IMITATE: An intensive computer-based treatment for aphasia based on action observation and imitation

Background: Neurophysiological evidence from primates has demonstrated the presence of mirror neurons, with visual and motor properties, that discharge both when an action is performed and during observation of the same action. A similar system for observation-execution matching may also exist in humans. We postulate that behavioural stimulation of this parietal-frontal system may play an important role in motor learning for speech and thereby aid language recovery after stroke. Aims: The purpose of this article is to describe the development of IMITATE, a computer-assisted system for aphasia therapy based on action observation and imitation. We also describe briefly the randomised controlled clinical trial that is currently underway to evaluate its efficacy and mechanism of action. Methods & Procedures: IMITATE therapy consists of silent observation of audio-visually presented words and phrases spoken aloud by six different speakers, followed by a period during which the participant orally repeats the stimuli. We describe the rationale for the therapeutic features, stimulus selection, and delineation of treatment levels. The clinical trial is a randomised single blind controlled trial in which participants receive two pre-treatment baseline assessments, 6 weeks apart, followed by either IMITATE or a control therapy. Both treatments are provided intensively (90 minutes per day). Treatment is followed by a post-treatment assessment, and a 6-week follow-up assessment. Outcomes & Results: Thus far, five participants have completed IMITATE. We expect the results of the randomised controlled trial to be available by late 2010. Conclusions: IMITATE is a novel computer-assisted treatment for aphasia that is supported by theoretical rationales and previous human and primate data from neurobiology. The treatment is feasible, and preliminary behavioural data are emerging. However, the results will not be known until the clinical trial data are available to evaluate fully the efficacy of IMITATE and to inform theoretically about the mechanism of action and the role of a human mirror system in aphasia treatment.