Action observation treatment. A brief overview of a new tool for rehabilitation and education in the clinical, neuropsychological and sports fields.

Paolo Soraci, Anna Maria Mariani, Roberta Cimaglia, Eleonora Guaitoli, Walter Monterosso, Mariachiara Trovato, Grazia Parente, Martina Marcelletti, Fulvia Lagattolla


In recent years, research in the clinical, neuropsychological, educational and sports fields has contributed to the development of numerous and different therapeutic interventions, radically changing the ability to deal with problems of various kinds in these areas. The objective of this brief review illustrates the new rehabilitation and educational approach of AOT (ACTION OBSERVATION TREATMENT), which exploits the neurophysiological mechanism of mirror neurons. Its potential for motor recovery could be used in clinical, educational, neuropsychological and sports settings.

Negli ultimi anni, la ricerca in ambito clinico, neuropsicologico, educativo e sportivo, ha contribuito allo sviluppo di numerosi e diversi interventi terapeutici cambiando radicalmente la capacità di affrontare i problemi di diversa natura in questi ambiti. L’obiettivo di questa breve review illustra il nuovo approccio riabilitativo ed educativo dell’ AOT (ACTION OBSERVATION TREATMENT), che sfrutta il meccanismo neurofisiologico dei neuroni specchio. Il suo potenziale per il recupero motorio potrebbe essere utilizzabile in ambito clinico, educativo, neuropsicologico e sportivo


neuro-rehabilitation, mirror neuron system, action observation treatment, evidence-based medicine, learning, health, sport, autism

Full Text:

PDF (Italiano)


Aldridge, M.A., Stone, K.R., Sweeney, M.H., Bower, T.G.R. (2000). Preverbal Children with Autism Understand the Intentions of Others. Dev. Sci. 3, 294–301.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Bandura, Albert (1977), Social Learning Theory, Prentice Hall, Englewood Cliffs, NJ.

Bellelli, G., Buccino, G., Bernardini, B., Padovani, A., & Trabucchi, M. (2010). Action observation treatment improves recovery of postsurgical orthopedic patients: evidence for a top-down effect?. Archives of physical medicine and rehabilitation, 91(10), 1489–1494.

Bhat, A.N., Landa, R.J., Galloway, J.C. (2011). Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders. Phys Ther. 91, 1116–1129. [PubMed: 21546566].

Bonifazi, S., Tomaiuolo, F., Altoè, G., Ceravolo, M. G., Provinciali, L., & Marangolo, P. (2013). Action observation as a useful approach for enhancing recovery of verb production: new evidence from aphasia. European journal of physical and rehabilitation medicine, 49(4), 473–481.

Borges LRDM, Fernandes ABGS, Melo L, Guerra RO, Campos TF. (2018, October 31). Action observation for arm rehabilitation after stroke. Retrieved January 07, 2021, from,execution%20of%20the%20same%20task.

Borges, L. R., Fernandes, A. B., Melo, L. P., Guerra, R. O., & Campos, T. F. (2018). Action observation for upper limb rehabilitation after stroke. The Cochrane database of systematic reviews, 10(10), CD011887.

Bremer, E., Crozier, M., Lloyd, M. (2016). A systematic review of the behavioural outcomes following exercise interventions for children and youth with autism spectrum disorder. Autism. 20, 899–915. [PubMed: 26823546].

Brunner, I. C., Skouen, J. S., Ersland, L., & Grüner, R. (2014). Plasticity and response to action observation: a longitudinal FMRI study of potential mirror neurons in patients with subacute stroke. Neurorehabilitation and neural repair, 28(9), 874–884.

Bryson, S.E., Smith, I.M. (1998). Epidemiology of autism: Prevalence, associated characteristics, and implications for research and service delivery. Ment. Retard. Dev. Disabil. Res. Rev. 4, 97–103.

Buccino G, Vogt S, Ritzl A, Fink GR, Zilles K, Freund HJ, Rizzolatti G (2004) Neural circuits underlying imitation learning of hand actions; an eventrelated FMRI study. Neuron 42:323–334.

