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Action observation (AO) and motor imagery (MI) has emerged as promising tool for physiotherapy intervention in Parkinson's disease (PD). This narrative review summarizes why, how, and when applying AO and MI training in individual with PD. We report the neural underpinning of AO and MI and their effects on motor learning. We examine the characteristics and the current evidence regarding the effectiveness of physiotherapy interventions and we provide suggestions about their implementation with technologies. Neurophysiological data suggest a substantial correct activation of brain networks underlying AO and MI in people with PD, although the occurrence of compensatory mechanisms has been documented. Regarding the efficacy of training, in general evidence indicates that both these techniques improve mobility and functional activities in PD. However, these findings should be interpreted with caution due to variety of the study designs, training characteristics, and the modalities in which AO and MI were applied. Finally, results on long-term effects are still uncertain. Several elements should be considered to optimize the use of AO and MI in clinical setting, such as the selection of the task, the imagery or the video perspectives, the modalities of training. However, a comprehensive individual assessment, including motor and cognitive abilities, is essential to select which between AO and MI suite the best to each PD patients. Much unrealized potential exists for the use AO and MI training to provide personalized intervention aimed at fostering motor learning in both the clinic and home setting. [ABSTRACT FROM AUTHOR]

Background: This is a retrospective longitudinal study comparing 374 patients with Parkinson's disease (PD) who were treated in centers offering a specialized program of enhanced rehabilitation therapy in addition to expert outpatient care to 387 patients with PD, who only received expert outpatient care at movement disorders centers in Italy. Methods: The data are from subjects recruited in the Parkinson's Outcome Project (POP) at six Italian centers that are part of a multicenter collaboration for care quality improvement (the Fresco Network). The effects were measured with a baseline and a follow-up clinical evaluation of the Timed-Up-and-Go test (TUG), Parkinson's Disease Questionnaire (PDQ-39), and Multidimensional Caregiver Strain Index (MCSI), the number of falls and hospitalizations for any cause. We used a generalized linear mixed model with the dependent variables being the response variable, which included the covariates demographics, evaluation, and treatment variables. Results: We found that the subjects who underwent specialized enhanced rehabilitation had a better motor outcome over time than those who were managed by expert neurologists but had participated in community programs for exercise and other allied health interventions. The greatest effects were seen in patients in the early stages of the disease with a high amount of vigorous exercise per week in the last six months. Similar effects were seen for PDQ39, MCSI, the number of falls, and hospitalization. Conclusions: Long-term benefits to motor function and the quality of life in patients with PD and burden reduction in their caregivers can be achieved through a systematic program of specialized enhanced rehabilitation interventions. [ABSTRACT FROM AUTHOR]

Walking encompasses a complex interplay of neuromuscular coordination and cognitive processes. Disruptions in gait can impact personal independence and quality of life, especially among the elderly and neurodegenerative patients. While traditional biomechanical analyses and neuroimaging techniques have contributed to understanding gait control, they often lack the temporal resolution needed for rapid neural dynamics. This study employs a mobile brain/body imaging (MoBI) platform with high-density electroencephalography (hd-EEG) to explore event-related desynchronization and synchronization (ERD/ERS) during overground walking. Simultaneous to hdEEG, we recorded gait spatiotemporal parameters. Participants were asked to walk under usual walking and dual-task walking conditions. For data analysis, we extracted ERD/ERS in α, β, and γ bands from 17 selected regions of interest encompassing not only the sensorimotor cerebral network but also the cognitive and affective networks. A correlation analysis was performed between gait parameters and ERD/ERS intensities in different networks in the different phases of gait. Results showed that ERD/ERS modulations across gait phases in the α and β bands extended beyond the sensorimotor network, over the cognitive and limbic networks, and were more prominent in all networks during dual tasks with respect to usual walking. Correlation analyses showed that a stronger α ERS in the initial double-support phases correlates with shorter step length, emphasizing the role of attention in motor control. Additionally, β ERD/ERS in affective and cognitive networks during dual-task walking correlated with dual-task gait performance, suggesting compensatory mechanisms in complex tasks. This study advances our understanding of neural dynamics during overground walking, emphasizing the multidimensional nature of gait control involving cognitive and affective networks. [ABSTRACT FROM AUTHOR]

Background: Motor symptoms in functional motor disorders (FMDs) refer to involuntary, but learned, altered movement patterns associated with aberrant self‐focus, sense of agency, and belief/expectations. These conditions commonly lead to impaired posture control, raising the likelihood of falls and disability. Utilizing visual and cognitive tasks to manipulate attentional focus, virtual reality (VR) integrated with posturography is a promising tool for exploring postural control disorders. Objectives: To investigate whether postural control can be adapted by manipulating attentional focus in a 3D immersive VR environment. Methods: We compared postural parameters in 17 FMDs patients and 19 age‐matched healthy controls over a single session under four increasingly more complex and attention‐demanding conditions: simple fixation task (1) in the real room and (2) in 3D VR room‐like condition; complex fixation task in a 3D VR city‐like condition (3) avoiding distractors and (4) counting them. Dual‐task effect (DTE) measured the relative change in performance induced by the different attention‐demanding conditions on postural parameters. Results: Patients reduced sway area and mediolateral center of pressure displacement velocity DTE compared to controls (all, P < 0.049), but only under condition 4. They also showed a significant reduction in the sway area DTE under condition 4 compared to condition 3 (P = 0.025). Conclusions: This study provides novel preliminary evidence for the value of a 3D immersive VR environment combined with different attention‐demanding conditions in adapting postural control in patients with FMDs. As supported by quantitative and objective posturographic measures, our findings may inform interventions to explore FMDs pathophysiology. [ABSTRACT FROM AUTHOR]

