Compromised motor imagery ability in individuals with multiple sclerosis and mild physical disability: an ERP study

Activation of the brain during motor imagination task with auditory stimulation

Introduction

Auditory stimulation is one of the most important influence factors in the cognitive process. It is an important guiding role in cognitive motor process. However, previous studies on auditory stimuli mainly focused on the cognitive effects of auditory stimuli on the cortex, while the role of auditory stimuli in motor imagery tasks is still unclear.

Methods

In order to explore the role of auditory stimuli in motor imagery tasks, we studied the EEG power spectrum distribution characteristics, frontal parietal mismatch negative (MMN) wave characteristics, and the Inter trial phase locking consistency (ITPC) characteristics of the prefrontal cognitive cortex and parietal motor cortex. In this study, 18 subjects were hired to complete the motor imagery tasks, induced by auditory stimuli of task related verbs and task independent nouns.

Results

EEG power spectrum analysis showed that the activity of the contralateral motor cortex was significantly increased under the stimulation of verbs, and the amplitude of mismatch negative wave was also significantly increased. ITPC is mainly concentrated in μ, α, and γ bands in the process of motor imagery task guided by the auditory stimulus of verbs, while it is mainly concentrated in the β band under the nouns stimulation. This difference may be due to the impact of auditory cognitive process on motor imagery.

Discussion

We speculate that there may be a more complex mechanism for the effect of auditory stimulation on the inter test phase lock consistency. When the stimulus sound has the corresponding meaning to the motor action, the parietal motor cortex may be more affected by the cognitive prefrontal cortex, thus changing its normal response mode. This mode change is due to the joint action of motor imagination, cognitive and auditory stimuli. This study provides new insight into the neural mechanism of motor imagery task guided by auditory stimuli, and provides more information on the activity characteristics of the brain network in motor imagery task by cognitive auditory stimulation.

Factors and strategies affecting motor imagery ability in people with multiple sclerosis: a systematic review

BACKGROUND

Although growing evidence has shown beneficial effects of motor imagery (MI) training in different populations including people with multiple sclerosis (pwMS), not all patients with neurological diseases may benefit from MI.

OBJECTIVES

To investigate factors and strategies affecting and enhancing MI ability in pwMS.

DATA SOURCES

MEDLINE/PubMed, PsycINFO, Cochrane Library, Scopus, EMBASE, EBSCOhost, Web of Science and REHABDATA databases, clinical trials registries, dissertation repositories, study bibliographies and internet search engines were searched through August 2021.

STUDY SELECTION

Any study type but single case studies investigating factors or strategies contributing to MI ability in pwMS.

STUDY APPRAISAL AND SYNTHESIS METHODS

Risk of bias (RoB) was assessed using the Joanna Briggs Institute Checklist for Case-Control and Analytical Cross-Sectional Studies and Cochrane RoB-2.0 tool for randomised trials. A qualitative synthesis was performed summarising main results.

RESULTS

Eight databases, 4 trial registries, 9 dissertation repositories, and 1 internet search engine were searched. Fourteen studies including 366 pwMS and 236 healthy controls were included. Most frequently, cognitive impairment was reported as a negative factor influencing MI ability in pwMS. Other negative factors were cognitive fatigue and disability. Inconsistent evidence was found on the contribution of MS phenotype, anxiety, and depression. Using a theory-based MI framework and familiarisation to MI and external cueing may enhance MI ability.

LIMITATIONS

Eligible studies were highly heterogeneous.

CONCLUSION AND IMPLICATIONS OF KEY FINDINGS

Cognitive impairment, cognitive fatigue and disability negatively influence MI ability in pwMS. Visual and/or auditory cueing of MI are strategies for facilitating MI ability.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020173081 CONTRIBUTION OF THE PAPER.

Mental Practice and Manipulative Skills Training Among People With Multiple Sclerosis: A Pilot Study

IMPORTANCE

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system that produces both motor and cognitive dysfunctions. Impairments in limb function as a result of MS cause a decline in the performance of activities of daily living (ADLs).

OBJECTIVE

To determine whether the use of mental practice (MP) or MP combined with training in motor manipulation skills (skills training) would improve gross and fine motor skills and treatment satisfaction among people with MS.

DESIGN

Pilot study with a duration of 3 mo plus 3-mo follow-up.

SETTING

Two MS associations.