Buccino G. (2014). Action observation treatment: a novel tool in neurorehabilitation. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 369(1644), 20130185.

Caligiore, D., Mustile, M., Spalletta, G., & Baldassarre, G. (2017). Action observation and motor imagery for rehabilitation in Parkinson's disease: A systematic review and an integrative hypothesis. Neuroscience and biobehavioral reviews, 72, 210–222.

Calvo-Merino, B., Glaser, D. E., Grèzes, J., Passingham, R. E.,& Haggard, P. (2005). Action observation and acquired motor skills: An fMRI study with expert dancers. Cerebral Cortex, 15, 1243–1249.

Calvo-Merino, B., Grèzes, J., Glaser, D. E., Passingham, R. E., & Haggard, P. (2006). Seeing or doing? Influence of visual and motor familiarity in action observation. Current Biology, 16, 1905–1910.

Celnik, P., Stefan, K., Hummel, F., Duque, J., Classen, J., & Cohen, L. G. (2006). Encoding a motor memory in the older adult by action observation. NeuroImage, 29(2), 677–684.

Celnik, P., Webster, B., Glasser, D. M., & Cohen, L. G. (2008). Effects of action observation on physical training after stroke. Stroke, 39(6), 1814–1820.

di Pellegrino, G., Fadiga, L., Fogassi, L., Gallese, V., & Rizzolatti, G. (1992). Understanding motor events: a neurophysiological study. Experimental brain research, 91(1), 176–180.

Driskell J. E., Copper C., Moran A. (1994). Does mental practice enhance performance? J. Appl. Psychol. 79, 481–492. 10.1037/0021-9010.79.4.481.

Eaves, D. L., Riach, M., Holmes, P. S., & Wright, D. J. (2016). Motor imagery during action observation: a brief review of evidence, theory and future research opportunities. Frontiers in Neuroscience, 10, 514.

Fabbri-Destro, M., & Rizzolatti, G. (2008). Mirror neurons and mirror systems in monkeys and humans. Physiology (Bethesda, Md.), 23, 171–179.

Fecteau, S., Lepage, J. F., & Theoret, H. (2006). Autism spectrum disorder: seeing is not understanding. Current Biology, 16, 131–133.

Ferrari, P. F., & Rizzolatti, G. (Eds.). (2015). New frontiers in mirror neurons research. Oxford University Press, USA.

Feltz, D. L., & Landers, D. M. (1983). The effects of mental practice on motor skill learning and performance: A meta-analysis. Journal of Sport Psychology, 5, 25–57.

Gallese, V. (2001). The 'shared manifold' hypothesis: From mirror neurons to empathy. In E. Thompson (Ed.), Between ourselves: Second-person issues in the study of consciousness (p. 33–50). Imprint Academic.

Gallese, V., Keysers, C., & Rizzolatti, G. (2004). A unifying view of the basis of social cognition. Trends in cognitive sciences, 8(9), 396–403.

Gatti R, Tettamanti A, Gough PM, Riboldi E, Marinoni L, Buccino G. (2013). Action observation versus motor imagery in learning a complex motor task: a short review of literature and a kinematics study. Neurosci. Lett. 540, 37–42. 10.1016/j.neulet.2012.11.039.

Halsband, U., & Lange, R. K. (2006). Motor learning in man: a review of functional and clinical studies. Journal of physiology, Paris, 99(4-6), 414–424.

Hamilton, A. F. (2013). Reflecting on the mirror neuron system in autism: a systematic review of current theories. Developmental Cognitive Neuroscience, 3, 91–105.

Holmes, P., & Calmels, C. (2008). A neuroscientific review of imagery and observation use in sport. Journal of motor behavior, 40(5), 433-445.

Holloway, J.M.; Long, T.M.; Biasini, F. Relationships between gross motor skills and social function in young boys with autism spectrum disorder. Pediatr. Phys. Ther. 2018, 30, 184–190.

