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Neuroscience Letters 480 (2010) 138–142

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Improvement of motor performance by observational training in elderly people
Banty Tia a,b , France Mourey a,b , Yves Ballay a , Cyril Sirandré a , Thierry Pozzo a,c , Christos Paizis a,d,∗

Motricité et Plasticité, INSERM/U877, Université de Bourgogne, Campus Universitaire, B.P. 27877, 21078 Dijon, France Gérontopôle, Centre Hospitalier Universitaire de Dijon, 2 rue Jules Violle, BP 87909 21079, Dijon Cedex, France c Italian Institute of Technology, Via Morego 30, 16163 Genova, Italy d Centre d’Expertise de la Performance « Gilles Cometti », UFR STAPS, Université de Bourgogne, B.P. 27877, 21078 Dijon, France

a r t i c l e

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a b s t r a c t
Action observation influences action execution; this strong coupling is underlined by an overlap of cortical areas activated during observation and execution of action, and is dependent of specific motor experience. The goal of the present study was to verify if action observation can be used for rehabilitation of elderly people. We tested this question with a protocol of observational practice of 2 frequently used movements: walking and sit-to-stand/back-to-sit. Both tasks were performed at normal and maximal speed before and after training, by 8 elderly subjects. Observational practice led to an increase in walking velocity via an increase in step frequency, but without modification of step length. In addition, we noted a reduction in BTS duration, but no modification of STS duration. These results highlight the fact that observational practice induces a reactivation in mental representation of action, and may lead to better movement control. Overall, observational practice offers interesting perspectives for rehabilitation of elderly people. © 2010 Elsevier Ireland Ltd. All rights reserved.

Article history: Received 16 April 2010 Received in revised form 25 May 2010 Accepted 8 June 2010 Keywords: Observation Action Elderly Sit to stand Back to sit Walking

Introduction Physical practice, when coupled with observational practice, leads to enhanced motor learning [34]. Moreover, it was demonstrated that action observation alone can affect movement execution. Observing a specific movement has facilitation effects on movement execution (i.e., shorter initiation times) [4], and can lead to an increase in force production when executing the observed movement [27]. These behavioral effects remain valid even if the observed movement is task irrelevant; in effect, a “speed contagion” of point-light biological motion has been demonstrated on an unrelated reaction-time task [33]. On a more applied level, several studies demonstrated that stroke rehabilitation programs could benefit from action observation, as it enhances the effects of physical training by reactivation of motor areas [6,10]. Indeed, action observation and action execution activate a common network of cortical areas [28]. Action observation represents a covert access to motor representation, and is supposed to correspond to an implicit mental simulation of action [16]. Surprisingly, few studies have investigated the effect of action observation on action execution with elderly people. However, it is known that

Abbreviations: STS, Sit-To-Stand; BTS, Back-To-Sit; S, Second; SD, Standard Deviation; SE, Standard Error. ∗ Corresponding author at: Université de Bourgogne, UFR STAPS, Campus Universitaire, BP 27877, F-21078 Dijon, France. Tel.: +33 380396729; fax: +33 380396702. E-mail address: (C. Paizis). 0304-3940/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.neulet.2010.06.026

the decrease in motor performance with age has a dramatic impact on the quality of life among elderly people. Numerous studies show positive effects of exercise programs to improve motor and postural abilities. Because sit-to-stand (STS), back-to-sit (BTS) and walking are very important motor activities in daily life, they are often included in geriatric assessment and rehabilitation programs. The goal of this study is to verify if, in an elderly population, the strong coupling between action observation and execution can be used in rehabilitation. To consider this question, we tested the contribution of observational practice on the execution of two motor tasks (walking and STS/BTS movements). Both tasks involve dynamic equilibrium constraints and are good indicators of mobility and frailty of elderly people [31,32]. In aging people, locomotion is characterized by a reduction of walking speed due to a shortening of step length, a decrease in step height with a trend of shuffling steps, and an increase in double support duration [1,7]. Interesting findings concerning sit-to-stand movements in elderly people showed age-related differences in the control of center of mass motion, which the authors interpreted as a protective attitude to limit the risk of forward falling [20]. This protective change in the center of mass motion was also observed in another more complex task like whole body reaching [22]. Because action observation and action execution are strongly coupled, we hypothesized that modifying perception would lead to a modification in action execution. In order to test this assumption, we designed an observational practice protocol focused on walking and STS/BTS movements, and intended to reactivate the mental representation of movement. Observational training sessions con-

