Motor Imagery Training Research Articles

Motor Imagery Combined With Physical Training Improves Response Inhibition in the Stop Signal Task.

BackgroundMotor imagery training has a similar effect to that of physical training on motor performance. The objective of this study was to investigate the short-term effectiveness of motor imagery training on response inhibition using the stop signal task (SST).MethodsParticipants were divided into a physical training group (PT, n = 17), a motor imagery training group (MIT, n = 17), and a motor imagery combined with physical training group (MIPT, n = 17). All participants performed 10 SST training sessions over 5 days. Both stop signal reaction time (SSRT) and non-signal reaction time (NSRT) were measured before and after SST training.ResultsThere were significant interaction (time × group) and time effects, although the group effect was not statistically significant. Bonferroni post hoc analysis showed that MIPT group revealed a significantly greater change in SSRT than PT and MIT groups, while there was no significant difference between PT and MIT groups. SSRT significantly decreased after training in all groups. In NSRT, there was a significant effect of time, but there was no significant interaction effect (time × group) or group effect.ConclusionResponse inhibition could be enhanced via training, and it was most effective when motor imagery and physical training were combined. We demonstrate that motor imagery training significantly improves response inhibition and should be accompanied by physical training when performing SST.

Embodiment Comfort Levels During Motor Imagery Training Combined With Immersive Virtual Reality in a Spinal Cord Injury Patient.

Brain–machine interfaces combining visual, auditory, and tactile feedback have been previously used to generate embodiment experiences during spinal cord injury (SCI) rehabilitation. It is not known if adding temperature to these modalities can result in discomfort with embodiment experiences. Here, comfort levels with the embodiment experiences were investigated in an intervention that required a chronic pain SCI patient to generate lower limb motor imagery commands in an immersive environment combining visual (virtual reality -VR), auditory, tactile, and thermal feedback. Assessments were made pre-/ post-, throughout the intervention (Weeks 0–5), and at 7 weeks follow up. Overall, high levels of embodiment in the adapted three-domain scale of embodiment were found throughout the sessions. No significant adverse effects of VR were reported. Although sessions induced only a modest reduction in pain levels, an overall reduction occurred in all pain scales (Faces, Intensity, and Verbal) at follow up. A high degree of comfort in the comfort scale for the thermal-tactile sleeve, in both the thermal and tactile feedback components of the sleeve was reported. This study supports the feasibility of combining multimodal stimulation involving visual (VR), auditory, tactile, and thermal feedback to generate embodiment experiences in neurorehabilitation programs.

Intervention Platform for Action Observation and Motor Imagery Training After Stroke: Usability Test.

Action observation (AO) and motor imagery (MI) are considered as promising therapeutic approaches in the rehabilitation of patients after a stroke (PaS). Observing and mentally rehearsing motor movements stimulate the motor system in the brain and result in a positive effect on movement execution. To support patients in the early rehabilitation phase after a stroke, ANIMATE, a digital health intervention platform was developed. The platform guides the user through 6 activities of daily living by observing and imagining the corresponding movements. We conducted a scenario-based usability test with 9 PaS at a rehabilitation centre to identify existing usability issues. PaS found the app easy to use and they could interact with it without problems. Although they judged the app as useful, they stated to be not willing to use the app on a regular basis. Including features for customising ANIMATE regarding the individual rehabilitation goals and needs of PaS, as well as personalisation could help in increasing the motivation to use and the benefits of the platform.

Clinical and Neurophysiological Effects of Progressive Movement Imagery Training for Pathological Pain

Movement limitation is a common characteristic of chronic pain such that pain prevents the very movement and activity that is most likely to promote recovery. This is particularly the case for pathological pain states such as complex regional pain syndrome (CRPS). One clinical approach to CRPS that has growing evidence of efficacy involves progressive movement imagery training. Graded Motor Imagery (GMI) targets clinical and neurophysiological effects through a stepwise progression through implicit and explicit movement imagery training, mirror therapy and then functional tasks. Here we review experiences from over 20 years of clinical and research experience with GMI. We situate GMI in terms of its historical underpinnings, the benefits and outstanding challenges of its implementation, its potential application beyond CRPS. We then review the neuropathological targets of GMI and current thought on its effects on neurophysiological biomarkers. PerspectiveThis article provides an overview of our experiences with graded motor imagery training over the last 20 years focussing on the treatment of CRPS. It does both cover the theoretical underpinnings for this treatment approach, biomarkers which indicate potential changes driven by GMI, and experiences for achieving optimal treatment results.