Hsieh, Y. W., Lin, Y. H., Zhu, J. D., Wu, C. Y., Lin, Y. P., & Chen, C. C. (2020). Treatment Effects of Upper Limb Action Observation Therapy and Mirror Therapy on Rehabilitation Outcomes after Subacute Stroke: A Pilot Study. Behavioural neurology, 2020, 6250524.

Iacoboni, M., & Dapretto, M. (2006). The mirror neuron system and the consequences of its dysfunction. Nature Reviews Neuroscience, 7, 942-951.

Jeannerod, M. (1994). The representing brain: Neural correlates of motor intention and imagery. Behavioural and Brain Sciences, 17, 187–245. doi:10.1017/S0140525Å~00034026.

Jonas, M., Siebner, H. R., Biermann-Ruben, K., Kessler, K., Bäumer, T., Büchel, C., Schnitzler, A., & Münchau, A. (2007). Do simple intransitive finger movements consistently activate frontoparietal mirror neuron areas in humans?. NeuroImage, 36 Suppl 2, T44–T53.

Kaur, M. Srinivasan, S.M., Bhat, A.N. (2018). Comparing motor performance, praxis, coordination, and interpersonal synchrony between children with and without autism spectrum disorder (ASD). Res Dev Disabil. 72,79–95. [PMCID: PMC5743591] [PubMed: 29121516].

Kawasaki, T., Tozawa, R., & Aramaki, H. (2018). Effectiveness of using an unskilled model in action observation combined with motor imagery training for early motor learning in elderly people: a preliminary study. Somatosensory & motor research, 35(3-4), 204–211.

Kim K. (2015). Action observation for upper limb function after stroke: evidence-based review of randomized controlled trials. Journal of physical therapy science, 27(10), 3315–3317.

Kim, T., Frank, C., & Schack, T. (2017). A Systematic Investigation of the Effect of Action Observation Training and Motor Imagery Training on the Development of Mental Representation Structure and Skill Performance. Frontiers in human neuroscience, 11, 499.

Serotti, L., Molinaro, A., Alessandrini, A., Tansini, F., Serina, A., Ambrosi, C., Mascaro, L., Pinardi, C., Arisi, D., Gasparotti, R., Buccino, G., Fazzi, E. (2015) Gior Neuropsich Età Evol ;35:155-159.

Marsh, L., Hamilton, A. F. C. (2011). Dissociation of mirroring and mentalising systems in autism. NeuroImage, 56, 3, 1511–1519.

Mattar AAG, Gribble PL. (2005). Motor learning by observing.

Neuron 46, 153–160. 10.1016/j.neuron.2005.02.009.

Meltzoff, A.N. (1999). Origins of Theory of Mind, Cognition and Communication. J. Commun. Disord. 32, 251–269.

Meltzoff, A. N., Decety, J. (2003). What imitation tells us about social cognition: A rapprochement between developmental psychology and cognitive neuroscience. Philosophical Transactions of the Royal Society of London. Series B: Biological Sciences, 358(1431), 491-500. doi:10.1098/rstb.2002.1261.

Meltzoff, A. N., Moore, M. K. (1997). Explaining Facial Imitation: A Theoretical Model. Early development & parenting, 6(3-4), 179–192.<179::AID-EDP157>3.0.CO;2-R.

Mieres, A.C., Kirby, R.S., Armstrong, K.H., Murphy, T.K., Grossman, L. (2012). Autism spectrum disorder: an emerging opportunity for physical therapy. Pediatr Phys Ther. 24, 31–37. [PubMed: 22207463]

Ming, X., Brimacombe, M., Wagner, G.C. (2007). Prevalence of motor impairment in autism spectrum disorders. Brain and Development, 29, 9, 565-570.

Molinaro, A., Micheletti, S., Pagani, F., Garofalo, G., Galli, J., Rossi, A., ... & Buccino, G. (2020). Action Observation Treatment in a tele-rehabilitation setting: a pilot study in children with cerebral palsy. Disability and Rehabilitation, 1-6.

Morrier M, Ziegler S. (2018). I wanna play too: factors related to changes in social behavior for children with and without autism spectrum disorder after implementation of a structured outdoor play curriculum. J Autism Dev Disord. 48, 2530–2541.

