Mental practice for relearning locomotor skills

Motor imagery of body movements that can't be executed on Earth

BACKGROUND

Before participating in a space mission, astronauts undergo parabolic-flight and underwater training to facilitate their subsequent adaptation to weightlessness. A quick, simple and inexpensive alternative could be training by motor imagery (MI).

OBJECTIVE

An important prerequisite for this training approach is that humans are able to imagine movements which are unfamiliar, since they can't be performed in the presence of gravity. Our study addresses this prerequisite.

METHODS

68 young subjects completed a modified version of the CMI test (Schott, 2013). With eyes closed, subjects were asked to imagine moving their body according to six consecutive verbal instructions. After the sixth instruction, subjects opened their eyes and arranged the segments of a manikin into the assumed final body configuration. In a first condition, subjects received instructions only for moving individual body segments (CMIground). In a second condition, subjects received instructions for moving body segments or their full body (CMIfloat). After each condition, subjects were asked to rate their subjective visual and kinesthetic vividness of MI.

RESULTS

Condition differences emerged for the CMI scores and for the duration of correct trials with better performance in the CMIground condition. Condition differences were also represented for the subjective MI performance.

CONCLUSION

Motor imagery is possible but degraded when subjects are asked to imagine body movements while floating. This confirms that preflight training of MI while floating might be beneficial for astronauts' mission performance.

Effects of whole body vibration training and mental training on mobility, neuromuscular performance, and muscle strength in older men

This study was designed to evaluate the effects of whole body vibration (WBV) exercise, mental training (MT), and the concurrent effect of WBV and MT on lower body balance, neuromuscular performance, and leg muscle strength in elderly men. In a randomized control trial study with parallel group design, 42 older men (mean±standard deviation age, 68±5.78 years) were randomly divided into four groups: WBV (n=11), MT (n=12), WBV+MT (n=10), and control (n=9) groups. The protocol of training consisted of three sessions per week for 8 weeks and about 30 min for each session. The WBV exercise was performed on a vibration machine. In MT group, participants were asked to mentally visualize to do the Timed Up and Go and relaxation technics. postural stability, the Timed Up and Go test, 5-repetition chair-rising test, 6-m tandem gait test, 10-m walking, and leg isometric strength were measured in baseline and after 8-week intervention. Repeated measures-analysis of variance followed by post hoc was used to analyses the data. The results of this study showed that there were significant improvements (P<0.05) in postural stability, Timed Up and Go, 5-repetition chair-rising, 6-m tandem gait test, 10-m walking, and leg isometric strength in WBV, MT, and WBV+MT in comparison with baseline and in comparison with control group. It seems that older adults can take benefit from WBV and MT and WBV+MT exercise as a cost-effective and practical way without side effects to improve postural control, mobility, and functional performance.

Mental body transformation deficits in patients with chronic balance disorders

BACKGROUND

Movements may be generated consistent with imagining one's own body transformed or "disembodied" to a new position. Based on this concept we hypothesized that patients with objective balance deficits (obj-BD) would have altered neural transformation processes executing own body transformation (OBT) with functional consequences on balance control. Also we examined whether feeling unstable due to dizziness only (DO), without an obj-BD, also lead to an impaired OBT.

METHODS

32 patients with chronic dizziness were tested: 16 patients with obj-BD as determined by balance control during a sequence of stance and gait tasks, 16 patients with dizziness only (DO). Patients and 9 healthy controls (HCs) were asked to replicate roll trunk movements of an instructor in a life size video: first, with spontaneously copied (SPO) or "embodied" egocentric movements (lean when the instructor leans); second, with "disembodied" or "transformed" movements (OBT) with exact replication - lean left when the instructor leans left. Onset latency of trunk roll, rise time to peak roll angle (interval), roll velocity, and amplitude were measured.

RESULTS

SPO movements were always mirror-imaged. OBT task latencies were significantly longer and intervals shorter than for SPO tasks (p < 0.03) for all groups. Obj-BD but not DO patients had more errors for the OBT task and, compared to HCs, had longer onset latencies (p < 0.05) and smaller velocities (p < 0.003) and amplitudes (p < 0.001) in both the SPO and OBT tasks. Measures of DO patients were not significantly different from those of HCs.

CONCLUSIONS

Mental transformation (OBT) and SPO copying abilities are impaired in subjects with obj-BD and dizziness, but not with dizziness only. We conclude that processing the neuropsychological representation of the human body (body schema) slows when balance control is deficient.

Creative Dance Practice Improves Postural Control in a Child With Cerebral Palsy

PURPOSE

To investigate the effect of creative dance instruction on postural control and balance in an 11-year-old with spastic triplegic cerebral palsy, Gross Motor Function Classification Scale level II.

DESCRIPTIONS

We conducted 1-hour dance interventions twice weekly for 8 weeks, with a focus on somatosensory awareness and movement in all planes of motion. Computerized dynamic posturography using the SMART Balance Master/EquiTest (NeuroCom) was used to assess postural control and balance reactions before the first class and following the final class.

OUTCOMES

Gains in standing stability, balance recovery, directional control, and endpoint excursion of movement were found. Participation in creative dance lessons appears to improve somatosensory effectiveness and postural control in a child with cerebral palsy.

WHAT THIS CASE ADDS

Dance is a fun way to improve balance and coordination. These interventions could be easily implemented into programs for children with cerebral palsy.