The regional ethics committee of Burgundy (C. Higher walking velocity normally implies an increased step length and step frequency [14. height: 162 ± 7. With . Tia et al. Subjects were seated on an armless chair and their feet were placed flat on the floor. 2 questions on the STS movement and 2 questions on the BTS movement. When a significant interaction effect was detected. Two of these blocks were applied 3 times and one block was applied 4 times over the whole training period (10 sessions).5 ± 6. Each training session lasted 10 min. which will in turn lead to motor improvement. We placed a reflexive marker on subjects’ shoulder (acromion). The participants had a perceptual and a motor evaluation pre-training and post-training. After showing each movie. or the actor achieved the movement with only one foot touching the ground and with altered coordination.0 and After Effect cs3 and cs4 (Adobe Systems Incorporated. LCD touch-screen monitor (Elo TouchSystems. Step length and movement duration were recorded using the Optojump system (Microgate. All the participants followed 10 observational training sessions over a 3-week period. USA) placed on a table. 1. and below the question.05 level. / Neuroscience Letters 480 (2010) 138–142 139 sisted of discriminating between correct and altered movements. post hoc differences were assessed by means of Newman–Keuls test.) approved the experimental protocol which was carried out in agreement with legal requirements and international norms (Declaration of Helsinki. By modifying the velocity of the display. and therefore making the actor’s apparent walking velocity independent of other walking parameters. For the STS movement.02 m/s. From this initial position. participants sat in front of a 19-in. The number of correct responses was recorded for the walking movement and the STS/BTS movement. For each actor. we distorted the biological characteristics of the movement.9 ± 9. Milan) at a sampling frequency of 120 Hz. The same exercise was designed for the BTS movement. For each subject and condition. [11]) score of 24 or higher (mean ± SD: 28.R.1 (Statsoft. This exercise was repeated 6 times (2 × 6 different movies applied randomly). the words “correct answer” were displayed on the screen. a movie of their walking slowed down to 40% of normal speed and a movie accelerated to 200% of normal speed were created using Adobe Premiere Pro 2. except that participants were provided with visual feedback. We hypothesize that observational training will induce a reactivation of the neural networks involved in the representation of action. 1964). Each movie was created in the avi format and displayed at a rate of 29. weight: 69.49).). The chair was set at knee height and it had a back support which maintained the trunk of subjects in vertical position. at respectively 1.90 m/s. the mean of the 3 trials was used for subsequent data analysis. participants were first asked to walk along 6 m. A specific software created in our laboratory was used to display the tests and record subjects’ answers.17 m/s. the question “Is the movement natural?” was displayed again and 2 boxes (“Yes” and “No”) were shown below the question. the question “Which is the correct movement?” was shown again. peripheral neuropathology.5 kg). “incorrect answer” was displayed on the screen. when the participant answered incorrectly. Concerning real movement execution. Materials and methods Eight elderly subjects participated in this study (7 female and 1 male. with the experimenter sitting next to them. All the participants gave their informed consent before taking part in the experiment. which consisted of 10 observational training sessions.6 cm. 1 accelerated and 1 slowed down movie). they were requested to start walking at a distance of 2 m from the recording system. on the contrary. age: 70. Statistical significance for all tests was evaluated at the p < 0. and 0. we verified that the analyzed data was normally distributed (Kolmogorov–Smirnoff test). After the movie. Inc. Participants were recruited in a local center for elderly people activities. Prior to statistical analysis. For the STS/BTS question. The 12 walking movies and the 2 × 12 STS/BTS movies were separated into 3 blocks of 4 walking movies and 2 × 4 STS/BTS movies for the training sessions. All participants obtained a 100% score to the Barthel Index. the subject was then asked to touch the screen on the right answer. to maintain this position for 2 s and to sit down again (BTS). the question “Is the movement natural?” first appeared on the screen. During the perceptual evaluations. Immediately before each trial. post hoc differences were assessed by means of Newman–Keuls test. 3 slowed down movies. step length and step frequency were calculated. the last image of each movie was showed. This exercise was repeated 12 times (6 normal speed movies. Then the question disappeared and one movie was showed. walking velocity. Subjects repeated this exercise 3 times at normal speed and 3 times as fast as possible. 0. Perceptual abilities and actual movement execution were evaluated before and after training. subjects were asked to stand up (STS). a one-way repeated measures ANOVA was performed on accuracy with one within-subject factor (training). 3 accelerated movies applied randomly). When the participant answered correctly. or musculoskeletal conditions that could have limited their movements or affected their stability or balance control.4 years.E. Movies of the walking movement were created with 1 actress (aged 70 years) and 3 actors (aged 22. The MathWorks Inc. They were selected in order to exclude any neurological disease. All had a Mini Mental State Examination (MMSE. Data analyses were performed using Matlab (Version 7. the question “Which is the correct movement?” was first displayed.25 ± 1. a two-way repeated measures ANOVA was performed on accuracy with 2 within-subject factors (training and category (STS/BTS)). Subjects had to answer 4 questions on the walking movement (2 normal speed. Perceptual abilities and actual movement execution were evaluated before and after observational practice. Five infra-red emitting cameras were attached to five vertical poles and were placed circularly to the right side of the participants at a distance of 2 m. the body leant excessively to the right or left.5 R2007b.) and Statistica 7. USA). The subject was asked to touch the screen on the right movie. In the altered sequences. whereas motor evaluation consisted of an assessment of kinematic properties of walking and STS/BTS movements. indicating complete autonomy.15]. Actual execution of the walking and STS/BTS movements was analyzed during the motor evaluations.97 frames/s.B. 41 and 87 years) walking across a distance of 4 m. accuracy was defined as the percentage of correct answers per subject and per movement. Italy). A two-way repeated measures ANOVA was performed on each of these variables with 2 within-subject factors (training and speed (fast/normal walk)). with a visual feedback indicating after each question whether the answer was correct or not. Perceptual evaluation consisted of the same tasks as observational training without visual feedback. For locomotion. In case of significant interaction effect. Subjects were allowed to use their hands freely while performing STS/BTS movements. The STS/BTS movement was evaluated using an optoelectronic measuring device SMART (BTS. Subjects repeated this exercise 3 times at normal speed and 3 times as fast as possible. and all had normal or corrected-to-normal vision. Concerning perceptual evaluation. The perceptual evaluations involved a walking movement and a STS/BTS movement. For the walking question.92 m/s. Then the question disappeared and 2 movies showing a person standing up normally or in an altered manner were displayed successively. Observational training consisted of the same exercises as those presented in the perceptual evaluation.