Mulder T. (2007). Motor imagery and action observation: cognitive tools for rehabilitation. Journal of neural transmission (Vienna, Austria : 1996), 114(10), 1265–1278.

Nedelko, V., Hassa, T., Hamzei, F., Schoenfeld, M. A., & Dettmers, C. (2012). Action imagery combined with action observation activates more corticomotor regions than action observation alone. Journal of Neurologic Physical Therapy, 36(4), 182-188.

Oberman, L. M., Ramachandran, V. S. (2007). The simulating social mind: the role of the mirror neuron system and simulation in thesocial and communicative deficits of autism spectrum disorders. Psychological Bulletin, 133, 310–327.

Patel M. (2017). Action observation in the modification of postural sway and gait: Theory and use in rehabilitation. Gait & posture, 58, 115–120.

Pelosin, E., Avanzino, L., Bove, M., Stramesi, P., Nieuwboer, A., & Abbruzzese, G. (2010). Action observation improves freezing of gait in patients with Parkinson's disease. Neurorehabilitation and neural repair, 24(8), 746–752.

Pelosin, E., Bove, M., Ruggeri, P., Avanzino, L., & Abbruzzese, G. (2013). Reduction of Bradykinesia of Finger Movements by a Single Session of Action Observation in Parkinson Disease. Neurorehabilitation and Neural Repair, 27(6), 552–560.

Peng, T. H., Zhu, J. D., Chen, C. C., Tai, R. Y., Lee, C. Y., & Hsieh, Y. W. (2019). Action observation therapy for improving arm function, walking ability, and daily activity performance after stroke: a systematic review and meta-analysis. Clinical rehabilitation, 33(8), 1277–1285.

Plata-Bello, J. (2017). The Study of Action Observation Therapy in Neurological Diseases: A Few Technical Considerations. Neurological Physical Therapy. doi:10.5772/67651.

Porro, C. A., Facchin, P., Fusi, S., Dri, G., & Fadiga, L. (2007). Enhancement of force after action observation: behavioural and neurophysiological studies. Neuropsychologia, 45(13), 3114–3121.

Potvin, M.C., Snider, L., Prelock, P., Kehayia, E., Wood-Dauphinee, S. (2013). Recreational participation of children with high functioning autism. J Autism Dev Disord. 43, 445–457. [PubMed: 22752846].

Poulin-Lord, M. P., Barbeau, E. B., Soulières, I., Monchi, O., Doyon, J., Benali, H., et al. (2014). Increased topographical variability of taskrelated activation in perceptive and motor associative regions in adult autistics. Neuroimage Clinical, 4, 444–453.

Ramachandran, V. S., & Rogers-Ramachandran, D. (2000).

Phantom limbs and neural plasticity. Archives of neurology, 57(3), 317–320.

Ridderinkhof, K. R., & Brass, M. (2015). How Kinesthetic Motor Imagery works: a predictive-processing theory of visualization in sports and motor expertise. Journal of physiology, Paris, 109(1-3), 53–63.

Rizzolatti, G., Fabbri-Destro, M., Cattaneo, L. (2009). Mirror neurons and their clinical relevance. Nature Clinical Practice Neurology, 5, 24–34.

Rizzolatti, G., Craighero, L. (2004). The mirror-neuron system. Annual review of neuroscience, 27, 169–192.

Rocca, M. A., Meani, A., Fumagalli, S., Pagani, E., Gatti, R., Martinelli-Boneschi, F., Esposito, F., Preziosa, P., Cordani, C., Comi, G., & Filippi, M. (2019). Functional and structural plasticity following action observation training in multiple sclerosis. Multiple sclerosis (Houndmills, Basingstoke, England), 25(11), 1472–1487.

Rogers, S.J., Bennetto, L., McEvoy, R., Pennington, B.F. (1996). Imitation and Pantomime in High-Functioning Adolescents with Autism Spectrum Disorders. Child Dev. 67, 2060–2073.

