Physical, cognitive and psychosocial effects of telerehabilitation-based motor imagery training in people with multiple sclerosis: A randomized controlled pilot trial

Abstract

Introduction Motor imagery training delivered at home via telerehabilitation is a novel rehabilitation concept. The aim was to investigate the effects of telerehabilitation-based motor imaging training (Tele-MIT) on gait, balance and cognitive and psychosocial outcomes in people with multiple sclerosis (pwMS). Methods This randomized, controlled pilot trial included pwMS and healthy individuals. pwMS were randomly divided into two groups, intervention and control. The intervention group received Tele-MIT twice a week for 8 weeks. The control group was a wait-list group without any additional specific treatment. Healthy participants served as a baseline comparison. The Dynamic Gait Index, used to assess dynamic balance during walking, was the primary outcome. Secondary outcomes included assessments of walking speed, endurance and perceived ability, balance performance assessed by a computerized posturography device, balance confidence, cognitive functions, fatigue, anxiety, depression and quality of life. Results Baseline comparisons with healthy individuals revealed that motor imagery abilities were preserved in pwMS ( p > 0.05). The intervention group exhibited significant improvements in dynamic balance during walking ( p = 0.002), walking speed ( p = 0.007), perceived walking ability ( p = 0.008), balance confidence ( p = 0.002), most cognitive functions ( p = 0.001–0.008), fatigue ( p = 0.001), anxiety ( p = 0.001), depression ( p = 0.005) and quality of life ( p = 0.002). No significant changes were observed in the control group in any of the outcome measures ( p > 0.05). Discussion Tele-MIT is a novel method that proved feasible and effective in improving dynamic balance during walking, walking speed and perceived walking ability, balance confidence, cognitive functions, fatigue, anxiety, depression and quality of life in pwMS.

Spatial constraints and cognitive fatigue affect motor imagery of walking in people with multiple sclerosis

“…The few studies investigating MI in PwMS are mainly limited to considering upper limb actions 13 , 15 , 17 , showing also how cognitive and mood disorders affect MI 28 , 41 , 42 . Only recently the focus has been shifted to lower limb movements 43 – 45 . Interestingly, evidence indicates that MI has been shown to improve not only walking, but also balance, fatigue, mood and quality of life in MS 43 – 45 .…”

“…Only recently the focus has been shifted to lower limb movements 43 – 45 . Interestingly, evidence indicates that MI has been shown to improve not only walking, but also balance, fatigue, mood and quality of life in MS 43 – 45 . However, to date, it remains unclear whether PwMS show anisochrony between actual and mental locomotion as well and, if so, whether this temporal discrepancy is modulated by spatial constraints 5 , 13 , 15 , 17 and/or affected by cognitive fatigue.…”

Motor Imagery: A Resource in the Fatigue Rehabilitation for Return-to-Work in Multiple Sclerosis Patients—A Mini Systematic Review

“…After removing duplicates, 3,115 records were assessed for eligibility. Following the application of inclusion and exclusion criteria and verifying the full-text articles for eligibility, a total of five articles (34)(35)(36)(37)(38) were included in the qualitative synthesis, including two feasibility pilot RCTs and 3 RCTs, as shown in the study flowchart (Figure 1). The mean methodological quality of the five included RCTs, according to the PEDro scale, was 6.8/10 (Table 2), indicating the good overall quality of the included studies.…”

“…The patients were asked to imagine themselves walking in various manners, accompanied by music and beat, as described by a recent publication ( 42 ). Three studies ( 34 , 37 , 38 ) for MI standardization followed the PETTLEP (physical, environmental, task, timing, learning, emotional, and perspective) approach, which may serve as a viable tool to enhance the effectiveness of an intervention. The PETTLEP model is based on neuroscientific findings, developed by Holmes and Collins, and includes a 7-point checklist of guidelines to follow when devising an imagery intervention ( 43 ).…”

Feasibility of motor imagery and effects of activating and relaxing practice on autonomic functions in healthy young adults: A randomised, controlled, assessor-blinded, pilot trial

“…MI improves muscle strength in healthy adults [12] and facilitates motor function in people with Parkinson's disease [13]. Moreover, RCTs have shown that MI is effective for people with multiple sclerosis [14][15][16][17][18].…”