Objective: To assess brain functional reorganization and gait changes performing dual-task after 6 weeks of action observation training (AOT) and motor imagery (MI) associated with gait/balance exercises in PD-PIGD patients.

Background: Dual-task is challenging for Parkinson’s disease patients with postural instability and gait disorders (PD-PIGD) and impacts on postural stability and gait safety.

Method: Twenty PD-PIGD patients were randomized into 2 groups: the AOT-MI-group performed a 6-week (W6) gait/balance training consisting of AOT-MI combined with practicing the observed-imagined exercises; LANDSCAPE-group performed the same exercises combined with watching landscape videos. Exercises were increasingly difficult, up to include dual-task.  At baseline and W6, patients underwent: i) functional MRI (fMRI) dual-task (foot anti-phase movements while counting backwards by threes starting from 100) and ii) gait/balance evaluations including Timed-Up-and-Go-test (TUG) and TUG associated with dual-task, Mini-Balance-Evaluation-System-test (MiniBESTest) and Activities Balance Confidence questionnaire (ABC).

Results: At W6 compared to baseline, both groups showed an improvement in TUG execution time, whereas only the AOT-MI group improved in TUG with dual-task, MiniBESTest and ABC. AOT-MI-group also showed improvements in gait speed during the turn phase of TUG and TUG with dual-task, ABC and MiniBESTest relative to LANDSCAPE-group. At W6 relative to baseline, during the fMRI dual-task, the AOT-MI-group showed reduced recruitment of frontal, occipital, insular areas and hippocampus and increased activity of parietal areas. The LANDSCAPE group presented decreased activity of occipital areas and increased recruitment of fronto-temporal areas. AOT-MI relative to LANDSCAPE group showed reduced recruitment of frontal, occipital, and temporal areas and of the right putamen.

Conclusion: Our results suggest that increasingly difficult gait/balance exercises improve gait speed in PD-PIGD patients; however, only when exercises were preceded by a motor-learning facilitation strategy (AOT-MI), patients showed gait/balance improvements and increased brain efficiency during dual-task circumstances, which are among the most challenging for PD-PIGD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-fmri-effects-of-action-observation-and-motor-imagery-training-on-dual-task-performances-in-parkinsons-disease-patients-with-postural-instability-and-gait-disorders/