Sakzewski, L., Ziviani, J., & Boyd, R. N. (2014). Efficacy of upper limb therapies for unilateral cerebral palsy: a meta-analysis. Pediatrics, 133(1), e175–e204.

Scott, M. W., Emerson, J. R., Dixon, J., Tayler, M. A., & Eaves, D. L. (2020). Motor imagery during action observation enhances imitation of everyday rhythmical actions in children with and without developmental coordination disorder. Human movement science, 71, 102620.

Simpson, K., Keen, D., Adams, D., Alston-Knox, C., Roberts, J. (2018). Participation of children on the autism spectrum in home, school, and community. Child Care Health Dev. 44, 99–107. [PubMed: 28664633].

Sowa, M., Meulenbroek, R. (2012). Effects of physical exercise on autism spectrum disorders: a meta-analysis. Res Autism Spectr Disord. 6, 46–57.

Srinivasan, S.M., Cavagnino, D.T., Bhat, A.N. (2018). Effects of equine therapy on individuals with autism spectrum disorder: a systematic review. Rev J Autism Dev Disord. 5, 156–175. [PMCID: PMC6178825] [PubMed: 30319932].

Srinivasan, S.M., Pescatello, L.S., Bhat, A.N. (2014). Current perspectives on physical activity and exercise recommendations for children and adolescents with autism spectrum disorders. Phys Ther. 94, 875–889. [PMCID: PMC4040426] [PubMed: 24525861].

Stefan, K., Cohen, L. G., Duque, J., Mazzocchio, R., Celnik, P., Sawaki, L., Ungerleider, L., & Classen, J. (2005). Formation of a motor memory by action observation. The Journal of neuroscience : the official journal of the Society for Neuroscience, 25(41), 9339–9346.

Sugg, K., Müller, S., Winstein, C., Hathorn, D., & Dempsey, A. (2015). Does Action Observation Training With Immediate Physical Practice Improve Hemiparetic Upper-Limb Function in Chronic Stroke?. Neurorehabilitation and neural repair, 29(9), 807–817.

Tani, M., Ono, Y., Matsubara, M., Ohmatsu, S., Yukawa, Y., Kohno, M., & Tominaga, T. (2018). Action observation facilitates motor cortical activity in patients with stroke and hemiplegia. Neuroscience Research, 133, 7-14.

Vealey, R. S., & Greenleaf, C. A. (2010). Seeing is believing: Understanding and using imagery in sports. In J. M. Williams (Ed.), Applied sport psychology: Personal growth to peak performance (pp. 267–299). Boston, MA: McGraw-Hill.

Villafañe, J. H., Isgrò, M., Borsatti, M., Berjano, P., Pirali, C., & Negrini, S. (2017). Effects of action observation treatment in recovery after total knee replacement: a prospective clinical trial. Clinical Rehabilitation, 31(3), 361–368.

Vogt, S., & Thomaschke, R. (2007). From visuo-motor interactions to imitation learning: behavioural and brain imaging studies. Journal of sports sciences, 25(5), 497–517.

Wang, W., Collinger, J. L., Perez, M. A., Tyler-Kabara, E. C., Cohen, L. G., Birbaumer, N., Brose, S. W., Schwartz, A. B., Boninger, M. L., & Weber, D. J. (2010). Neural interface technology for rehabilitation: exploiting and promoting neuroplasticity. Physical medicine and rehabilitation clinics of North America, 21(1), 157–178.

Wright, D. J., McCormick, S. A., Birks, S., Loporto, M., & Holmes, P. S. (2015). Action observation and imagery training improve the ease with which athletes can generate imagery. Journal of Applied Sport Psychology, 27(2), 156-170.

Yang, J., Hofmann, J. (2015). Action observation and imitation in autism spectrum disorders:an ALE meta-analysis of fMRI studies. Brain Imaging and Behavior, 9, 3.



  • There are currently no refbacks.

Copyright (c) 2021 Giornale Italiano di Educazione alla Salute, Sport e Didattica Inclusiva

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Italian Journal of Health Education, Sports and Inclusive Didactics 
ISSN: 2532-3296