PARTICIPANTS

Thirty-five patients diagnosed with MS of the relapsing-remitting and progressive secondary subtypes, ages 25 to 60 yr.

INTERVENTION

The participants were allocated to one of three groups according to their order of inclusion in the study: (1) MP, (2) MP + skills training, or (3) control group. The treatment protocol had a 6-wk duration and a total of 12 sessions. Outcomes and Measures: Blinded evaluators performed three assessments for each patient (pretreatment, posttreatment, and 3-mo follow-up) using the Nine-Hole Peg Test, Box and Block Test, ABILHAND, and Canadian Occupational Performance Measure (COPM).

RESULTS

We found no evidence of benefits in self-perceived performance of ADLs with respect to gross and fine motor skills; however, there was an improvement in perceived satisfaction and in the performance of activities, independent of the treatment received.

CONCLUSIONS AND RELEVANCE

Perceived ADL performance and satisfaction with performance increases among people with MS when they receive MP, MP + skills training, and conventional rehabilitation treatment. What This Article Adds: Mental practice combined with conventional treatment could contribute to patients perceiving improved performance of ADLs. Self-reported outcome measures, such as the COPM, could provide highly valuable information about occupation performance that may not match the objective evidence.

Identifying Early Neuropsychological Indicators of Cognitive Involvement in Multiple Sclerosis

Multiple sclerosis (MS) is a debilitating disease of the central nervous system that is most commonly seen in early to middle adulthood, although it can be diagnosed during childhood or later in life. While cognitive impairment can become more prevalent and severe as the disease progresses, signs of cognitive involvement can be apparent in the early stages of the disease. In this review, we discuss the prevalence and types of cognitive impairment seen in early MS, including the specific measures used to identify them, as well as the challenges in characterizing their frequency and progression. In addition to examining the progression of early cognitive involvement over time, we explore the clinical factors associated with early cognitive involvement, including demographics, level of physical disability, disease modifying therapy use, vocational status, and psychological and physical symptoms. Given the prevalence and functional impact these impairments can have for persons with MS, considerations for clinicians are provided, such as the role of early cognitive screenings and the importance of comprehensive neuropsychological assessments.

Effectiveness of Motor Imagery on Motor Recovery in Patients with Multiple Sclerosis: Systematic Review

The effects of motor imagery (MI) on functional recovery of patients with neurological pathologies, such as stroke, has been recently proven. The aim of this study is to evaluate the effectiveness of MI on motor recovery and quality of life (QOL) in patients with multiple sclerosis (pwMS). A search was carried out in the following scientific databases: PubMed, CINAHL, PEDro, Scopus, Cochrane and Web of Science, up to November 2020. The grey literature and reference lists of potentially relevant articles were also searched. The Checklist for Measuring Quality and The Cochrane collaboration’s tool were used to assess the methodological quality and risk of bias of the studies. Five studies were included in the systematic review. Findings showed that pwMS using MI had significant improvements in walking speed and distance, fatigue and QOL. In addition, several benefits were also found in dynamic balance and perceived walking ability. Although the evidence is limited, rehabilitation using MI with the application of musical and verbal guides (compared to non-intervention or other interventions), can produce benefits on gait, fatigue and QOL in pwMS with a low score in the Expanded Disability Status Scale.

The effect of handedness on mental rotation of hands: a systematic review and meta-analysis

Body-specific mental rotation is thought to rely upon internal representations of motor actions. Handedness is a source of distinctly different motor experience that shapes the development of such internal representations. Yet, the influence of handedness upon hand mental rotation has never been systematically evaluated. Five databases were searched for studies evaluating hand left/right judgement tasks in adults. Two independent reviewers performed screening, data extraction, and critical appraisal. Eighty-seven datasets were included, with 72 datasets pooled; all had unclear/high risk of bias. Meta-analyses showed that right-handers were faster, but not more accurate, than left-handers at hand mental rotation. A unique effect of handedness was found on performance facilitation for images corresponding to the dominant hand. Meta-analyses showed that right-handers were quicker at identifying images of right hands than left hands-a dominance advantage not evident in left-handers. Differing hand representations (more lateralised hand dominance in right-handers) likely underpin these findings. Given potential differences between hand preference and motor performance, future research exploring their distinct contributions to mental rotation is warranted.