Mental steps: Differential activation of internal pacemakers in motor imagery and in mental imitation of gait

Gait imagery and gait observation can boost the recovery of locomotion dysfunctions; yet, a neurologically justified rationale for their clinical application is lacking as much as a direct comparison of their neural correlates. Using functional magnetic resonance imaging, we measured the neural correlates of explicit motor imagery of gait during observation of in-motion videos shot in a park with a steady cam (Virtual Walking task). In a 2 × 2 factorial design, we assessed the modulatory effect of gait observation and of foot movement execution on the neural correlates of the Virtual Walking task: in half of the trials, the participants were asked to mentally imitate a human model shown while walking along the same route (mental imitation condition); moreover, for half of all the trials, the participants also performed rhythmic ankle dorsiflexion as a proxy for stepping movements. We found that, beyond the areas associated with the execution of lower limb movements (the paracentral lobule, the supplementary motor area, and the cerebellum), gait imagery also recruited dorsal premotor and posterior parietal areas known to contribute to the adaptation of walking patterns to environmental cues. When compared with mental imitation, motor imagery recruited a more extensive network, including a brainstem area compatible with the human mesencephalic locomotor region (MLR). Reduced activation of the MLR in mental imitation indicates that this more visually guided task poses less demand on subcortical structures crucial for internally generated gait patterns. This finding may explain why patients with subcortical degeneration benefit from rehabilitation protocols based on gait observation. Hum Brain Mapp 38:5195-5216, 2017. © 2017 Wiley Periodicals, Inc.

Motor Imagery-Based Rehabilitation: Potential Neural Correlates and Clinical Application for Functional Recovery of Motor Deficits after Stroke

Motor imagery (MI), defined as the mental implementation of an action in the absence of movement or muscle activation, is a rehabilitation technique that offers a means to replace or restore lost motor function in stroke patients when used in conjunction with conventional physiotherapy procedures. This article briefly reviews the concepts and neural correlates of MI in order to promote improved understanding, as well as to enhance the clinical utility of MI-based rehabilitation regimens. We specifically highlight the role of the cerebellum and basal ganglia, premotor, supplementary motor, and prefrontal areas, primary motor cortex, and parietal cortex. Additionally, we examine the recent literature related to MI and its potential as a therapeutic technique in both upper and lower limb stroke rehabilitation.

Tai Chi with mental imagery theory improves soleus H-reflex and nerve conduction velocity in patients with type 2 diabetes

OBJECTIVES

Diabetes is a disease that leads to damage to the peripheral nerves which may eventually cause balance instability. The purpose of this study was to determine the effect of 8 weeks of Tai Chi (TC) training combined with mental imagery (MI) on soleus H-reflex and nerve conduction velocity (NCV) of the sural and superficial peroneal nerves in people with diabetes.

DESIGNS

Quasi-experimental, one group pretest-posttest design.

SETTING

Human Research Laboratory.

INTERVENTIONS

A series of Yang style of Tai Chi classes with mental imagery, one hour, two sessions per week for 8 weeks was done.

MAIN OUTCOME MEASURES

The Activities-specific Balance Confidence (ABC) Scale, Functional Reach Test (FRT), and One Leg Standing Test (OLS) were measured as functional data. Hoffman reflex (H-reflex), and sural and superficial peroneal NCV were measured as main outcomes.

RESULTS

All functional outcomes measures were significantly improved after the intervention (p<0.01). In the H-reflex, there was a significant increase in amplitude (μV) after completing 8 weeks of TC exercise (p=0.02). In the sural nerve, the velocity (p=0.01), amplitude (p=0.01), and latency (p=0.01) were significantly improved between pre and post-test. In the superficial peroneal nerve, significant improvements were observed in (p=0.02) and latency (p=0.01), but not in amplitude (μV) (p>0.05).

CONCLUSIONS

Combining TC intervention with MI theory showed an improvement in the H-reflex and NCV tests, which suggests improved balance and walking stability.

Influence of functional task-oriented mental practice on the gait of transtibial amputees: a randomized, clinical trial

Background

Mental practice (MP) through motor imagery is a cognitive training strategy used to improve locomotor skills during rehabilitation programs. Recent works have used MP tasks to investigate the neurophysiology of human gait; however, its effect on functional performance has not been evaluated. In the present study, the influence of gait-oriented MP tasks on the rehabilitation process of gait in transtibial amputees was investigated by assessing the vertical (V), anterior-posterior (AP), and medio-lateral (ML) ground reaction forces (GRFs) and the time duration of the support phase of the prosthetic limb.

Methods

Unilateral transtibial amputees, who were capable of performing motor imagination tasks (MIQ-RS score ≥4), were randomly divided into two groups: Group A (n = 10), who performed functional gait-oriented MP combined with gait training, and Group B (n = 5), who performed non-motor task MP. The MP intervention was performed in the first-person perspective for 40 min, 3 times/week, for 4 weeks. The GRF outcome measures were recorded by a force platform to evaluate gait performance during 4 distinct stages: at baseline (BL), 1 month before the MP session; Pre-MP, 1–3 days before the MP session; Post-MP, 1–3 days after the MP session; and follow-up (FU), 1 month after MP session. The gait variables were compared inter- and intra-group by applying the Mann-Whitney and Friedman tests (alpha = 0.05).

Results

All volunteers exhibited a homogenous gait pattern prior to MP intervention, with no gait improvement during the BL and Pre-MP stages. Only Group A showed significant improvements in gait performance after the intervention, with enhanced impact absorption, as indicated by decreased first V and AP peaks; propulsion capacity, indicated by increasing second V and AP peaks; and balance control of the prosthetic limb, indicated by decreasing ML peaks and increasing duration of support. This gait pattern persisted until the FU stage.

