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Picardi M, Guidali G, Caronni A, Rota V, Corbo M, Bolognini N. Visuomotor paired associative stimulation enhances corticospinal excitability in post-stroke patients with upper-limb hemiparesis. Sci Rep 2025; 15:15313. [PMID: 40312465 PMCID: PMC12046018 DOI: 10.1038/s41598-025-98595-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 04/14/2025] [Indexed: 05/03/2025] Open
Abstract
We assess the effectiveness of a visuomotor paired associative stimulation (vm-PAS) protocol targeting the Action Observation Network (AON) in chronic post-stroke patients with upper-limb mild hemiparesis. Vm-PAS consisted of hand-grasping action observation stimuli repeatedly paired with transcranial magnetic stimulation (TMS) pulses over the ipsilesional primary motor cortex (M1). Fifteen post-stroke patients underwent a session of the vm-PAS and, as a control, of the standard excitatory PAS (M1-PAS), during which slow-rate electrical stimulation of the paretic limb was paired with M1-TMS. Before and after each PAS, we assessed corticospinal excitability (CSE), short-interval intracortical inhibition (SICI), and paretic wrist's voluntary movements. The two protocols induce distinct muscle-specific CSE enhancements: vm-PAS increases motor-evoked potentials (MEPs) recorded from the paretic first dorsal interosseous muscle. Conversely, M1-PAS increases MEPs recorded from the electrically stimulated extensor carpi radialis muscle. Vm-PAS efficacy correlates with hemiparesis chronicity: the higher the time elapsed since the stroke, the greater vm-PAS effects on CSE. Neither protocol affected SICI or wrist movements. Our results suggest that vm-PAS leads to muscle-specific enhancements of CSE in post-stroke patients, highlighting its potential for modulating M1 excitability after stroke. These findings show the efficacy of a cross-modal PAS protocol targeting the AON in an injured motor system.
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Affiliation(s)
- Michela Picardi
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giacomo Guidali
- Department of Psychology and Milan Center for Neuroscience-NeuroMI, University of Milano-Bicocca, Milan, Italy.
| | - Antonio Caronni
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Viviana Rota
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience-NeuroMI, University of Milano-Bicocca, Milan, Italy.
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy.
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Antonioni A, Raho EM, Straudi S, Granieri E, Koch G, Fadiga L. The cerebellum and the Mirror Neuron System: A matter of inhibition? From neurophysiological evidence to neuromodulatory implications. A narrative review. Neurosci Biobehav Rev 2024; 164:105830. [PMID: 39069236 DOI: 10.1016/j.neubiorev.2024.105830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/20/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
Mirror neurons show activity during both the execution (AE) and observation of actions (AO). The Mirror Neuron System (MNS) could be involved during motor imagery (MI) as well. Extensive research suggests that the cerebellum is interconnected with the MNS and may be critically involved in its activities. We gathered evidence on the cerebellum's role in MNS functions, both theoretically and experimentally. Evidence shows that the cerebellum plays a major role during AO and MI and that its lesions impair MNS functions likely because, by modulating the activity of cortical inhibitory interneurons with mirror properties, the cerebellum may contribute to visuomotor matching, which is fundamental for shaping mirror properties. Indeed, the cerebellum may strengthen sensory-motor patterns that minimise the discrepancy between predicted and actual outcome, both during AE and AO. Furthermore, through its connections with the hippocampus, the cerebellum might be involved in internal simulations of motor programs during MI. Finally, as cerebellar neuromodulation might improve its impact on MNS activity, we explored its potential neurophysiological and neurorehabilitation implications.