Effectiveness of Tai Chi Yunshou motor imagery training for hemiplegic upper extremity motor function in poststroke patients: study protocol for a randomized clinical trial

BackgroundEvidence concerning the effect of Tai Chi Yunshou motor imagery training (TCY-MIT) on upper extremity motor function (UE-MF) recovery in poststroke patients is lacking, and few studies have examined the neural mechanisms of MIT. The study was designed to assess the effectiveness of TCY-MIT and its possible neural mechanisms.Methods/designThe study is an assessor-blinded, parallel, superiority, randomized clinical trial. A total of 78 eligible participants will be randomly assigned to 2 groups in a 1:1 ratio. Participants in the control group will receive (conventional rehabilitation therapies) CRTs for 40 min per day, 6 days per week, for 3 weeks. Participants in the intervention group will receive CRTs combined with TCY-MIT (30 min per day, 6 days per week, for 3 weeks). The primary outcome measure is the Fugl-Meyer Assessment of Upper Extremity. Secondary outcome measures are the Box and Block Test, muscle strength test, modified Barthel index, and Pearson correlation coefficients. All outcomes will be assessed at baseline, after completion of the intervention (1, 2, and 3 weeks), and at the end of follow-up (2 months). The outcome assessor will be blinded to the group allocation of the participants.DiscussionWe expect this assessor-blinded, parallel, superiority, randomized clinical trial to explore the effectiveness of TCY-MIT combined with CRTs compared with CRTs alone for UE-MF in poststroke patients.Trial registrationChinese Clinical Trial Registry ID: ChiCTR2100048868. Registered on 19 July 2021

Effectiveness of Motor Imagery Training to Improve Gait Abilities of Patients with Sub-Acute Stroke

Aim: To determine the effectiveness of motor imagery training to improve the lower extremity function and gait in subjects with sub-acute stroke. Methods: Forty four patients with subacute stroke with gait impairment were randomly assigned to one of two groups: motor imagery training group or muscle relaxation group. At the beginning and after six weeks of therapy, the ability to use motor imagery and lower limb performance were assessed. Results: There were substantial differences of scores between both groups, with the motor imagery group progressing more than the muscle relaxation group. Conclusion: Motor imagery may have a beneficial and effective task-specific effect on gait function in sub-acute stroke patients. Keywords: motor imagery; gait rehabilitation; sub-acute stroke patients

Changes in Functional Connectivity of Resting-state after Motor Imagery Training Detected by Eigenvector Centrality Mapping

Motor imagery training has been indicated to be effective in motor function rehabilitation and motor skill learning. The neural mechanism underlying motor training has attracted increased neuroimaging explorations. Related neuroimaging studies demonstrated that resting-state can offer the possibility to examine the neural mechanism of motor execution training. However, motor imagery training, as another part of motor training, has been few investigated. To address this issue, eigenvector centrality mapping (ECM) method was applied to explore functional connectivity of resting-state in motor imagery training. As a data-driven analysis method, although ECM can assess the computational measurement of eigenvector centrality for capturing intrinsic neural architecture on a voxel-wise level without any prior assumptions, it is still limited in application for making pseudo enhancement in some nodes or zero centrality in all nodes. In this study, we proposed an improved ECM by adding threshold, dispersion coefficient, weighted coefficient and the initial parameters referring to Google Webpage search ranking algorithm, and applied the proposed ECM to functional connectivity measure of resting-state before and after motor imagery training. The proposed ECM showed the advantage of automatic discharge weak links and the enhancement in node ordering resolution comparing with the original ECM. The results from voxel-based comparison of the centrality between the resting-state after and before motor imagery training revealed that the significantly increased eigenvector centrality was detected in the precuneus and medial frontal gyrus for the experimental group while no significant alterations were found for the control group after training. These alterations may be related to the spatial information integration and inner state modulation of motor imagery training, and further provided new insights into the understanding of the neural mechanism underlying motor imagery training.