Conclusions

MP combined with gait training allowed transtibial amputees to reestablish independent locomotion. Since the effects of MP were preserved after 1 month, the improvement is considered related to the specificity of the MP tasks. Therefore, MP may improve the clinical aspect of gait rehabilitation when included in a training program.

Effects of a standard transfer exercise program on transfer quality and activities of daily living for transfer-dependent spinal cord injury patients

[Purpose] The objective of this study was to analyze the effect of a standard transfer exercise program on the transfer quality and activities of daily living (ADL) in wheelchair-dependent spinal cord injury patients. [Subjects and Methods] We randomly divided 22 patients into 2 groups. During the intervention period, one group received treatment with both conventional physical therapy and a standard sitting pivot transfer exercise program (experimental group, n=12) and the other group was managed solely with conventional physical therapy (control group, n=10). The standard transfer exercise program comprised of an independent and a dependent program. Exercises were conducted 30 minutes daily, 3 times per week, over a period of 6 weeks. All subjects were tested using a transfer assessment instrument (TAI) and spinal cord independence measure (SCIM) before and after the intervention. [Results] Compared to the control group, the intervention group scored higher on both the transfer assessment instrument (TAI Part 1, Part 2, TAI total score) and spinal cord independence measure tests (SCIM mobility room and toilet score; SCIM total score). [Conclusion] In conclusion, the standard transfer exercise program is an effective tool which improves transfer quality and the ability of wheelchair-dependent spinal cord injury patients to carry out their ADLs.

Does Motor Simulation Theory Explain the Cognitive Mechanisms Underlying Motor Imagery? A Critical Review

Motor simulation theory (MST; Jeannerod, 2001) purports to explain how various action-related cognitive states relate to actual motor execution. Specifically, it proposes that motor imagery (MI; imagining an action without executing the movements involved) shares certain mental representations and mechanisms with action execution, and hence, activates similar neural pathways to those elicited during the latter process. Furthermore, MST postulates that MI works by rehearsing neural motor systems off-line via a hypothetical simulation process. In this paper, we review evidence cited in support of MST and evaluate its efficacy in understanding the cognitive mechanisms underlying MI. In doing so, we delineate the precise postulates of simulation theory and clarify relevant terminology. Based on our cognitive-level analysis, we argue firstly that the psychological mechanisms underlying MI are poorly understood and require additional conceptual and empirical analysis. In addition, we identify a number of potentially fruitful lines of inquiry for future investigators of MST and MI.

Interactive virtual feedback improves gait motor imagery after spinal cord injury: An exploratory study

Purpose: Motor imagery can improve motor function and reduce pain. This is relevant to individuals with spinal cord injury (SCI) in whom motor dysfunction and neuropathic pain are prevalent. However, therapy efficacy could be dependent on motor imagery ability, and a clear understanding of how motor imagery might be facilitated is currently lacking. Thus, the aim of the present study was to assess the immediate effects of interactive virtual feedback on motor imagery performance after SCI.

Methods: Nine individuals with a traumatic SCI participated in the experiment. Motor imagery tasks consisted of forward (i.e. simpler) and backward (i.e. more complex) walking while receiving interactive versus static virtual feedback. Motor imagery performance (vividness, effort and speed), neuropathic pain intensity and feasibility (immersion, distraction, side-effects) were assessed.

Results: During interactive feedback trials, motor imagery vividness and speed were significantly higher and effort was significantly lower as compared static feedback trials. No change in neuropathic pain was observed. Adverse effects were minor, and immersion was reported to be good.

Conclusions: This exploratory study showed that interactive virtual walking was feasible and facilitated motor imagery performance. The response to motor imagery interventions after SCI might be improved by using interactive virtual feedback.

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.

Mental chronometry and mental rotation abilities in stroke patients with different degrees of sensory deficit

BACKGROUND

Motor imagery is used for treatment of motor deficits after stroke. Clinical observations suggested that motor imagery abilities might be reduced in patients with severe sensory deficits. This study investigated the influence of somatosensory deficits on temporal (mental chronometry, MC) and spatial aspects of motor imagery abilities.

METHODS

Stroke patients (n = 70; <6 months after stroke) were subdivided into 3 groups according to their somatosensory functions. Group 1 (n = 31) had no sensory deficits, group 2 (n = 27) had a mild to moderate sensory impairment and group 3 (n = 12) had severe sensory deficits. Patients and a healthy age-matched control group (n = 23) participated in a mental chronometry task (Box and Block Test, BBT) and a mental rotation task (Hand Identification Test, HIT). MC abilities were expressed as a ratio (motor execution time-motor imagery time/motor execution time).

RESULTS

MC for the affected hand was significantly impaired in group 3 in comparison to stroke patients of group 1 (p = 0.006), group 2 (p = 0.005) and healthy controls (p < 0.001). For the non-affected hand MC was similar across all groups. Stroke patients had a slower BBT motor execution than healthy controls (p < 0.001), and group 1 executed the task faster than group 3 (p = 0.002). The percentage of correct responses in the HIT was similar for all groups.

CONCLUSION

Severe sensory deficits impair mental chronometry abilities but have no impact on mental rotation abilities. Future studies should explore whether the presence of severe sensory deficits in stroke patients reduces the benefit from motor imagery therapy.

