Motor Imagery and Action Observation as Appropriate Strategies for Home-Based Rehabilitation: A Mini-Review Focusing on Improving Physical Function in Orthopedic Patients

Abstract

Dynamic stability of the knee and weakness of the extensor muscles are considered to be the most important functional limitations after anterior cruciate ligament (ACL) injury, probably due to changes at the central (cortical and corticospinal) level of motor control rather than at the peripheral level. Despite general technological advances, fewer contraindicative surgical procedures, and extensive postoperative rehabilitation, up to 65% of patients fail to return to their preinjury level of sports, and only half were able to return to competitive sport. Later, it becomes clear that current rehabilitation after knee surgery is not sufficient to address the functional limitations after ACL reconstruction even years after surgery. Therefore, new therapeutic tools targeting the central neural system, i.e., the higher centers of motor control, should be investigated and integrated into current rehabilitation practice. To improve motor performance when overt movement cannot be fully performed (e.g., due to pain, impaired motor control, and/or joint immobilization), several techniques have been developed to increase physical and mental activation without the need to perform overt movements. Among the most popular cognitive techniques used to increase physical performance are motor imagery and action observation practices. This review, which examines the available evidence, presents the underlying mechanisms of the efficacy of cognitive interventions and provides guidelines for their use at home.

Motor Imagery as Adjunct Therapy for Rehabilitation of Total Knee Arthroplasty Patients: The State-of-the-Art Umbrella Review with Meta-Analysis

“…Considering MI practice programming, only one review with meta-analysis examined a MI practice dose-response relationship, suggesting that effects of cognitive training on outcomes in TKA patients were predicted by the total number of training sessions per study [9]. A recent review by Paravlic suggested recommendations for MI rehabilitation practice in the home setting [32]. In brief, there are some steps that should be followed to benefit from MI practice: (a) patients' imagery ability must be assessed to inform the therapist which MI perspective and which MI type should be used; (b) it is recommended to provide patients with audio instructions to follow during practice sessions [33]; (c) at the beginning of MI practice therapist should propose simple motor task that is easy to perform by patient and (d) the following motor imagery variables were associated with strength improvement: a training period of 4 weeks, a training frequency of three sessions per week, a training volume of two to three sets, 25 repetitions per set and a single session duration of 15 minutes [19].…”

Cortical Changes as a Result of Sports Injuries: A Short Commentary

“…Unlike AOT, motor imagery is a mental simulation of a specific muscle action without any corresponding motor output. These motor simulation practice techniques have been proven to enhance recovery and muscle strength during the injury rehabilitation period (Paravlic, 2022).  Local vibration increases muscle activity and, therefore, has been used for rehabilitation and performance enhancement.…”

The effect of action observation combined with high-definition transcranial direct current stimulation on motor performance in healthy adults: A randomized controlled trial

“…It is possible to acquire novel motor skills or to improve motor performance by observing the actions of others (Mattar and Gribble, 2005;Osman et al, 2005;Porro et al, 2007;Lee et al, 2013;Kim et al, 2017). Action observation (AO) has been found to improve a variety of motor tasks, such as serial reaction time tests (Osman et al, 2005) and force production (Porro et al, 2007), among healthy subjects and populations with neurological (Pelosin et al, 2010(Pelosin et al, , 2013Buccino et al, 2011;Lee et al, 2013;Park and Hwangbo, 2015) and orthopedic conditions (Paravlic, 2022) (however, see also Sarasso et al, 2015;Gatti et al, 2019;Borges et al, 2022).…”