A Randomized Controlled Trial of Motor Imagery Combined with Virtual Reality Techniques in Patients with Parkinson's Disease.

Background: Parkinson’s disease is the second most common neurological disease, affecting balance, motor function, and activities of daily living. Virtual reality and motor imagery are two emerging approaches for the rehabilitation of patients with Parkinson’s disease. This study aimed to determine the combined effects of virtual reality and motor imagery techniques with routine physical therapy on the motor function components of individuals with Parkinson’s disease. Methods: The study was a prospective, two-arm, parallel-design randomized controlled trial. Forty-four patients with idiopathic Parkinson’s disease were randomly assigned to one of two groups. Virtual reality and motor imagery were given together with physical therapy in the experimental group (N: 20), while physical therapy treatment alone was given in the control group (N: 21). Both groups received allocated treatment for 12 weeks, 3 days a week, on alternate days. Motor function was assessed at baseline, six weeks, twelve weeks, and sixteen weeks after discontinuing treatment with the Unified Parkinson’s Disease Rating Scale part III. SPSS 24 was used to analyze the data. Results: Study results indicate that the experimental group showed significant improvements in the motor function components: tremor at rest at the 6th week (p = 0.028), 12th week (p = 0.05), and 16th week (p = 0.001), rigidity at the 6th week (p = 0.03), 12th week (p = 0.000), and 16th week (p = 0.001), posture at the 12th week (p = 0.005) and 16th week (p = 0.004), and gait at the 6th week with a p-value of (p = 0.034). Conclusions: This study demonstrated that virtual reality and motor imagery training in combination with routine physical therapy can significantly improve resting tremors, rigidity, posture, gait, and body bradykinesia in individuals with PD in comparison to patients receiving only routine physical therapy.

" A Motor Imagery Training for Improving Action Cognition Results in the Reduction of Residual Symptoms after Major Depressive Disorder: A Single-Case Study"

The high rate of recurrence and residual symptoms of depression continuously motivate the search for new treatments addressing this challenging condition. In this single-case study, we reported the application of a cognitive rehabilitation skills training based on remote kinematics as a treatment for residual depression by targeting deficits of mental simulations of action. We found that the administration of Kinect-based rehabilitation training resulted in important improvements showed by significant mean baseline reductions (MBLR) of difficulty in imagining positive actions (MBLR= 54 %), negative emotions (MBLR = 36.3 %), cognitive flexibility (MBLR= 69.7 %), depressive symptoms (MBLR= 80%), and physical retardation (MBLR= 50 %). Similarly, improvements in positive affect (MBLR = 107 %) and vividness of motor imagery for positive actions were registered (MBLR= 100 %). We also found unique effects of our intervention such as reports of involuntary action simulations to distant stimuli or extended affordances. The training was well-accepted and the patient considered it was an entertaining way to do physical exercises and to get in physical and mental shape. We concluded that further scientific research of remote Kinematic interventions in depression may be warranted.

Effectiveness of Motor Imagery Training to Improve Gait Abilities of Patients with Sub-Acute Stroke

Aim: To determine the effectiveness of motor imagery training to improve the lower extremity function and gait in subjects with sub-acute stroke. Methods: Forty four patients with subacute stroke with gait impairment were randomly assigned to one of two groups: motor imagery training group or muscle relaxation group. At the beginning and after six weeks of therapy, the ability to use motor imagery and lower limb performance were assessed. Results: There were substantial differences of scores between both groups, with the motor imagery group progressing more than the muscle relaxation group. Conclusion: Motor imagery may have a beneficial and effective task-specific effect on gait function in sub-acute stroke patients. Keywords: motor imagery; gait rehabilitation; sub-acute stroke patients

Continuous Hybrid BCI Control for Robotic Arm Using Noninvasive Electroencephalogram, Computer Vision, and Eye Tracking

