Evidence of motor resonance in stroke patients with severe upper limb function impairments

For the past fifteen years, observation of actions has proved to be effective in the motor rehabilitation of stroke. Despite this, no evidence has ever been provided that this practice is able to activate the efferent motor system of a limb unable to perform the observed action due to stroke. In fact, transcranial magnetic stimulation cannot easily be used in these patients, and the fMRI evidence is inconclusive. This creates a logical problem, as the effectiveness of action observation in functional recovery is attributed to its ability to evoke action simulation, up to sub-threshold muscle activation (i.e., motor resonance), in healthy individuals. To provide the necessary proof-of-concept, patients with severe upper limb function impairments and matched control participants were submitted to a verified action prediction paradigm. They were asked to watch videos showing gripping movements towards a graspable or an ungraspable object, and to press a button the instant the agent touched the object. The presence of more accurate responses for the graspable object trials is considered an indirect evidence of motor resonance. All participants were asked to perform the task with both hands. Despite the serious difficulty of movement, 8 out of 18 patients were able to perform the task with their impaired hand. We found that the responses given by the paretic hand showed a modulation of the action prediction time no different from that showed by the no paretic hand, which, in turn, did not differ from that showed by the matched control participants. The present proof-of-concept study shows that action observation involves the efferent motor system even when the hand used to respond is unable to perform the observed action due to a cortical lesion, providing evidence that the Action Observation Training (AOT) is effective in recruiting the paretic limb in the simulation of action.