5. Discussion
5.4 Observed model
In the studies examined for this review, the most common model used to produce observed action stimuli was a healthy subject. Some recent evidences (Errante et al., 2019) showed a better improvement in the performance when patients observed and imitated a pathological model, that is an actor with a movement disorder similar to the subject’s one. In future studies and clinical practice, then, should be also considered the use of a different model, whose motor and functional features are more similar to those of the impaired subject. One of the reasons underlying this choice is that sometimes the action performed by the healthy subject is too complex and far away from the observer’s motor repertoire to be readily imitated, so patients prefer to copy the final outcome of the action rather than the specific motor patterns used to achieve it.
45
For instance, it was demonstrated that PD patients had a motor facilitation only when the observed actor exhibited kinematic features similar to their own (Castiello et al., 2009) and not when observing a healthy subject performing the same actions. Any kind of motor impairment leads to a re-adaptation of the system, which develops new ways to interact with the environment with the spared resources. For this reason, watching a neurologically healthy subject performing an action in a typical way may not allow the patient to “resonate” properly, because he/she does not have the motor representations of those actions anymore. Interestingly, the relevance of a correspondence between the modeled action and the observer’s behavioral repertoire is also evidenced in healthy subjects: a stronger activation of the MN system in humans occurs when the observer has a greater motor expertise of the observed action (Calvo-Merino et al., 2006; 2010; Aglioti et al., 2008). The extensive use of an adequate pathological model may thus better approximate the available motor resources of the observer and hence promoting a better and faster motor improvement of patients treated with AOT.
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