The controlling of robotic arms based on brain–computer interface (BCI) can revolutionize the quality of life and living conditions for individuals with physical disabilities. Invasive electroencephalography (EEG)-based BCI has been able to control multiple degrees of freedom (DOFs) robotic arms in three dimensions. However, it is still hard to control a multi-DOF robotic arm to reach and grasp the desired target accurately in complex three-dimensional (3D) space by a noninvasive system mainly due to the limitation of EEG decoding performance. In this study, we propose a noninvasive EEG-based BCI for a robotic arm control system that enables users to complete multitarget reach and grasp tasks and avoid obstacles by hybrid control. The results obtained from seven subjects demonstrated that motor imagery (MI) training could modulate brain rhythms, and six of them completed the online tasks using the hybrid-control-based robotic arm system. The proposed system shows effective performance due to the combination of MI-based EEG, computer vision, gaze detection, and partially autonomous guidance, which drastically improve the accuracy of online tasks and reduce the brain burden caused by long-term mental activities.

Neurofeedback-guided kinesthetic motor imagery training in Parkinson’s disease: Randomized trial

BackgroundParkinson’s disease (PD) causes difficulty with maintaining the speed, size, and vigor of movements, especially when they are internally generated. We previously proposed that the insula is important in motivating intentional movement via its connections with the dorsomedial frontal cortex (dmFC). We demonstrated that subjects with PD can increase the right insula-dmFC functional connectivity using fMRI-based neurofeedback (NF) combined with kinesthetic motor imagery (MI). The current study is a randomized clinical trial testing whether NF-guided kinesthetic MI training can improve motor performance and increase task-based and resting-state right insula-dmFC functional connectivity in subjects with PD. MethodsWe assigned nondemented subjects with mild PD (Hoehn & Yahr stage ≤ 3) to the experimental kinesthetic MI with NF (MI-NF, n = 22) and active control visual imagery (VI, n = 22) groups. Only the MI-NF group received NF-guided MI training (10–12 runs). The NF signal was based on the right insula-dmFC functional connectivity strength. All subjects also practiced their respective imagery tasks at home daily for 4 weeks. Post-training changes in 1) task-based and resting-state right insula-dmFC functional connectivity were the primary imaging outcomes, and 2) MDS-UPDRS motor exam and motor function scores were the primary and secondary clinical outcomes, respectively. ResultsThe MI-NF group was not significantly different from the VI group in any of the primary imaging or clinical outcome measures. The MI-NF group reported subjective improvement in kinesthetic body awareness. There was significant and comparable improvement only in motor function scores in both groups (secondary clinical outcome). This improvement correlated with NF regulation of the right insula-dmFC functional connectivity only in the MI-NF group. Both groups showed specific training effects in whole-brain functional connectivity with distinct neural circuits supporting kinesthetic motor and visual imagery (exploratory imaging outcome). ConclusionsThe functional connectivity-based NF regulation was unsuccessful, however, both kinesthetic MI and VI practice improved motor function in our cohort with mild PD.

Improving Motor Imagery Training Through Combining Kinesthetic Motor Imagery with Immersive Virtual Reality

Improving Motor Imagery Training Through Combining Kinesthetic Motor Imagery with Immersive Virtual Reality

Kinestetičke i vizuelne slike kod mladih odraslih osoba sa hroničnim bolom u vratu

Background:Young adults complain of neck pain almost every year. In recent years the ability of motor imagery (kinesthetic and visual imagery) in many musculoskeletal system problems other than neck pain in young adults has been investigated in the literature. The Cross-Sectional study aimed to question motor imagery ability in young adults with chronic neck pain. Methods: Two groups were included in the study: the chronic neck pain group (n = 83) and the control group (n = 91). Motor imagery ability of both groups was evaluated with Movement Imagery Questionnaire-3. Additionally, in the chronic neck pain group, pain was evaluated with the Short Form-McGill Pain Questionnaire, disability was evaluated with the Neck Disability Index, and kinesiophobia was evaluated with Tampa Scale for Kinesiophobia. Conclusions: Internal visual imagery and kinesthetic imagery were significantly different between chronic neck pain and control groups. There was a negative linear relationship between disability and internal visual imagery, external visual imagery, and kinesthetic imagery. Motor imagery ability is reduced in young adults with chronic neck pain. In addition, as the severity of disability increases, the motor imagery ability decreases. Therefore, it is considered appropriate to include a motor imagery training program when treating chronic neck pain in the future.