The effect of rhythmic-cued motor imagery on walking, fatigue and quality of life in people with multiple sclerosis: A randomised controlled trial

BACKGROUND

Motor imagery and rhythmic auditory stimulation are physiotherapy strategies for walking rehabilitation.

OBJECTIVES

To investigate the effect of motor imagery combined with rhythmic cueing on walking, fatigue and quality of life (QoL) in people with multiple sclerosis (MS).

METHODS

Individuals with MS and Expanded Disability Status Scale scores of 1.5-4.5 were randomised into one of three groups: 17 minutes of motor imagery, six times per week, for 4 weeks, with music (A) or metronome cues (B), both with verbal cueing, and (C) controls. Primary outcomes were walking speed (Timed 25-Foot Walk) and distance (6-Minute Walk Test). Secondary outcomes were walking perception (Multiple Sclerosis Walking Scale-12), fatigue (Modified Fatigue Impact Scale) and QoL (Short Form-36 Health Survey, Multiple Sclerosis Impact Scale-29, Euroquol-5D-3L Questionnaire).

RESULTS

Of the 112 participants randomised, 101 completed the study. Compared to controls, both interventions significantly improved walking speed, distance and perception. Significant improvements in cognitive but not psychosocial fatigue were seen in the intervention groups, and physical fatigue improved only in the music-based group. Both interventions improved QoL; however, music-cued motor imagery was superior at improving health-related QoL.

CONCLUSION

Rhythmic-cued motor imagery improves walking, fatigue and QoL in people with MS, with music-cued motor imagery being more effective.

Immediate effects of adding mental practice to physical practice on the gait of individuals with Parkinson's disease: Randomized clinical trial

BACKGROUND

Mental practice has shown benefits in the rehabilitation of neurological patients, however, there is no evidence of immediate effects on gait of individuals with Parkinson's disease.

OBJECTIVE

Determine the effects of mental practice activity added to physical practice on the gait of individuals with Idiopathic Parkinson's Disease (IPD).

METHODS

20 patients classified with stage 2 and 3, according to the Hoehn and Yahr scale were randomized into 2 groups. The experimental group (N = 10) was submitted to a single session of mental practice and physical practice gait protocol and the control group (N = 10) only to physical practice. The primary outcomes were stride length and total stance and swing time. Secondary outcomes were hip range of motion, velocity and mobility. Subjects were reassessed 10 minutes, 1 day and 7 days after the end of the session.

RESULTS

There was no statistically significant difference between the groups. An intragroup difference was observed in velocity, stride length, hip range of motion, and mobility, as well as total stance and swing time. These results were also observed on follow-ups.

CONCLUSIONS

Mental practice did not have a greater effect on the gait of individuals with IPD than physical practice, after a single session.

A Program to Improve Reach Estimation and Reduce Fall Risk in the Elderly

Contemporary research findings indicate that in older persons (typically 64 > years) there are functional decrements in the ability to mentally represent and effectively plan motor actions. Actions, if poorly planned, can result in falling, a major health concern for the elderly. Whereas a number of factors may contribute to falls, over- or underestimation of reach abilities may lead to loss of postural control (balance) and pose a higher risk of falling. Our intent with this paper was to provide: (1) a brief background of the problem, (2) suggest strategies for mental (motor) imagery practice in the context of reach planning, and (3) describe general guidelines and a sample practice format of a training program for clinical use. Mental (motor) imagery practice of reach planning has potential for improving motor performance in reach-related everyday activities and reducing the risk of falls in older persons.

Supplementary motor area deactivation impacts the recovery of hand function from severe peripheral nerve injury

Although some patients have successful peripheral nerve regeneration, a poor recovery of hand function often occurs after peripheral nerve injury. It is believed that the capability of brain plasticity is crucial for the recovery of hand function. The supplementary motor area may play a key role in brain remodeling after peripheral nerve injury. In this study, we explored the activation mode of the supplementary motor area during a motor imagery task. We investigated the plasticity of the central nervous system after brachial plexus injury, using the motor imagery task. Results from functional magnetic resonance imaging showed that after brachial plexus injury, the motor imagery task for the affected limbs of the patients triggered no obvious activation of bilateral supplementary motor areas. This result indicates that it is difficult to excite the supplementary motor areas of brachial plexus injury patients during a motor imagery task, thereby impacting brain remodeling. Deactivation of the supplementary motor area is likely to be a serious problem for brachial plexus injury patients in terms of preparing, initiating and executing certain movements, which may be partly responsible for the unsatisfactory clinical recovery of hand function.

The dynamic motor imagery of locomotion is task-dependent in patients with stroke

PURPOSE

Recently, Motor Imagery (MI) has been associated with the execution of movements miming in part the mentally represented action (dynamic MI, dMI). Preliminary studies have reported as dMI may improve trainings in sport, with imagery timing close to the physical execution one. This study was aimed to investigate time and spatial parameters of dMI with actual locomotion in people with stroke.

METHODS

Twelve patients (stroke group, SG) were compared with twelve healthy elderly (elderly group, EG) and twenty young adults (young group, YG). Subjects performed mental representations of different walking (forward, FW; lateral, LW, backward, BW), accompanied or not by movements imitating walking (dMI and static MI, sMI). Then, they performed actual locomotion (AL). Outcome measures were related to the time and the number of steps spent for completing the tasks for all the given locomotor conditions.