05) were noted. without subjects being conscious of participating in a learning task. a significant effect of training was noted on step frequency (p < 0. we explored the possibility to improve motor abilities with observational training in elderly subjects.01) with shorter movement durations after training. Tia et al. mean ± SE). Data was low-pass filtered with a 2nd order Butterworth filter. Additionally. which implied increased mentalization compared to passive observation.58 ± 3. mean ± SE). it added a diverting aspect to the training device.06 m/s.30]. Since attentional and motivational resources presumably increase in active observation.3. These findings indicate that movement observation reactivates neural representation of action. For the STS movement. All the participants obtained a 100% accuracy pre. participants showed pre-training walking velocity 1. given that participants already obtained high percentages of correct answers before training. a two-way repeated measures ANOVA was performed on movement duration with 2 within-subject factors (training and speed (fast/normal movement).05) In the current study. Results In regard to perceptual evaluation. Concerning actual movement execution. For the total duration of STS movements.25 ± 5. 1A). (A) Walking velocities pre and post-training in both conditions (normal speed and as fast as possible. and a significant interaction between speed and training (p < 0.001) with shorter movement durations for fast movement.05 ± 0. It compelled participants to identify the correct movement. a significant effect of speed was noted (p < 0. although explicit motor imagery was also demonstrated to enhance the effects of physical practice [2. The kinematics of the shoulder marker was principally analyzed because during STS/BTS movements. A significant effect of training (p < 0.001). Participants obtained a score of 81. This implies an implicit neural engagement. as could be expected (p < 0. Furthermore. Conversely. mean ± SE). it indicates that perceptual training was implicit since there was no modification of participants’ explicit perception of correct movements. no effect from training was observed. Because of its implicit characteristics. as observers were asked to discriminate between correct and altered movements. 2.001) and training (p < 0. cutoff frequency 6 Hz. No effect of training was noted on step length (p > 0. it has been observed that this marker was the first to move and the last to stop [23]. there was a significant effect of speed (p < 0. (B) Step frequencies pre and post-training in both conditions (normal speed and as fast as possible.13]. explicit action simulation was shown to decline with aging [26. By comparing walking and STS/BTS movements before and after observational training. Previous work demonstrated that action observation may influence action execution implicitly. we found improvements in motor performance. observational practice could be a beneficial tool to complement rehabilitation and physical training programs for the elderly. shoulder tangential velocity profile was calculated in the sagittal plane and was used to define movement duration. this result was predictable. and also for its motivational aspects [34]. The ANOVA performed on walking velocity showed a significant effect of speed (p < 0. Discussion respect to STS/BTS movements. The ANOVAs performed on step length and step frequency revealed a significant effect of speed. with a higher step length and frequency during fast walking.05) (Fig. 2). When a significant interaction effect was detected. motor evocation and perception/action coupling were likely to be facilitated. . A post hoc analysis (Newman–Keuls test) revealed a significant difference pre and post-training (p < 0. independent of conscious strategies [19. Concerning the total duration of the BTS movement. The same analysis was performed for the BTS movement. More interestingly. post hoc differences were assessed by means of Newman–Keuls test.and post-training on the STS/BTS questions. at preferred walking speed.140 B. Fig. Moreover. indicating that they had no frailty or pathology. through the development of a game for individual or clinical motor training.05) (Fig. this decline could affect the use of explicit motor imagery for training and rehabilitation programs in elderly populations. STS and BTS movement duration pre and post-training in both conditions (normal speed and as fast as possible.27]. that the perceptual tasks and observational protocol were understandable by the participants. only for normal speed movements (Fig.29.84 (Mean ± SE) pre-training and 89. 1.05). Movement duration was defined as the time interval between the moment when shoulder tangential velocity profile exceeded 5% of its peak value and the moment when the same velocity dropped below that value [18]. an originality of the present protocol is that observational sessions were active. The present results showed no significant effect of training on the perceptual abilities of elderly subjects to distinguish between correct and altered walking movements. there was no significant effect of training on accuracy for the walking questions. if needed. Nevertheless it confirms. / Neuroscience Letters 480 (2010) 138–142 Fig.001).78 post-training. 1B). however.

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