Home-based transcranial direct current stimulation (tDCS) and motor imagery for phantom limb pain using statistical learning to predict treatment response: an open-label study protocol.

Phantom limb pain (PLP) management has been a challenge due to its response heterogeneity and lack of treatment access. This study will evaluate the feasibility of a remotely home-based M1 anodal tDCS combined with motor imagery in phantom limb patients and assess the preliminary efficacy, safety, and predictors of response of this therapy. This is a pilot, single-arm, open-label trial in which we will recruit 10 subjects with phantom limb pain. The study will include 20 sessions. All participants will receive active anodal M1 tDCS combined with phantom limb motor imagery training. Our primary outcome will be the acceptability and feasibility of this combined intervention. Moreover, we will assess preliminary clinical (pain intensity) and physiological (motor inhibition tasks and heart rate variability) changes after treatment. Finally, we will implement a supervised statistical learning (SL) model to identify predictors of treatment response (to tDCS and phantom limb motor imagery) in PLP patients. We will also use data from our previous clinical trial (total observations=224 [n=112 x timepoints = 2)) for our statistical learning algorithms. The new prospective data from this open-label study will be used as an independent test dataset. This protocol proposes to assess the feasibility of a novel, neuromodulatory combined intervention that will allow the design of larger remote clinical trials, thus increasing access to safe and effective treatments for PLP patients. Moreover, this study will allow us to identify possible predictors of pain response and PLP clinical endotypes.

Home-based transcranial direct current stimulation (tDCS) and motor imagery for phantom limb pain using statistical learning to predict treatment response: an open-label study protocol

Background: Phantom limb pain (PLP) management has been a challenge due to its response heterogeneity and lack of treatment access. This study will evaluate the feasibility of a remotely home-based M1 anodal tDCS combined with motor imagery in phantom limb patients and assess the preliminary efficacy, safety, and predictors of response of this therapy. Methods: This is a pilot, single-arm, open-label trial in which we will recruit 10 subjects with phantom limb pain. The study will include 20 sessions. All participants will receive active anodal M1 tDCS combined with phantom limb motor imagery training. Our primary outcome will be the acceptability and feasibility of this combined intervention. Moreover, we will assess preliminary clinical (pain intensity) and physiological (motor inhibition tasks and heart rate variability) changes after treatment. Finally, we will implement a supervised statistical learning (SL) model to identify predictors of treatment response (to tDCS and phantom limb motor imagery) in PLP patients. We will also use data from our previous clinical trial (total observations=224 [n=112 x timepoints = 2)) for our statistical learning algorithms. The new prospective data from this open-label study will be used as an independent test dataset. Discussion: This protocol proposes to assess the feasibility of a novel, neuromodulatory combined intervention that will allow the design of larger remote clinical trials, thus increasing access to safe and effective treatments for PLP patients. Moreover, this study will allow us to identify possible predictors of pain response and PLP clinical endotypes. Keywords: phantom limb pain, home-based tDCS, motor imagery, statistical learning, remote trial.

The effect of motor imagery training on individuals with unilateral cerebral palsy on motor imagery ability, functional mobility and muscle activity

Aim This study aims to examine the effect of motor imagery (MI) training on MI abilities, functional mobility, and lower extremity muscle activity in children with unilateral cerebral palsy (UCP). Method 34 UCP and 17 typically developing participants were included. UCP was randomised into 2 groups as UCP MI and UCP control. Participants typically developing were included for baseline comparisons. UCP MI group received 8 weeks of physiotherapy and MI training, the UCP control group 8 weeks of physiotherapy training. The MI abilities, functional mobility, and lower extremity muscle activation were assessed in all groups. Results It was found that MI training made a significant difference in favour of the UCP MI group in terms of Movement Imagery Questionnaire-For Children (MIQ-C), mental chronometry, functional mobility, and resting muscle activation (p < 0.05). There was no such significant change in the UCP control group. Conclusion This current approach in UCP is a feasible method, beneficial to include it in the rehabilitation process.

