The value of corticospinal excitability and intracortical inhibition in predicting motor skill improvement driven by action observation

BACKGROUND AND OBJECTIVEAction observation can sustain motor skill improvement. At the neurophysiological level, action observation affects the excitability of the motor cortices, as measured by transcranial magnetic stimulation. However, whether the cortical modulations induced by action observation may explain the amount of motor improvement driven by action observation training (AOT) remains to be addressed. METHODSWe conducted a two-phase study involving 40 volunteers. First, we assessed the effect of action observation on corticospinal excitability (amplitude of motor evoked potentials), short-interval intracortical inhibition, and transcallosal inhibition (ipsilateral silent period). Subsequently, a randomized-controlled design was applied, with AOT participants asked to observe and then execute, as quickly as possible, a right-hand dexterity task six consecutive times, whereas controls had to observe a no-action video before performing the same task. RESULTSAOT participants showed greater performance improvement relative to controls. The amount of improvement in the AOT group was predicted by the amplitude of corticospinal modulation during action observation and even more by the amount of intracortical inhibition induced by action observation. Importantly, these relations were found specifically for the AOT group and not for the controls. CONCLUSIONSIn this study, we identified the neurophysiological signatures associated with, and potentially sustaining, the outcome of AOT. Intracortical inhibition driven by action observation plays a major role. These findings elucidate the cortical mechanisms underlying AOT efficacy and open to predictive assessments for the identification of potential responders to AOT, informing the rehabilitative treatment individualization.