Abstract
Fatigue is a multidimensional symptom with both physical and cognitive aspects, which can affect the quality of daily and working life activities. Motor Imagery (MI) represents an important resource for use during the rehabilitation processes, useful, among others, for job integration/reintegration, of neurological pathologies, such as Multiple Sclerosis (MS). To define the effective rehabilitation protocols that integrate MI for the reduction of fatigue in patients with MS (PwMS), a literary review was performed through August 2020. Five articles were included in the qualitative synthesis, including two feasibility pilot randomized control trials (RCTs) and 3 RCTs with good quality according to the PEDro score and a low risk of bias according to the Cochrane Collaboration tool. The literature suggested that MI, in association with rhythmic-auditory cues, may be an effective rehabilitation resource for reducing fatigue. Positive effects were observed on perceived cognitive and psychological fatigue. PwMS require greater compensatory strategies than healthy individuals, and the use of rhythmic-auditory cues may be useful for optimizing the cognitive processing of MI, which acts as an internal stimulus that is enhanced and made more vivid by outside cues. These findings provide evidence that MI is a promising rehabilitation tool for reducing fatigue in PwMS and return to work strategies.
Highlights
Fatigue affects more than 80% of patients with multiple sclerosis (PwMS), among whom 55% report fatigue as being one of the worst symptoms that is experienced, often independently of the level of disability [1]
Some studies focusing on rehabilitation in Multiple Sclerosis (MS) have demonstrated a transitory positive effect on the reduction in fatigue symptoms [7,8,9, 12]; other studies that examined the efficacy of various specific rehabilitation programs showed no significant effects on fatigue compared with placebo [13, 14]
Novel approaches to physiotherapy in MS include Motor Imagery (MI) and Rhythmic Auditory Stimulation (RAS), which have been shown to improve walking in patients with MS (PwMS), accompanied by reductions in fatigue
Summary
Fatigue affects more than 80% of patients with multiple sclerosis (PwMS), among whom 55% report fatigue as being one of the worst symptoms that is experienced, often independently of the level of disability [1]. Novel approaches to physiotherapy in MS include Motor Imagery (MI) and Rhythmic Auditory Stimulation (RAS), which have been shown to improve walking in PwMS, accompanied by reductions in fatigue. Other authors, such as Hanson et al, have suggested that a neurocognitive rehabilitation approach— the use of MI could represent an important resource for reducing fatigue, because MI involves motor planning and mild exercise execution [15,16,17]. Several studies have suggested that the connections between rhythmic auditory and motor processing, which reflects sensorimotor synchronization with RAS, may apply to MI, which involves the mental execution of movements without performing any actual movements [26]. In people with other types of neurologic disorders, such as stroke, MI has been shown to improve motor performance [27], with moderate effect sizes [28]
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