Background: Real‐world monitoring using wearable sensors has enormous potential for assessing disease severity and symptoms among persons with Parkinson's disease (PD). Many distinct features can be extracted, reflecting multiple mobility domains. However, it is unclear which digital measures are related to PD severity and are sensitive to disease progression. Objectives: The aim was to identify real‐world mobility measures that reflect PD severity and show discriminant ability and sensitivity to disease progression, compared to the Movement Disorder Society‐Unified Parkinson's Disease Rating Scale (MDS‐UPDRS) scale. Methods: Multicenter real‐world continuous (24/7) digital mobility data from 587 persons with PD and 68 matched healthy controls were collected using an accelerometer adhered to the lower back. Machine learning feature selection and regression algorithms evaluated associations of the digital measures using the MDS‐UPDRS (I–III). Binary logistic regression assessed discriminatory value using controls, and longitudinal observational data from a subgroup (n = 33) evaluated sensitivity to change over time. Results: Digital measures were only moderately correlated with the MDS‐UPDRS (part II‐r = 0.60 and parts I and III‐r = 0.50). Most associated measures reflected activity quantity and distribution patterns. A model with 14 digital measures accurately distinguished recently diagnosed persons with PD from healthy controls (81.1%, area under the curve: 0.87); digital measures showed larger effect sizes (Cohen's d: [0.19–0.66]), for change over time than any of the MDS‐UPDRS parts (Cohen's d: [0.04–0.12]). Conclusions: Real‐world mobility measures are moderately associated with clinical assessments, suggesting that they capture different aspects of motor capacity and function. Digital mobility measures are sensitive to early‐stage disease and to disease progression, to a larger degree than conventional clinical assessments, demonstrating their utility, primarily for clinical trials but ultimately also for clinical care. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Background: VPS16 pathogenic variants have been recently associated with inherited dystonia. Most patients affected by dominant VPS16‐related disease display early‐onset isolated dystonia with prominent oromandibular, bulbar, cervical, and upper limb involvement, followed by slowly progressive generalization. Cases: We describe six newly reported dystonic patients carrying VPS16 mutations displaying unusual phenotypic features in addition to dystonia, such as myoclonus, choreoathetosis, pharyngospasm and freezing of gait. Response to bilateral Globus Pallidus Internus Deep Brain Stimulation (GPi‐DBS) is reported in three of them, associated with significant improvement of dystonia but only minor effect on other hyperkinetic movements. Moreover, five novel pathogenic/likely pathogenic variants are described. Conclusions: This case collection expands the genetic and clinical spectrum of VPS16‐related disease, prompting movement disorder specialists to suspect mutations of this gene not only in patients with isolated dystonia. [ABSTRACT FROM AUTHOR]

The processing of threat‐related emotional body language (EBL) has been shown to engage sensorimotor cortical areas early on and induce freezing in the observers' motor system, particularly when observing fearful EBL. To provide insights into the interplay between somatosensory and motor areas during observation of EBL, here, we used high‐density electroencephalography (hd‐EEG) in healthy humans while they observed EBL stimuli involving fearful and neutral expressions. To capture early sensorimotor brain response, we focused on P100 fronto‐central event‐related potentials (ERPs) and event‐related desynchronization/synchronization (ERD/ERS) in the mu‐alpha (8–13 Hz) and lower beta (13–20 Hz) bands over the primary motor (M1) and somatosensory (S1) cortices. Source‐level ERP and ERD/ERS analyses were conducted using eLORETA. Results revealed higher P100 amplitudes in motor and premotor channels for 'Neutral' compared with 'Fear'. Additionally, analysis of ERD/ERS showed increased beta band desynchronization in M1 for 'Neutral', and the opposite pattern in S1. Source‐level estimation showed significant differences between conditions mainly observed in the beta band over sensorimotor areas. These findings provide high‐temporal resolution evidence suggesting that seeing fearful EBL induces early activation of somatosensory areas, which in turn could suppress M1 activity. These findings highlight early dynamics within the observer's sensorimotor system and hint at a sensorimotor mechanism supporting freezing during the processing of EBL. By means of hd‐EEG, we provide high‐temporal resolution evidence that seeing fearful emotional body language (EBL) induces early activation of somatosensory areas, which in turn suppress M1 activity. These findings provide high‐temporal resolution evidence suggesting that seeing fearful EBL induces early activation of somatosensory areas, which in turn could suppress M1 activity. [ABSTRACT FROM AUTHOR]