RESULTS

Significant differences were found in patients with respect to healthy subjects, with time in sMI significantly shorter than in dMI (p < 0.004) and AL (p < 0.002), but not between dMI and AL in FW (p = 0.806). In patients, times obtained in sMI and dMI was significantly shorter with respect to those of AL in LW and BW. Patients performed imagery tasks with similar times in all locomotion. Healthy groups did not reveal differences among tasks in BW, while significant differences were found in LW. Analogous results were found in terms of number of performed steps.

CONCLUSIONS

In patients with stroke, a spatiotemporal functional equivalence with AL was found only for dMI, and not for sMI, in forward walking. This could be due to familiarity with this task. These results might have implications for the rehabilitative techniques based on MI.

Spinal cord injury affects the interplay between visual and sensorimotor representations of the body

The brain integrates multiple sensory inputs, including somatosensory and visual inputs, to produce a representation of the body. Spinal cord injury (SCI) interrupts the communication between brain and body and the effects of this deafferentation on body representation are poorly understood. We investigated whether the relative weight of somatosensory and visual frames of reference for body representation is altered in individuals with incomplete or complete SCI (affecting lower limbs’ somatosensation), with respect to controls. To study the influence of afferent somatosensory information on body representation, participants verbally judged the laterality of rotated images of feet, hands, and whole-bodies (mental rotation task) in two different postures (participants’ body parts were hidden from view). We found that (i) complete SCI disrupts the influence of postural changes on the representation of the deafferented body parts (feet, but not hands) and (ii) regardless of posture, whole-body representation progressively deteriorates proportionally to SCI completeness. These results demonstrate that the cortical representation of the body is dynamic, responsive, and adaptable to contingent conditions, in that the role of somatosensation is altered and partially compensated with a change in the relative weight of somatosensory versus visual bodily representations.

Damage to Fronto-Parietal Networks Impairs Motor Imagery Ability after Stroke: A Voxel-Based Lesion Symptom Mapping Study

Background: Mental practice with motor imagery has been shown to promote motor skill acquisition in healthy subjects and patients. Although lesions of the common motor imagery and motor execution neural network are expected to impair motor imagery ability, functional equivalence appears to be at least partially preserved in stroke patients.

Aim: To identify brain regions that are mandatory for preserved motor imagery ability after stroke.

Method:Thirty-seven patients with hemiplegia after a first time stroke participated. Motor imagery ability was measured using a Motor Imagery questionnaire and temporal congruence test. A voxelwise lesion symptom mapping approach was used to identify neural correlates of motor imagery in this cohort within the first year post-stroke.

Results: Poor motor imagery vividness was associated with lesions in the left putamen, left ventral premotor cortex and long association fibers linking parieto-occipital regions with the dorsolateral premotor and prefrontal areas. Poor temporal congruence was otherwise linked to lesions in the more rostrally located white matter of the superior corona radiata.

Conclusion: This voxel-based lesion symptom mapping study confirms the association between white matter tract lesions and impaired motor imagery ability, thus emphasizing the importance of an intact fronto-parietal network for motor imagery. Our results further highlight the crucial role of the basal ganglia and premotor cortex when performing motor imagery tasks.

Gait post-stroke: Pathophysiology and rehabilitation strategies

We reviewed neural control and biomechanical description of gait in both non-disabled and post-stroke subjects. In addition, we reviewed most of the gait rehabilitation strategies currently in use or in development and observed their principles in relation to recent pathophysiology of post-stroke gait. In both non-disabled and post-stroke subjects, motor control is organized on a task-oriented basis using a common set of a few muscle modules to simultaneously achieve body support, balance control, and forward progression during gait. Hemiparesis following stroke is due to disruption of descending neural pathways, usually with no direct lesion of the brainstem and cerebellar structures involved in motor automatic processes. Post-stroke, improvements of motor activities including standing and locomotion are variable but are typically characterized by a common postural behaviour which involves the unaffected side more for body support and balance control, likely in response to initial muscle weakness of the affected side. Various rehabilitation strategies are regularly used or in development, targeting muscle activity, postural and gait tasks, using more or less high-technology equipment. Reduced walking speed often improves with time and with various rehabilitation strategies, but asymmetric postural behaviour during standing and walking is often reinforced, maintained, or only transitorily decreased. This asymmetric compensatory postural behaviour appears to be robust, driven by support and balance tasks maintaining the predominant use of the unaffected side over the initially impaired affected side. Based on these elements, stroke rehabilitation including affected muscle strengthening and often stretching would first need to correct the postural asymmetric pattern by exploiting postural automatic processes in various particular motor tasks secondarily beneficial to gait.

Effect of Tai Chi Exercise Combined with Mental Imagery Theory in Improving Balance in a Diabetic and Elderly Population

Background

One of the effects of diabetes mellitus (DM), peripheral neuropathy, affects the sensation in the feet and can increase the chance of falling. The purpose of the study was to investigate the effect of 8 weeks of Tai Chi (TC) training combined with mental imagery (MI) on improving balance in people with diabetes and an age matched control group.

Material/Methods

Seventeen healthy subjects and 12 diabetic sedentary subjects ranging from 40–80 years of age were recruited. All subjects in both groups attended a Yang style of TC class using MI strategies, 2 sessions a week for 8 weeks. Each session was one hour long. Measures were taken using a balance platform test, an Activities-specific Balance Confidence (ABC) Scale, a one leg standing test (OLS), functional reach test (FRT) and hemoglobin A1C. These measures were taken twice, pre and post-study, for both groups.

Results

Both groups experienced significant improvements in ABC, OLS, FRT (P<0.01) after completing 8 weeks of TC exercise with no significant improvement between groups. Subjects using the balance platform test demonstrated improvement in balance in all different tasks with no significant change between groups. There was no significant change in HbA1C for the diabetic group.

