Effects of actual and imagined music-cued gait training on motor functioning and brain activity in people with multiple sclerosis: protocol of a randomised parallel multicentre trial

Abstract

IntroductionMotor imagery (MI) refers to the mental rehearsal of a physical action without muscular activity. Our previous studies showed that MI combined with rhythmic-auditory cues improved walking, fatigue and quality of life (QoL) in people with multiple sclerosis (pwMS). Largest improvements were seen after music and verbally cued MI. It is unclear whether actual cued gait training achieves similar effects on walking as cued MI in pwMS. Furthermore, in pwMS it is unknown whether any of these interventions leads to changes in brain activation. The purpose of this study is therefore to compare the effects of imagined and actual cued gait training and a combination thereof on walking, brain activation patterns, fatigue, cognitive and emotional functioning in pwMS.Methods and analysisA prospective double-blind randomised parallel multicentre trial will be conducted in 132 pwMS with mild to moderate disability. Randomised into three groups, participants will receive music, metronome and verbal cueing, plus MI of walking (1), MI combined with actual gait training (2) or actual gait training (3) for 30 min, 4× per week for 4 weeks. Supported by weekly phone calls, participants will practise at home, guided by recorded instructions. Primary endpoints will be walking speed (Timed 25-Foot Walk) and distance (2 min Walk Test). Secondary endpoints will be brain activation patterns, fatigue, QoL, MI ability, anxiety, depression, cognitive functioning, music-induced motivation-to-move, pleasure, arousal and self-efficacy. Data will be collected at baseline, postintervention and 3-month follow-up. MRI reference values will be generated using 15 matched healthy controls.Ethics and disseminationThis study follows the Standard Protocol Items: Recommendations for Interventional Trials-PRO Extension. Ethical approval was received from the Ethics Committees of the Medical Universities of Innsbruck (1347/2020) and Graz (33-056 ex 20/21), Austria. Results will be disseminated via national and international conferences and published in peer-reviewed journals.Trial registration numberDRKS00023978.

Actual and Imagined Music-Cued Gait Training in People with Multiple Sclerosis: A Double-Blind Randomized Parallel Multicenter Trial

“…Using a checklist and weekly phone calls, adherence was recorded. 19 A detailed description of the secondary outcomes is provided in Supplemental Material 2.…”

“…As a priori planned, after checking test assumptions, for continuous variables (T25FW, 2MWT, and mental chronometry), a mixed design ANOVA was conducted using time as the within-subject factor and group as between-subject factor, with the 3 DMT categories serving as covariates (no DMT, moderately effective DMT, highly effective DMT). 19 Post-hoc Bonferroni adjustment was applied as deemed appropriate. Effect sizes were computed as partial Eta-squared values (η 2 ).…”

“…A template for intervention description and replication (TIDieR) checklist is provided with the published study protocol. 19 Interventions were provided by physiotherapists, occupational therapists, and psychologists who had at least 5 years professional experience. They were trained by the lead investigator during the initial preparatory trial phase on participants' instructions and interventions.…”

“…Full eligibility criteria are reported in the protocol paper. 19 Assessments were performed by trained masked assessors at baseline, 4 weeks post-intervention, and 13 weeks followup (9 months post-randomization). At 4 weeks follow-up, further data were collected via telephone.…”

Musicoterapia en La Rehabilitación De La Función Motora De Miembros Superiores en Paciente Con Esclerosis Múltiple Por Medio Del Uso Del Teclado

“…Se han estudiado diferentes estrategias musicales en pacientes con esclerosis múltiple para optimizar el patrón de marcha (Seebacher et al, 2022;Moumdjian et al, 2020), la función de miembros superiores (Lamers, 2016), y al menos dos estudios en los que se ha trabajado la función motora del tren superior por medio del uso del teclado (Gatti et al, 2015). Mantener la funcionalidad de miembros superiores es de extrema importancia para pacientes que ya tienen un compromiso mayor en su capacidad de marcha: sus manos representan su independencia, su capacidad para llevar a cabo elementos esenciales de la vida cotidiana, como el aseo personal, la alimentación, los traslados -ya sea con muletas, o de una silla de ruedas a otro lugar como la cama -, etc.…”