Abstract
BackgroundMotor imagery (MI) is increasingly used in neurorehabilitation to facilitate motor performance. Our previous study results demonstrated significantly improved walking after rhythmic-cued MI in people with multiple sclerosis (pwMS). The present feasibility study was aimed to obtain preliminary information of changes in walking, fatigue, quality of life (QoL) and MI ability following cued and non-cued MI in pwMS. The study further investigated the feasibility of a larger study and examined the reliability of a two-dimensional gait analysis system.MethodsAt the MS-Clinic, Department of Neurology, Medical University of Innsbruck, Austria, 15 adult pwMS (1.5–4.5 on the Expanded Disability Status Scale, 13 females) were randomised to one of three groups: 24 sessions of 17 min of MI with music and verbal cueing (MVMI), with music alone (MMI), or non-cued (MI). Descriptive statistics were reported for all outcomes. Primary outcomes were walking speed (Timed 25-Foot Walk) and walking distance (6-Minute Walk Test). Secondary outcomes were recruitment rate, retention, adherence, acceptability, adverse events, MI ability (Kinaesthetic and Visual Imagery Questionnaire, Time-Dependent MI test), fatigue (Modified Fatigue Impact Scale) and QoL (Multiple Sclerosis Impact Scale-29). The reliability of a gait analysis system used to assess gait synchronisation with music beat was tested.ResultsParticipants showed adequate MI abilities. Post-intervention, improvements in walking speed, walking distance, fatigue, QoL and MI ability were observed in all groups. Success of the feasibility criteria was demonstrated by recruitment and retention rates of 8.6% (95% confidence interval, CI 5.2, 13.8%) and 100% (95% CI 76.4, 100%), which exceeded the target rates of 5.7% and 80%. Additionally, the 83% (95% CI 0.42, 0.99) adherence rate surpassed the 67% target rate. Intra-rater reliability analysis of the gait measurement instruments demonstrated excellent Intra-Class Correlation coefficients for step length of 0.978 (95% CI 0.973, 0.982) and step time of 0.880 (95% CI 0.855, 0.902).ConclusionResults from our study suggest that cued and non-cued MI are valuable interventions in pwMS who were able to imagine movements. A larger study appears feasible, however, substantial improvements to the methods are required such as stratified randomisation using a computer-generated sequence and blinding of the assessors.Trial registrationISRCTN ISRCTN92351899. Registered 10 December 2015.
Highlights
Motor imagery (MI) is increasingly used in neurorehabilitation to facilitate motor performance
Mental chronometry studies showed that the MI accuracy and its temporal organisation were impaired in participants with Multiple Sclerosis (MS) versus controls; these deficits in MI ability were associated with cognitive impairment, but were independent from motor functioning [13,14,15,16]
As there were no falls or adverse events, it seems safe to continue with the study procedures. 10 out of 10 participants in both music-cued MI groups reported that they liked the music styles and they regarded the intervention acceptable, with 8 out of 10 participants reporting the music intervention as pleasurable
Summary
Motor imagery (MI) is increasingly used in neurorehabilitation to facilitate motor performance. Motor areas of the brain responsible for movements’ physical execution are activated, to a lesser degree, during imagined movements [6,7,8,9]. Both real and imagined movements are associated with similar motor preparation processes [7, 8]. Mental chronometry studies showed that the MI accuracy and its temporal organisation were impaired in participants with MS versus controls; these deficits in MI ability were associated with cognitive impairment, but were independent from motor functioning [13,14,15,16]. Rhythmic auditory cueing has been found to promote the MI ability in people with MS, by optimising their MI duration and movement amplitudes during an upper limb task [17]
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