Conclusions

All results showed an improvement in balance in the diabetic and the control groups; however, no significant difference between the groups was observed. Since the DM group had more problems with balance impairment at baseline than the control, the diabetic group showed the most benefit from the TC exercise.

Attenuation of brain grey matter volume in brachial plexus injury patients

Brachial plexus injury (BPI) causes functional changes in the brain, but the structural changes resulting from BPI remain unknown. In this study, we compared grey matter volume between nine BPI patients and ten healthy controls by means of voxel-based morphometry. This was the first study of cortical morphology in BPI. We found that brain regions including the cerebellum, anterior cingulate cortex, bilateral inferior, medial, superior frontal lobe, and bilateral insula had less grey matter in BPI patients. Most of the affected brain regions of BPI patients are closely related to motor function. We speculate that the loss of grey matter in multiple regions might be the neural basis of the difficulties in the motor rehabilitation of BPI patients. The mapping result might provide new target regions for interventions of motor rehabilitation.

Current insights in the development of children's motor imagery ability

Over the last two decades, the number of studies on motor imagery in children has witnessed a large expansion. Most studies used the hand laterality judgment paradigm or the mental chronometry paradigm to examine motor imagery ability. The main objective of the current review is to collate these studies to provide a more comprehensive insight in children’s motor imagery development and its age of onset. Motor imagery is a form of motor cognition and aligns with forward (or predictive) models of motor control. Studying age-related differences in motor imagery ability in children therefore provides insight in underlying processes of motor development during childhood. Another motivation for studying age-related differences in motor imagery is that in order to effectively apply motor imagery training in children (with motor impairments), it is pertinent to first establish the age at which children are actually able to perform motor imagery. Overall, performance in the imagery tasks develops between 5 and 12 years of age. The age of motor imagery onset, however, remains equivocal, as some studies indicate that children of 5 to 7 years old can already enlist motor imagery in an implicit motor imagery task, whereas other studies using explicit instructions revealed that children do not use motor imagery before the age of 10. From the findings of the current study, we can conclude that motor imagery training is potentially a feasible method for pediatric rehabilitation in children from 5 years on. We suggest that younger children are most likely to benefit from motor imagery training that is presented in an implicit way. Action observation training might be a beneficial adjunct to implicit motor imagery training. From 10 years of age, more explicit forms of motor imagery training can be effectively used.

Brain-computer interface boosts motor imagery practice during stroke recovery

OBJECTIVE

Motor imagery (MI) is assumed to enhance poststroke motor recovery, yet its benefits are debatable. Brain-computer interfaces (BCIs) can provide instantaneous and quantitative measure of cerebral functions modulated by MI. The efficacy of BCI-monitored MI practice as add-on intervention to usual rehabilitation care was evaluated in a randomized controlled pilot study in subacute stroke patients.

METHODS

Twenty-eight hospitalized subacute stroke patients with severe motor deficits were randomized into 2 intervention groups: 1-month BCI-supported MI training (BCI group, n = 14) and 1-month MI training without BCI support (control group; n = 14). Functional and neurophysiological assessments were performed before and after the interventions, including evaluation of the upper limbs by Fugl-Meyer Assessment (FMA; primary outcome measure) and analysis of oscillatory activity and connectivity at rest, based on high-density electroencephalographic (EEG) recordings.

RESULTS

Better functional outcome was observed in the BCI group, including a significantly higher probability of achieving a clinically relevant increase in the FMA score (p < 0.03). Post-BCI training changes in EEG sensorimotor power spectra (ie, stronger desynchronization in the alpha and beta bands) occurred with greater involvement of the ipsilesional hemisphere in response to MI of the paralyzed trained hand. Also, FMA improvements (effectiveness of FMA) correlated with the changes (ie, post-training increase) at rest in ipsilesional intrahemispheric connectivity in the same bands (p < 0.05).

INTERPRETATION

The introduction of BCI technology in assisting MI practice demonstrates the rehabilitative potential of MI, contributing to significantly better motor functional outcomes in subacute stroke patients with severe motor impairments.

Effects of proprioception training with exercise imagery on balance ability of stroke patients

[Purpose] The purpose of the present study was to examine and compare the effects of proprioceptive training accompanied by motor imagery training and general proprioceptive training on the balance of stroke patients. [Subjects and Methods] Thirty-six stroke patients were randomly assigned to either an experimental group of 18 patients or a control group of 18 patients. The experimental group was given motor imagery training for 5 minutes and proprioceptive training for 25 minutes, while the control group was given proprioceptive training for 30 minutes. Each session and training program was implemented 5 times a week for 8 weeks. The Korean version of the Berg Balance Scale (K-BBS), Timed Up and Go test (TUG), weight bearing ratio (AFA-50, Alfoots, Republic of Korea), and joint position sense error (Dualer IQ Inclinometer, JTECH Medical, USA) were measured. [Results] Both groups showed improvements in K-BBS, TUG, weight bearing ratio, and joint position sense error. The measures of the experimental group showed greater improvement than the control group. [Conclusion] Motor imagery training, which is not subject to time restrictions, is not very risky and can be used as an effective treatment method for improving the balance ability of stroke patients.

