Immersive AOT: Multisensory Stimulation and Neurophysiological Correlates in Children With Cerebral Palsy and Typical Development - A Pilot Study

Official title

Immersive AOT: Multisensory Stimulation and Neurophysiological Correlates - A Pilot Study

Overview

The discovery of the Mirror Neuron System (MNS) has promoted the development of rehabilitation techniques such as Action Observation Treatment (AOT) and Motor Imagery (MI). These are based on the principle that neural circuits active during execution, also activate during the observation or imagination of movements. These techniques have been found to be effective in several clinical populations including children with Cerebral Palsy (CP), the most common childhood-onset motor disorder. We hypothesize that a multimodal version of AOT, integrating not only visual stimuli (standard practice) but also auditory and tactile stimuli, could further enhance the activation of the MNS. In fact, everyday actions naturally involve multiple sensory channels, and evidence indicate that audio-visual action observation activates the MNS more intensely than visual stimuli alone, thus offering a potential improvement for CP rehabilitation. The primary aim of this observational pilot study, conducted at IRCCS Fondazione Stella Maris, is to verify whether a multisensory (=immersive) AO session - combining visual, auditory, and tactile stimuli - produces greater activation of the MNS, than a traditional session (visual AO alone). Neural correlates will be measured through high-density Electroencephalography (hdEEG), with a specific focus on the modulation of the sensorimotor mu rhythm. Twenty children and adolescents with CP, aged 7-25 years, and 20 typically developing (TD) aged-matched peers will be recruited in the study. The study also aims to assess the level of participants' attention during stimuli presentation through eye tracking, and to verify whether immersive AO can influence MI abilities, measured through specific tasks and questionnaires (i.e., Motor Imagery Questionnaire for Children (MIQ-C, aged 7-12) and the Motor Imagery Questionnaire - 3 (MIQ-3) for adolescent). In an initial phase of the study both questionnaires will be the validated in a separate sample of 120 TD Italian children and 120 Italian adolescents or adults. The absence of intellectual disability will be assessed using the age-appropriate version of Raven's Progressive Matrices test. Each participant will undergo two EEG sessions: the immersive session will consist of watching first-person videos accompanied by auditory stimuli consistent with the action and tactile stimuli provided by TouchDIVER Pro haptic gloves (Weart, CE-marked device), suitably adapted for the paediatric population. The traditional session will consist of watching videos without sounds or any tactile additional stimulus. The two sessions will be performed in a in random order. In both sessions, after the observation phase, participants will be asked to perform or imagine the same actions presented in the videos. During observation, eye movements and gaze behavior will be monitored using an eye tracking system. Throughout each session, cortical activity will be recorded using a 128-channel hdEEG net. The sessions will be video-recorded to accurately monitor participants motor behavior, response times, and compliance with the protocol. At the end of each EEG session, participants will be administered the MIQ-C or MIQ-3 questionnaire and a short task to assess MI abilities. In this task, participants will watch some of the videos previously used during the EEG session and will then be asked to imagine the same action. In this case, their imagery will be interrupted at specific time points, and they will be asked to select, from two images, the moment of the action corresponding to the point at which they were interrupted. Data analysis will examine within- and between-groups differences for the immersive AO vs the traditional AO. Correlation analysis will be also performed between neurophysiological data, attentional data, questionnaires, MI responses and standardized clinical assessments ( for the CP group), in order to understand how the participants' motor and cognitive abilities influence the activation of the circuits involved in the experimental tasks.

Primary outcome measures

• Neurophysiological data (hdEEG) [Time frame: one hour per session]

Secondary outcome measures (1)

• Attention and motor imagery data [Time frame: One hour per session]

Eligibility criteria

Study Group: Inclusion Criteria:

• Confirmed diagnosis of cerebral palsy, documented by clinical history and instrumental examinations;
• Age between 7 and 25 years at the time of recruitment;
• At least one verbal or nonverbal intellectual functioning index >= 70, to ensure understanding and compliance with the tasks required.

Exclusion criteria

• Severe sensory disorders that compromise the feasibility of the study;
• Neuropsychiatric comorbidity that precludes participation in the study.

Control group: Inclusion Criteria

• Age between 7 and 25 years at the time of recruitment;
• Absence of intellectual disability, assessed through age-appropriate versions of the Raven's Progressive Matrices (Coloured Progressive Matrices for children up to 11 years; Standard Progressive Matrices for participants aged 12 years and older), yielding scores within the normative range and used to estimate non-verbal fluid intelligence;
• Age-appropriate academic performance with no reports of significant learning difficulties, as verified through parental interview;
• Absence of known neurological or psychiatric disorders, confirmed through parental interview;
• Absence of motor impairments, defined as scoring above the 25th percentile on the Movement Assessment Battery for Children, Second Edition (MABC-2).

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Observational model

Case-control

Study locations

Italy · 1 center

• IRCCS Fondazione Stella Maris — Calambrone

Publications

• Rizzolatti G, Fadiga L, Gallese V, Fogassi L. Premotor cortex and the recognition of motor actions. Brain Res Cogn Brain Res. 1996 Mar;3(2):131-41. doi: 10.1016/0926-6410(95)00038-0. PMID 8713554
• Pineda JA. The functional significance of mu rhythms: translating "seeing" and "hearing" into "doing". Brain Res Brain Res Rev. 2005 Dec 1;50(1):57-68. doi: 10.1016/j.brainresrev.2005.04.005. Epub 2005 May 31. PMID 15925412
• Paulus M, Hunnius S, Bekkering H. Neurocognitive mechanisms underlying social learning in infancy: infants' neural processing of the effects of others' actions. Soc Cogn Affect Neurosci. 2013 Oct;8(7):774-9. doi: 10.1093/scan/nss065. Epub 2012 Jun 11. PMID 22689219
• Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A, Langdon K, Namara MM, Paton MC, Popat H, Shore B, Khamis A, Stanton E, Finemore OP, Tricks A, Te Velde A, Dark L, Morton N, Badawi N. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Curr Neurol Neurosci Rep. 2020 Feb 21;20(2):3. doi: 10.1007/s1191 PMID 32086598
• Marshall PJ, Meltzoff AN. Neural mirroring systems: exploring the EEG mu rhythm in human infancy. Dev Cogn Neurosci. 2011 Apr;1(2):110-23. doi: 10.1016/j.dcn.2010.09.001. PMID 21528008
• Kohler E, Keysers C, Umilta MA, Fogassi L, Gallese V, Rizzolatti G. Hearing sounds, understanding actions: action representation in mirror neurons. Science. 2002 Aug 2;297(5582):846-8. doi: 10.1126/science.1070311. PMID 12161656
• Keysers C, Kohler E, Umilta MA, Nanetti L, Fogassi L, Gallese V. Audiovisual mirror neurons and action recognition. Exp Brain Res. 2003 Dec;153(4):628-36. doi: 10.1007/s00221-003-1603-5. Epub 2003 Aug 23. PMID 12937876
• Keysers C, Kaas JH, Gazzola V. Somatosensation in social perception. Nat Rev Neurosci. 2010 Jun;11(6):417-28. doi: 10.1038/nrn2833. Epub 2010 May 6. PMID 20445542

Identifiers

NCT: NCT07369193 · ImmersiveAOT

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