Motor Imagery-Based Brain-Computer Interface Combined with Multimodal Feedback to Promote Upper Limb Motor Function after Stroke: A Preliminary Study.

Background Recently, the brain-computer interface (BCI) has seen rapid development, which may promote the recovery of motor function in chronic stroke patients. Methods Twelve stroke patients with severe upper limb and hand motor impairment were enrolled and randomly assigned into two groups: motor imagery (MI)-based BCI training with multimodal feedback (BCI group, n = 7) and classical motor imagery training (control group, n = 5). Motor function and electrophysiology were evaluated before and after the intervention. The Fugl-Meyer assessment-upper extremity (FMA-UE) is the primary outcome measure. Secondary outcome measures include an increase in wrist active extension or surface electromyography (the amplitude and cocontraction of extensor carpi radialis during movement), the action research arm test (ARAT), the motor status scale (MSS), and Barthel index (BI). Time-frequency analysis and power spectral analysis were used to reflect the electroencephalogram (EEG) change before and after the intervention. Results Compared with the baseline, the FMA-UE score increased significantly in the BCI group (p = 0.006). MSS scores improved significantly in both groups, while ARAT did not improve significantly. In addition, before the intervention, all patients could not actively extend their wrists or just had muscle contractions. After the intervention, four patients regained the ability to extend their paretic wrists (two in each group). The amplitude and area under the curve of extensor carpi radialis improved to some extent, but there was no statistical significance between the groups. Conclusion MI-based BCI combined with sensory and visual feedback might improve severe upper limb and hand impairment in chronic stroke patients, showing the potential for application in rehabilitation medicine.

An Immersive Motor Imagery Training System for Post-Stroke Rehabilitation Combining VR and EMG-based Real-Time Feedback.

Motor imagery combining virtual reality (VR) technique has recently been reported to have an increasingly positive impact on post-stroke rehabilitation. However, there is a common problem that the engagement of patients cannot be confirmed during motor imagery training due to a lack of effective feedback control. This paper proposes a VR-based motor imagery training system for post-stroke rehabilitation, using surface electromyographic (EMG)-based real-time feedback to enable the personalized training and quantitative assessment of participation degree. Three different experiments including assessment experiment, action observation (AO), combined motor imagery and action observation (MI+AO) experiment were performed on 4 post-stroke patients to verify the system. The immersive scenario of the VR system provides a shooting basketball training for bilateral upper limbs. The EMG data of assessment of each participant was collected to calculate the thresholds, which was utilized in the subsequent experiments based on real-time feedback of EMG. The result reveals significant differences of the muscle strength between AO and MI+AO experiments. This demonstrates that the EMG-based feedback is effective to be of use in assessment of participation degree. The primary application shows that VR-assisted motor imagery system has potential to provide personalized and more engaged training for post-stroke rehabilitation.

The effects of physical training versus combined action observation and motor imagery in conjunction with physical training on upper-extremity performance

Introduction Combined action observation and motor imagery training (AO+MI training), which involves motor imagery during action observation and physical training, has been attracting attention as an effective strategy for learning motor skills. However, little has been reported on the effects of AO+MI training. In the present study, we compared the effects of AO+MI training to the effects of physical training on upper-extremity performance. Materials and methods Ninety-six healthy participants were randomly assigned to either the control group or the experimental group. Sport stacking, which is often used to evaluate upper-extremity performance, was adopted for the task. The experiment was scheduled for three days. The training was 20 min per day. The control group performed only physical training, while the experimental group performed four 5-min AO+MI training sessions. Time taken to complete a sport stacking try (task completion time) was defined as the index of speed of upper-extremity performance and number of fallen cups as the index of its accuracy. The outcomes within each group and between the two groups were compared. Results Both AO+MI training and physical training showed reduced task completion time and increased number of fallen cups. There were no significant differences in the degree of changes between the groups. Conclusion Results from the present study showed that AO+MI training and physical training had almost the same influence on upper-extremity performance in the early stages of learning sport stacking. This result suggests that AO+MI training may be an effective and low-burden training method for participants.