Assessing motor imagery ability in younger and older adults by combining measures of vividness, controllability and timing of motor imagery

With the population aging, a large number of patients undergoing rehabilitation are older than 60 years. Also, since the use of motor imagery (MI) training in rehabilitation is becoming more popular, it is important to gain a better knowledge about the age-related changes in MI ability. The main goal of this study was to compare MI ability in younger and older adults as well as to propose a new procedure for testing this ability. Thirty healthy young subjects (mean age: 22.9±2.7 years) and 28 healthy elderly subjects (mean age: 72.4±5.5 years) participated in the experiment. They were administered three tests aimed at assessing three dimensions of MI: (1) the kinesthetic and visual imagery questionnaire (KVIQ) to assess MI vividness; (2) a finger-thumb opposition task to assess MI controllability; and (3) a chronometric task to assess the timing of MI. On average, the younger and older groups showed similar results on the KVIQ and the chronometric task, but the younger group was more accurate at the finger-thumb opposition task. Interestingly, there was a large variability in the performance within both groups, emphasizing the importance of considering each person individually regarding MI ability, whatever his age. Finally, we propose two indexes of MI ability to identify the potential of persons to engage in MI training programs. Future studies are needed to confirm the predictive value of these MI indexes and define inclusion/exclusion thresholds for their use as a screening tool in both younger and older adults.

Non-physical practice improves task performance in an unstable, perturbed environment: motor imagery and observational balance training

For consciously performed motor tasks executed in a defined and constant way, both motor imagery (MI) and action observation (AO) have been shown to promote motor learning. It is not known whether these forms of non-physical training also improve motor actions when these actions have to be variably applied in an unstable and unpredictable environment. The present study therefore investigated the influence of MI balance training (MI_BT) and a balance training combining AO and MI (AO+MI_BT) on postural control of undisturbed and disturbed upright stance on unstable ground. As spinal reflex excitability after classical (i.e., physical) balance training (BT) is generally decreased, we tested whether non-physical BT also has an impact on spinal reflex circuits. Thirty-six participants were randomly allocated into an MI_BT group, in which participants imagined postural exercises, an AO+MI_BT group, in which participants observed videos of other people performing balance exercises and imagined being the person in the video, and a non-active control group (CON). Before and after 4 weeks of non-physical training, balance performance was assessed on a free-moving platform during stance without perturbation and during perturbed stance. Soleus H-reflexes were recorded during stable and unstable stance. The post-measurement revealed significantly decreased postural sway during undisturbed and disturbed stance after both MI_BT and AO+MI_BT. Spinal reflex excitability remained unchanged. This is the first study showing that non-physical training (MI_BT and AO+MI_BT) not only promotes motor learning of “rigid” postural tasks but also improves performance of highly variable and unpredictable balance actions. These findings may be relevant to improve postural control and thus reduce the risk of falls in temporarily immobilized patients.

The embodied nature of motor imagery processes highlighted by short-term limb immobilization

We investigated the embodied nature of motor imagery processes through a recent use-dependent plasticity approach, a short-term limb immobilization paradigm. A splint placed on the participants' left-hand during a brief period of 24 h was used for immobilization. The immobilized participants performed two mental rotation tasks (a hand mental rotation task and a number mental rotation task) before (pre-test) and immediately after (post-test) the splint removal. The control group did not undergo the immobilization procedure. The main results showed an immobilization-induced effect on left-hand stimuli, resulting in a lack of task-repetition benefit. By contrast, accuracy was higher and response times were shorter for right-hand stimuli. No immobilization-induced effects appeared for number stimuli. These results revealed that the cognitive representation of hand movements can be modified by a brief period of sensorimotor deprivation, supporting the hypothesis of the embodied nature of motor simulation processes.

Neuroplasticity of imagined wrist actions after spinal cord injury: a pilot study

Motor imagery (MI - i.e., the mental representation of an action without physically executing it) stimulates brain motor networks and promotes motor learning after spinal cord injury (SCI). An interesting issue is whether the brain networks controlling MI are being reorganized with reference to spared motor functions. In this pilot study, we tested using magnetoencephalography (MEG) whether changes in cortical recruitment during MI were related to the motor changes elicited by rehabilitation. Over a 1-year period of inclusion, C6 SCI participants (n = 4) met stringent criteria for inclusion in a rehabilitation program focused on the tenodesis prehension (i.e., a compensatory prehension enabling seizing of objects in spite of hand and forearm muscles paralysis). After an extended baseline period of 5 weeks including repeated MEG and chronometric assessments of motor performance, MI training was embedded to the classical course of physiotherapy for five additional weeks. Posttest MEG and motor performance data were collected. A group of matched healthy control participants underwent a similar procedure. The MI intervention resulted in changes in the variability of the wrist extensions, i.e., a key movement of the tenodesis grasp (p < .05). Interestingly, the extent of cortical recruitment, quantified by the number of MEG activation sources recorded within Brodmann areas 1-8 during MI of the wrist extension, significantly predicted actual movement variability changes across sessions (p < .001). However, no such relationship was present for movement times. Repeated measurements afforded a reliable statistical power (range .70-.97). This pilot study does not provide straightforward evidence of MI efficacy, which would require a randomized controlled trial. Nonetheless, the data showed that the relationship between action and imagery of spared actions may be preserved after SCI.

