A prolonged motor imagery session alter imagined and actual movement durations: Potential implications for neurorehabilitation

Prior Mental Fatigue Impairs Marksmanship Decision Performance

Purpose: Mental fatigue has been shown to impair subsequent physical performance in continuous and discontinuous exercise. However, its influence on subsequent fine-motor performance in an applied setting (e.g., marksmanship for trained soldiers) is relatively unknown. The purpose of this study was to investigate whether prior mental fatigue influences subsequent marksmanship performance as measured by shooting accuracy and judgment of soldiers in a live-fire scenario.

Methods: Twenty trained infantry soldiers engaged targets after completing either a mental fatigue or control intervention in a repeated measure design. Heart rate variability and the NASA-TLX were used to gauge physiological and subjective effects of the interventions. Target hit proportion, projectile group accuracy, and precision were used to measure marksmanship accuracy. Marksmanship accuracy was assessed by measuring bullet group accuracy (i.e., how close a group of shots are relative to center of mass) and bullet group precision (i.e., how close are each individual shot to each other). Additionally, marksmanship decision accuracy (correctly shooting vs. correctly withholding shot) when engaging targets was used to examine marksmanship performance.

Results: Soldiers rated the mentally fatiguing task (59.88 ± 23.7) as having greater mental workload relative to the control intervention [31.29 ± 12.3, t₍₁₉₎ = 1.72, p < 0.001]. Additionally, soldiers completing the mental fatigue intervention (96.04 ± = 37.1) also had lower time-domain (standard deviation of normal to normal R-R intervals) heart rate variability relative to the control [134.39 ± 47.4, t₍₁₈₎ = 3.59, p < 0.001]. Projectile group accuracy and group precision failed to show differences between interventions [t₍₁₉₎ = 0.98, p = 0.34, t₍₁₉₎ = 0.18, p = 0.87, respectively]. Marksmanship decision errors significantly increased after soldiers completed the mental fatigue intervention (48% ± 22.4) relative to the control intervention [M = 32% ± 79.9, t₍₁₉₎ = 4.39, p < 0.001]. There was a significant negative correlation between shooting response time and errors of commission (r = −0.61; p = 0.004) when preceded by the mental fatigue intervention, but not the control (r = −0.31; p = 0.17).

Conclusion: The mental fatigue intervention was successful in eliciting fatigue which was supported subjectively and objectively. Marksmanship judgment performance is significantly reduced when soldiers are mentally fatigued, although shot accuracy is not.

The Videoinsight® Method: improving early results following total knee arthroplasty

PURPOSE

The purpose of this randomized double-blind study was to investigate the effectiveness of the Videoinsight^® psychological enhancing method in promoting early recovery during rehabilitation following total knee arthroplasty.

METHODS

One-hundred and ten patients treated with cemented total knee arthroplasty were randomly assigned to Group A or Group B, and both groups underwent the same rehabilitation programme. Group A (55 patients) received one art video selected according to Videoinsight^® concept. This art video promoting self-confidence and psychological support to the patient has been shown in the physical therapy department before any rehabilitation session, in the first 15 days after surgery and then three times a week for the next 4 weeks. Group B (55 patients) underwent the same rehabilitation protocol in the same setting, after TKA surgery, without the video support. Patients were evaluated pre-operatively and 3 months after surgery with Physical and Mental SF-36, State-Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Tampa Scale of Kinesiophobia (TSK), Knee Society Score (KSS), VAS, and WOMAC scores.

RESULTS

Eight patients were lost to follow-up, and 102 patients (Group A: 52 patients; Group B: 50 patients) were available at mean 3.0 ± 0.2 months follow-up. Age at surgery was 69.1 ± 13.0 years. The two groups were homogeneous regarding pre-operative demographic data and clinical outcomes. Significant improvements were observed in both groups compared to baseline and in Group A compared to Group B at final follow-up for functional and psychological scores except for SF-36. Respectively, Group A and Group B showed WOMAC 79.9 ± 13.0 and 69.7 ± 9.5 (p < 0.005), VAS 2.8 ± 1.6 and 4.0 ± 1.5, (p < 0.005), KSS 87.8 ± 9.6 and 78.3 ± 8.2 (p < 0.005), BDI 5.1 ± 4.8 and 9.4 ± 3.9 (p < 0.005), STAI 30.8 ± 7.9 and 34.8 ± 7.8 (p < 0.005), and TSK 24.4 ± 5.5 and 29.3 ± 4.8 (p < 0.005).

CONCLUSION

The Videoinsight(^®) psychological enhancing method, by the view of video art images, combined to an adequate rehabilitation protocol can be a means for further improving short-term clinical and functional outcomes by giving a psychological support to patients who underwent total knee arthroplasty.

LEVEL OF EVIDENCE

I.

Virtual and Actual Humanoid Robot Control with Four-Class Motor-Imagery-Based Optical Brain-Computer Interface

Motor-imagery tasks are a popular input method for controlling brain-computer interfaces (BCIs), partially due to their similarities to naturally produced motor signals. The use of functional near-infrared spectroscopy (fNIRS) in BCIs is still emerging and has shown potential as a supplement or replacement for electroencephalography. However, studies often use only two or three motor-imagery tasks, limiting the number of available commands. In this work, we present the results of the first four-class motor-imagery-based online fNIRS-BCI for robot control. Thirteen participants utilized upper- and lower-limb motor-imagery tasks (left hand, right hand, left foot, and right foot) that were mapped to four high-level commands (turn left, turn right, move forward, and move backward) to control the navigation of a simulated or real robot. A significant improvement in classification accuracy was found between the virtual-robot-based BCI (control of a virtual robot) and the physical-robot BCI (control of the DARwIn-OP humanoid robot). Differences were also found in the oxygenated hemoglobin activation patterns of the four tasks between the first and second BCI. These results corroborate previous findings that motor imagery can be improved with feedback and imply that a four-class motor-imagery-based fNIRS-BCI could be feasible with sufficient subject training.