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Affiliation(s)
- Annibale Antonioni
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara 44121, Italy; Department of Neuroscience, Ferrara University Hospital, Ferrara 44124, Italy; Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, Ferrara 44121, Italy.
| | - Emanuela Maria Raho
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara 44121, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara 44121, Italy; Department of Neuroscience, Ferrara University Hospital, Ferrara 44124, Italy
| | - Enrico Granieri
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara 44121, Italy
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara 44121, Italy; Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), Ferrara 44121 , Italy; Non Invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia, Rome 00179, Italy
| | - Luciano Fadiga
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara 44121, Italy; Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), Ferrara 44121 , Italy
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Antonioni A, Galluccio M, Baroni A, Fregna G, Pozzo T, Koch G, Manfredini F, Fadiga L, Malerba P, Straudi S. Event-related desynchronization during action observation is an early predictor of recovery in subcortical stroke: An EEG study. Ann Phys Rehabil Med 2024; 67:101817. [PMID: 38479116 DOI: 10.1016/j.rehab.2024.101817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/11/2023] [Accepted: 12/21/2023] [Indexed: 04/13/2024]
Affiliation(s)
- Annibale Antonioni
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy; Doctoral Program in Translational Neurosciences and Neurotechnologies, Ferrara University, Ferrara, Italy
| | - Martina Galluccio
- Iit@Unife Center for Translational Neurophysiology, Istituto Italiano Di Tecnologia, Ferrara, Italy
| | - Andrea Baroni
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Giulia Fregna
- Doctoral Program in Translational Neurosciences and Neurotechnologies, Ferrara University, Ferrara, Italy
| | - Thierry Pozzo
- Iit@Unife Center for Translational Neurophysiology, Istituto Italiano Di Tecnologia, Ferrara, Italy; INSERM UMR 1093-CAPS, Université Bourgogne, F-21000 France
| | - Giacomo Koch
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy; Iit@Unife Center for Translational Neurophysiology, Istituto Italiano Di Tecnologia, Ferrara, Italy; Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Fabio Manfredini
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy; Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | - Luciano Fadiga
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy; Iit@Unife Center for Translational Neurophysiology, Istituto Italiano Di Tecnologia, Ferrara, Italy
| | - Paola Malerba
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, USA; School of Medicine, The Ohio State University, Columbus, OH, USA
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy; Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy.
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Estrada-Barranco C, Martinez-Javaloyes MDLÁ, Rodriguez-Costa I, Sanz-Esteban I, Bermejo-Franco A, Aranda-Ruiperez A, Gallegos-Martínez MDLÁ. Effectiveness of a Program Based on Action-Observation Training (AOT) on Motor, Functional and Cognitive Aspects in Patients with Cognitive Impairment: A Non-Randomized Controlled Trial. Healthcare (Basel) 2023; 11:healthcare11071030. [PMID: 37046957 PMCID: PMC10093786 DOI: 10.3390/healthcare11071030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/14/2023] Open
Abstract
Cognitive impairment is frequent in elderly subjects. It is associated with motor impairment, a limitation in quality of life and frequently, institutionalization. The aim of this work is to test the efficacy of a therapeutic group program based on action-observation learning. METHODS a non-randomized controlled trial study was conducted. We included 40 patients with cognitive impairment from a nursing home who were categorized into mild and moderate cognitive impairment and divided separately into a control and experimental group. Experimental group performed a 4-week group work, in which each patient with mild cognitive impairment was paired with a patient with moderate cognitive impairment. Thus, patients with mild cognitive impairment observed a series of functional exercises performed by their peers and replicated them. Simultaneously, the patients with moderate cognitive impairment replicated the movement after observing it performed by a patient with mild cognitive impairment. The control group continued to receive their usual care at the center. The upper limb function, cognitive level and function in basic activities of human daily life were measured before and after the intervention and compared with the control group. RESULTS statistically significant differences were found in the functionality of basic activities of daily living, in the functionality of the upper limb and in the cognitive level in all patients in the experimental group regardless of the initial cognitive level. No statistically significant differences were found in the control group. CONCLUSIONS the implementation of a group, peer-based, action-observation learning therapeutic program is effective in improving the basic activities of human daily life, cognitive level and upper limb functionality in patients with mild and moderate dementia.
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Affiliation(s)
- Cecilia Estrada-Barranco
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Isabel Rodriguez-Costa
- Humanization in the Intervention of Physiotherapy for the Integral Attention to the People (HIPATIA) Research Group, Physiotherapy Department, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28805 Madrid, Spain
| | - Ismael Sanz-Esteban
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Alberto Bermejo-Franco
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
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