Mental representation and motor imagery training

Research in sports, dance and rehabilitation has shown that basic action concepts (BACs) are fundamental building blocks of mental action representations. BACs are based on chunked body postures related to common functions for realizing action goals. In this paper, we outline issues in research methodology and an experimental method, the structural dimensional analysis of mental representation (SDA-M), to assess action-relevant representational structures that reflect the organization of BACs. The SDA-M reveals a strong relationship between cognitive representation and performance if complex actions are performed. We show how the SDA-M can improve motor imagery training and how it contributes to our understanding of coaching processes. The SDA-M capitalizes on the objective measurement of individual mental movement representations before training and the integration of these results into the motor imagery training. Such motor imagery training based on mental representations (MTMR) has been applied successfully in professional sports such as golf, volleyball, gymnastics, windsurfing, and recently in the rehabilitation of patients who have suffered a stroke.

Mental representation for action in the elderly: implications for movement efficiency and injury risk

Recent research findings indicate that with older adulthood, there are functional decrements in spatial cognition and more specially, in the ability to mentally represent and effectively plan motor actions. A typical finding is a significant over- or underestimation of one's actual physical abilities with movement planning-planning that has implications for movement efficiency and physical safety. A practical, daily life example is estimation of reachability--a situation that for the elderly may be linked with fall incidence. A strategy used to mentally represent action is the use of motor imagery--an ability that also declines with advancing older age. This brief review highlights research findings on mental representation and motor imagery in the elderly and addresses the implications for improving movement efficiency and lowering the risk of movement-related injury.

What surgeons can learn from athletes: mental practice in sports and surgery

BACKGROUND

Mental practice has been successfully applied in professional sports for skills acquisition and performance enhancement. The goals of this review are to describe the literature on mental practice within sport psychology and surgery and to explore how the specific principles of mental practice can be applied to the improvement of surgical performance-both in novice and expert surgeons.

METHOD

The authors reviewed the sports psychology, education, and surgery literatures through Medline, PubMed, PsycINFO, and Embase.

RESULTS

In sports, mental practice is a valuable tool for optimizing existing motor skill sets once core competencies have been mastered. These techniques have been shown to be more advantageous when used by elite athletes. Within surgery, mental practice studies have focused on skill acquisition among novices with little study of how expert surgeons use it to optimize surgical preparation.

CONCLUSIONS

We propose that performance optimization and skills acquisition should be viewed as 2 separate domains of mental practice. Further understanding of this phenomenon has implications for changing how we teach and train not only novice surgeons but also how experienced surgeons continue to maintain their skills, acquire new ones, and excel in surgery.

Is motor-imagery brain-computer interface feasible in stroke rehabilitation?

In the past 3 decades, interest has increased in brain-computer interface (BCI) technology as a tool for assisting, augmenting, and rehabilitating sensorimotor functions in clinical populations. Initially designed as an assistive device for partial or total body impairments, BCI systems have since been explored as a possible adjuvant therapy in the rehabilitation of patients who have had a stroke. In particular, BCI systems incorporating a robotic manipulanda to passively manipulate affected limbs have been studied. These systems can use a range of invasive (ie, intracranial implanted electrodes) or noninvasive neurophysiologic recording techniques (ie, electroencephalography [EEG], near-infrared spectroscopy, and magnetoencephalography) to establish communication links between the brain and the BCI system. Trials are most commonly performed on EEG-based BCI in comparison with the other techniques because of its high temporal resolution, relatively low setup costs, portability, and noninvasive nature. EEG-based BCI detects event-related desynchronization/synchronization in sensorimotor oscillatory rhythms associated with motor imagery (MI), which in turn drives the BCI. Previous evidence suggests that the process of MI preferentially activates sensorimotor regions similar to actual task performance and that repeated practice of MI can induce plasticity changes in the brain. It is therefore postulated that the combination of MI and BCI may augment rehabilitation gains in patients who have had a stroke by activating corticomotor networks via MI and providing sensory feedback from the affected limb using end-effector robots. In this review we examine the current literature surrounding the feasibility of EEG-based MI-BCI systems in stroke rehabilitation. We also discuss the limitations of using EEG-based MI-BCI in patients who have had a stroke and suggest possible solutions to overcome these limitations.

Bra.Di.P.O. and P.I.G.R.O.: Innovative Devices for Motor Learning Programs

Two mechatronics prototypes, useful for robotic neurotreatments and new clinical trainings, are here presented. P.I.G.R.O. (pneumatic interactive gait rehabilitation orthosis) is an active exoskeleton with an electropneumatic control. It imposes movements on lower limbs in order to produce in the patient’s brain proper motor cortex activation. Bra.Di.P.O. (brain discovery pneumatic orthosis) is an MR-compatible device, designed to improve fMRI (functional magnetic resonance imaging) analysis. The two devices are presented together because both are involved in the study of new robotic treatments of patients affected by ictus or brain stroke or in some motor learning experimental investigations carried out on healthy subjects.

A Comparison of Movement Imagery Ability Self-Report and Imagery Use in a Motor Task: A Preliminary Investigation

The present study used the Movement Imagery Questionnaire (MIQ-3) to determine the relationship between self-report movement imagery ability and performance on a motor task requiring use of visual and kinesthetic imagery. Young adults were asked to view a number sequence of 4- and 5 digits, maintain the information over a 6 s delay (blank screen) using visual imagery maintenance, and complete the sequence by finger-tapping complementary numbers using motor (kinesthetic) imagery and actually executing movements. We predicted higher movement imagery ability scores would be associated with faster movement times, and imagery ability would be significantly related to the motor tasks. Correlation results indicated no significant differences between self-report and finger-tapping scores, suggesting that in the context of the motor tasks used here, performance was independent of movement imagery ability. Discussion of this preliminary study focuses on the role of visual working memory in the motor task used here and its lack of assessment using the MIQ-3 and other current self-reports.