvement driven by action observation

The observation of other's actions represents an essential element for the acquisition of motor skills. While action observation is known to induce changes in the excitability of the motor cortices, whether such modulations may explain the amount of motor improvement driven by action observation training (AOT) remains to be addressed. Using transcranial magnetic stimulation (TMS), we first assessed in 41 volunteers the effect of action observation on corticospinal excitability, intracortical inhibition, and transcallosal inhibition. Subsequently, half of the participants (AOT-group) were asked to observe and then execute a right-hand dexterity task, while the controls had to observe a no-action video before practicing the same task. AOT participants showed greater performance improvement relative to controls. More importantly, the amount of improvement in the AOT group was predicted by the amplitude of corticospinal modulation during action observation and, even more, by the amount of intracortical inhibition induced by action observation. These relations were specific for the AOT group, while the same patterns were not found in controls. Taken together, our findings demonstrate that the efficacy of AOT in promoting motor learning is rooted in the capacity of action observation to modulate the trainee's motor system excitability, especially its intracortical inhibition. Our study not only enriches the picture of the neurophysiological effects induced by action observation onto the observer's motor excitability, but linking them to the efficacy of AOT, it also paves the way for the development of models predicting the outcome of training procedures based on the observation of other's actions.

Mapping relational links between motor imagery, action observation, action-related language, and action execution

Actions can be physically executed, observed, imagined, or simply thought about. Unifying mental processes, such as simulation, emulation, or predictive processing, are thought to underlie different action types, whether they are mental states, as in the case of motor imagery and action observation, or involve physical execution. While overlapping brain activity is typically observed across different actions which indicates commonalities, research interest is also concerned with investigating the distinct functional components of these action types. Unfortunately, untangling subtleties associated with the neurocognitive bases of different action types is a complex endeavour due to the high dimensional nature of their neural substrate (e.g., any action process is likely to activate multiple brain regions thereby having multiple dimensions to consider when comparing across them). This has impeded progress in action-related theorising and application. The present study addresses this challenge by using the novel approach of multidimensional modeling to reduce the high-dimensional neural substrate of four action-related behaviours (motor imagery, action observation, action-related language, and action execution), find the least number of dimensions that distinguish or relate these action types, and characterise their neurocognitive relational links. Data for the model comprised brain activations for action types from whole-brain analyses reported in 53 published articles. Eighty-two dimensions (i.e., 82 brain regions) for the action types were reduced to a three-dimensional model, that mapped action types in ordination space where the greater the distance between the action types, the more dissimilar they are. A series of one-way ANOVAs and post-hoc comparisons performed on the mean coordinates for each action type in the model showed that across all action types, action execution and concurrent action observation (AO)-motor imagery (MI) were most neurocognitively similar, while action execution and AO were most dissimilar. Most action types were similar on at least one neurocognitive dimension, the exception to this being action-related language. The import of the findings are discussed in terms of future research and implications for application.

Mirror neurons 30 years later: implications and applications

Mirror neurons (MNs) were first described in a seminal paper in 1992 as a class of monkey premotor cells discharging during both action execution and observation. Despite their debated origin and function, recent studies in several species, from birds to humans, revealed that beyond MNs properly so called, a variety of cell types distributed among multiple motor, sensory, and emotional brain areas form a 'mirror mechanism' more complex and flexible than originally thought, which has an evolutionarily conserved role in social interaction. Here, we trace the current limits and envisage the future trends of this discovery, showing that it inspired translational research and the development of new neurorehabilitation approaches, and constitutes a point of no return in social and affective neuroscience.

The Added Value of Point-Light Display Observation in Total Knee Arthroplasty Rehabilitation Program: A Prospective Randomized Controlled Pilot Study

Background and Objectives: The present study aimed to assess the potential benefit of the observation of rehabilitation-related point-light display in addition to a conventional 3-week rehabilitation program, the objective being to improve functional capacity in patients having undergone total knee arthroplasty. Materials and Methods: Patients randomized in the control group had conventional rehabilitation treatment with two sessions per day 5 days a week of physical therapy (90 min), whereas patients in the experimental group had a program of conventional rehabilitation combined with a point-light display observation two times per day (5 min) and 3 days a week. Results: The patients of both groups had improved their performances by the end of the program, and the pre- and post-test improvement were superior for the experimental group over the control group concerning the total WOMAC score (p = 0.04), the functional WOMAC score (p = 0.03), and correct recognition of point-light displays (p = 0.003). Conclusions: These findings provide new insight favoring systematic point-light display observation to improve functional recovery in patients with total knee arthroplasty.

The Proactive Synergy Between Action Observation and Execution in the Acquisition of New Motor Skills

Motor learning can be defined as a process that leads to relatively permanent changes in motor behavior through repeated interactions with the environment. Different strategies can be adopted to achieve motor learning: movements can be overtly practiced leading to an amelioration of motor performance; alternatively, covert strategies (e.g., action observation) can promote neuroplastic changes in the motor system even in the absence of real movement execution. However, whether a training regularly alternating action observation and execution (i.e., Action Observation Training, AOT) may surpass the pure motor practice (MP) and observational learning (OL) remains to be established. To address this issue, we enrolled 54 subjects requiring them to learn tying nautical knots via one out of three types of training (AOT, MP, OL) with the scope to investigate which element mostly contributes to motor learning. We evaluated the overall improvement of each group, along with the predictive role that neuropsychological indexes exert on each treatment outcome. The AOT group exhibited the highest performance improvement (42%), indicating that the regular alternation between observation and execution biases participants toward a better performance. The reiteration of this sequence provides an incremental, adjunct value that super-adds onto the efficacy of motor practice or observational learning in isolation (42% > 25% + 10%, i.e., OL + MP). These findings extend the use of the AOT from clinical and rehabilitative contexts to daily routines requiring the learning and perfectioning of new motor skills such as sports training, music, and occupational activities requiring fine motor control.

A Repertoire of Virtual-Reality, Occupational Therapy Exercises for Motor Rehabilitation Based on Action Observation

There is a growing interest in action observation treatment (AOT), i.e., a rehabilitative procedure combining action observation, motor imagery, and action execution to promote the recovery, maintenance, and acquisition of motor abilities. AOT studies employed basic upper limb gestures as stimuli, but—in principle—the AOT approach can be effectively extended to more complex actions like occupational gestures. Here, we present a repertoire of virtual-reality (VR) stimuli depicting occupational therapy exercises intended for AOT, potentially suitable for occupational safety and injury prevention. We animated a humanoid avatar by fitting the kinematics recorded by a healthy subject performing the exercises. All the stimuli are available via a custom-made graphical user interface, which allows the user to adjust several visualization parameters like the viewpoint, the number of repetitions, and the observed movement’s speed. Beyond providing clinicians with a set of VR stimuli promoting via AOT the recovery of goal-oriented, occupational gestures, such a repertoire could extend the use of AOT to the field of occupational safety and injury prevention.