Video therapy

The video therapy is a new experimental therapies for the treatment of stroke patients , in which the concentrated observation of everyday relevant movements with their active exercise is alternated. A patient watches videos of individual movements that are part of an everyday action .

State of testing

The benefit of video therapy has been researched for several years in Germany (Hamburg, Lübeck), Italy (Parma) and America (Chicago) by several research groups in a clinical context with patients. It is currently an experimental therapy method, the effectiveness of which has been proven since 2007. However, it is not yet part of routine hospital treatment.

Medical basics

The video therapy is intended to strengthen those centers in the brain that are responsible for movements and their control: the so-called "motor brain areas". For many stroke patients, these areas are damaged as a result of the stroke. The resulting disabilities consist of difficulties in normal movement, from lack of control of movements to complete inability to move. The primary motor areas in the so-called “ motor cortex ” include those areas of the cerebrum (“cortex”) that are responsible for performing simple movements and giving the body commands, e.g. B. to move the arms and legs. Closely connected to the primary motor areas are the adjacent higher motor areas in the premotor and parietal cortex, which are responsible for the complex coordination and planning of movements. The movement patterns generated in the higher motor areas are then passed on to the primary motor areas for movement execution. Many of these movement patterns are stored in the higher motor areas and can e.g. B. already activated by the idea of ​​a movement.

The video therapy is based on the results of brain research , which have shown a clear activation of the motor areas through movement observation alone. By observing movements, the higher motor brain areas are reactivated and then act with impulses on the primary motor areas that were shut down by the stroke. Through the subsequent repeated execution of the movements, the newly activated primary motor areas are strengthened and solidified through the constant activity, the impulses from the higher motor areas and the feedback from the body.

A research group led by Giacomo Rizzolatti from Parma, Italy, demonstrated in 1996 that certain nerve cells in the higher motor areas also show activity when movements are only observed. These cells become active during the execution of a certain movement, but at the same time also when the execution of a comparable movement is observed. They are therefore also referred to as “ mirror neurons ”. The neurons then transfer their activity to the motor areas. The fact that an observed movement does not always trigger a similar movement of its own is due to other areas of the brain that exert inhibitory influences on the commands of the primary motor area. The mirror neurons are believed to play an important role in understanding movement and learning it at the same time. By storing patterns of action, the neurons can coordinate and plan actions . They pass this information on to the motor area, which ultimately activates the muscles.

If a stroke damages the mirror cells, many movement sequences are no longer possible, but repeated observation of the same scene activates the stored behavior pattern and thus skills that were long believed to be lost . This effect increases when the patient then imitates the action. This has been confirmed in first attempts, because video therapy has enlarged the mirror cell areas in the brain.

Implementation of the basics in training

Video therapy makes use of the phenomenon of “mirror-image” brain activity when observing movement. The observation stimulates the mirror neurons to be active and can thus activate remaining nerve cells in the damaged areas of the motor brain area. This indirect access to the nerve cells is supplemented by the subsequent practice of the observed action in order to strengthen a damaged area of ​​the brain again.

literature

• Binkofski F., Ertelt D., Dettmers C., Buccino G. (2004). The mirror neuron system and its role in neurological rehabilitation. Neurol. Rehabil., 10 (3): 113-120.

• Ertelt, D., Buccino, G., Dettmers, C., McNamara, A., Binkofski, F. (2005). The role of action observation in rehabilitation of motor deficits. Akt. Neurol., S4, 32.

• Ertelt, D., McNamara, A., Dettmers, C., Hamzei, F., Buccino, G., Binkofski, F. (2006). Movement observation reactivates the sensorimotor network during recovery after a stroke. Akt. Neurol., S1, 33.

• Ertelt, D., Buccino, G., Small, S., Solodkin, A., McNamara, A., Binkofski, F. (2007). Movement observation has a positive impact on rehabilitation of motor deficits after stroke. NeuroImage, 36 Suppl 2: 164-73.

• Ertelt, D. (2007). Better motor outcome through motion observation. Neurol. Rehabil., 13 (3): 166.

• Ertelt, D., Buccino, G., Dettmers, Chr., Binkofski, F. (2007). Movement observation in a neurorehabilitation context. Neurol. Rehabil., 13 (5): 260-269.

• Ertelt, D. (2008). Motion observation. Hippocampus, Bad Honnef

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