Daily modulation of the speed-accuracy trade-off

Goal-oriented arm movements are characterized by a balance between speed and accuracy. The relation between speed and accuracy has been formalized by Fitts' law and predicts a linear increase in movement duration with task constraints. Up to now this relation has been investigated on a short-time scale only, that is during a single experimental session, although chronobiological studies report that the motor system is shaped by circadian rhythms. Here, we examine whether the speed-accuracy trade-off could vary during the day. Healthy adults carried out arm-pointing movements as accurately and fast as possible toward targets of different sizes at various hours of the day, and variations in Fitts' law parameters were scrutinized. To investigate whether the potential modulation of the speed-accuracy trade-off has peripheral and/or central origins, a motor imagery paradigm was used as well. Results indicated a daily (circadian-like) variation for the durations of both executed and mentally simulated movements, in strictly controlled accuracy conditions. While Fitts' law was held for the whole sessions of the day, the slope of the relation between movement duration and task difficulty expressed a clear modulation, with the lowest values in the afternoon. This variation of the speed-accuracy trade-off in executed and mental movements suggests that, beyond execution parameters, motor planning mechanisms are modulated during the day. Daily update of forward models is discussed as a potential mechanism.

Comparison of Brain Activation during Motor Imagery and Motor Movement Using fNIRS

Motor-activity-related mental tasks are widely adopted for brain-computer interfaces (BCIs) as they are a natural extension of movement intention, requiring no training to evoke brain activity. The ideal BCI aims to eliminate neuromuscular movement, making motor imagery tasks, or imagined actions with no muscle movement, good candidates. This study explores cortical activation differences between motor imagery and motor execution for both upper and lower limbs using functional near-infrared spectroscopy (fNIRS). Four simple finger- or toe-tapping tasks (left hand, right hand, left foot, and right foot) were performed with both motor imagery and motor execution and compared to resting state. Significant activation was found during all four motor imagery tasks, indicating that they can be detected via fNIRS. Motor execution produced higher activation levels, a faster response, and a different spatial distribution compared to motor imagery, which should be taken into account when designing an imagery-based BCI. When comparing left versus right, upper limb tasks are the most clearly distinguishable, particularly during motor execution. Left and right lower limb activation patterns were found to be highly similar during both imagery and execution, indicating that higher resolution imaging, advanced signal processing, or improved subject training may be required to reliably distinguish them.

Neural plasticity during motor learning with motor imagery practice: Review and perspectives

In the last decade, many studies confirmed the benefits of mental practice with motor imagery. In this review we first aimed to compile data issued from fundamental and clinical investigations and to provide the key-components for the optimization of motor imagery strategy. We focused on transcranial magnetic stimulation studies, supported by brain imaging research, that sustain the current hypothesis of a functional link between cortical reorganization and behavioral improvement. As perspectives, we suggest a model of neural adaptation following mental practice, in which synapse conductivity and inhibitory mechanisms at the spinal level may also play an important role.

Online and Offline Performance Gains Following Motor Imagery Practice: A Comprehensive Review of Behavioral and Neuroimaging Studies

There is now compelling evidence that motor imagery (MI) promotes motor learning. While MI has been shown to influence the early stages of the learning process, recent data revealed that sleep also contributes to the consolidation of the memory trace. How such "online" and "offline" processes take place and how they interact to impact the neural underpinnings of movements has received little attention. The aim of the present review is twofold: (i) providing an overview of recent applied and fundamental studies investigating the effects of MI practice (MIP) on motor learning; and (ii) detangling applied and fundamental findings in support of a sleep contribution to motor consolidation after MIP. We conclude with an integrative approach of online and offline learning resulting from intense MIP in healthy participants, and underline research avenues in the motor learning/clinical domains.

Effect of Gait Imagery Tasks on Lower Limb Muscle Activity With Respect to Body Posture

The objective of this study was to evaluate the effect of gait imagery tasks on lower limb muscle activity with respect to body posture. The sitting and standing position and lower limb muscle activity were evaluated in 27 healthy female students (24.4 ± 1.3 years, 167.2 ± 5.2 cm, 60.10 ± 6.4 kg). Surface electromyography was assessed during rest and in three different experimental conditions using mental imagery. These included a rhythmic gait, rhythmic gait simultaneously with observation of a model, and rhythmic gait after performing rhythmic gait. The normalized root mean square EMG values with respect to corresponding rest position were compared using non-parametric statistics. Standing gait imagery tasks had facilitatory effect on proximal lower limb muscle activity. However, electromyography activity of distal leg muscles decreased for all gait imagery tasks in the sitting position, when the proprioceptive feedback was less appropriate. For subsequent gait motor imagery tasks, the muscle activity decreased, probably as result of habituation. In conclusion, the effect of motor imagery on muscle activity appears to depend on relative strength of facilitatory and inhibitory inputs.