Brain plasticity in Parkinson's disease with freezing of gait induced by action observation training

Federica Agosta, Roberto Gatti, Elisabetta Sarasso, Maria Antonietta Volonté, Elisa Canu, Alessandro Meani, Lidia Sarro, Massimiliano Copetti, Erik Cattrysse, Eric Kerckhofs, Giancarlo Comi, Andrea Falini, Massimo Filippi

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40 Citations (Scopus)


Gait disorders represent a therapeutic challenge in Parkinson’s disease (PD). This study investigated the efficacy of 4-week action observation training (AOT) on disease severity, freezing of gait and motor abilities in PD, and evaluated treatment-related brain functional changes. 25 PD patients with freezing of gait were randomized into two groups: AOT (action observation combined with practicing the observed actions) and “Landscape” (same physical training combined with landscape-videos observation). At baseline and 4-week, patients underwent clinical evaluation and fMRI. Clinical assessment was repeated at 8-week. At 4-week, both groups showed reduced freezing of gait severity, improved walking speed and quality of life. Moreover, AOT was associated with reduced motor disability and improved balance. AOT group showed a sustained positive effect on motor disability, walking speed, balance and quality of life at 8-week, with a trend toward a persisting reduced freezing of gait severity. At 4-week vs. baseline, AOT group showed increased recruitment of fronto-parietal areas during fMRI tasks, while the Landscape group showed a reduced fMRI activity of the left postcentral and inferior parietal gyri and right rolandic operculum and supramarginal gyrus. In AOT group, functional brain changes were associated with clinical improvements at 4-week and predicted clinical evolution at 8-week. AOT has a more lasting effect in improving motor function, gait and quality of life in PD patients relative to physical therapy alone. AOT-related performance gains are associated with an increased recruitment of motor regions and fronto-parietal mirror neuron and attentional control areas.

Original languageEnglish
Pages (from-to)88-101
Number of pages14
JournalJournal of Neurology
Issue number1
Publication statusPublished - Jan 2017


  • Action observation
  • Freezing of gait
  • Functional MRI
  • Gait disorders
  • Parkinson’s disease

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