Altered sensorimotor representations after recovery from peripheral nerve damage in neuralgic amyotrophy

Neuralgic amyotrophy is a common peripheral nerve disorder caused by acute autoimmune inflammation of the brachial plexus. Subsequent weakness of the stabilizing shoulder muscles leads to compensatory strategies and abnormal motor control of the shoulder. Despite recovery of peripheral nerves and muscle strength over time, motor dysfunction often persists. Suboptimal motor recovery has been linked to maladaptive changes in the central motor system in several nervous system disorders. We therefore hypothesized that neuralgic amyotrophy patients with persistent motor dysfunction may have altered cerebral sensorimotor representations of the affected upper limb. To test this hypothesis, 21 neuralgic amyotrophy patients (mean age 45 ± 12 years, 5 female) with persistent lateralized symptoms in the right upper limb and 20 age- and sex-matched healthy controls, all right-handed, performed a hand laterality judgement task in a cross-sectional comparison. Previous evidence has shown that to solve this task, subjects rely on sensorimotor representations of their own upper limb, using a first-person imagery perspective without actual motor execution. This enabled us to investigate altered central sensorimotor representations while controlling for altered motor output and altered somatosensory afference. We found that neuralgic amyotrophy patients were specifically less accurate for laterality judgments of their affected right limb, as compared to healthy controls. There were no significant group differences in reaction times. Both groups used a first-person imagery perspective, as evidenced by changes in reaction times as a function of participants' own arm posture. We conclude that cerebral sensorimotor representations of the affected upper limb are altered in neuralgic amyotrophy patients. This suggests that maladaptive central neuroplasticity may occur in response to peripheral nerve damage, thereby contributing to motor dysfunction. Therapies focused on altering cerebral sensorimotor representations may help to treat peripheral nerve disorders such as neuralgic amyotrophy.

Biopsychosocial model of resilience in young adults with multiple sclerosis (BPS-ARMS): an observational study protocol exploring psychological reactions early after diagnosis

INTRODUCTION

Multiple sclerosis (MS), the most common neurological disease causing disability in young adults, is widely recognised as a major stress factor. Studies have shown that the first years after the diagnosis are distressing in terms of adjustment to the disease and that MS negatively affects patients' psychological well-being, quality of life (QoL) and social functioning. However, the links between disease-specific variables at diagnosis, resilience and psychological adjustment of patients with MS remain largely unexplored, especially in adolescents and young adults. This observational study aims to fill the gap of knowledge on biopsychosocial characteristics and resilience of young adults with MS to evaluate the relationship among these variables and to develop a biopsychosocial model of resilience.

METHODS AND ANALYSIS

Biological and clinical characteristics of young adults newly diagnosed with MS will be investigated by collecting clinical information, performing neurological examinations, MRI and analysing cerebrospinal fluid and blood biomarkers (eg, measures of inflammation), body composition, gut microbiota and movement/perceptual markers. Psychosocial characteristics (eg, psychological distress, coping strategies), QoL, psychological well-being and resilience will be assessed by self-report questionnaires. Comparative statistics (ie, analysis of variance or unpaired samples t-test, correlation and regression analyses) will be applied to evaluate the relationship among biological, psychological and social factors. The results are expected to allow a comprehensive understanding of the determinants of resilience in young patients with MS and to inform resilience interventions, tailored to young patients' specific needs, aiming to reduce the risk of maladaptive reactions to the disease and to improve psychological well-being and QoL.

ETHICS AND DISSEMINATION

The study has been approved by the Verona University Hospital Ethics Committee (approval number: 2029CESC). The findings will be disseminated through scientific publications in peer-reviewed journals, conference presentations, social media and specific websites.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT03825055).

The Power of Faith: The Influence of Athletes' Coping Self-Efficacy on the Cognitive Processing of Psychological Stress

Coping self-efficacy (CSE) has a positive mental health effect on athletes’ ability to cope with stress. To understand the mechanism underlying the potential impact of CSE, event-related potentials (ERPs) were used to explore the neural activity of the cerebral cortex under acute psychological stress in athletes with different CSE levels. Among 106 high-level athletes, 21 high-CSE athletes and 20 low-CSE athletes were selected to participate in the experiment. A mental arithmetic task was used to induce acute psychological stress. The results showed that high-CSE athletes responded more quickly than low-CSE athletes. In the stress response stage, the N1 peak latency of low-CSE athletes was longer than that of high-CSE athletes, and the N1 amplitude was significantly larger than that of high-CSE athletes. In the feedback stage, the FRN amplitude with error feedback of high-CSE athletes was larger than that of low-CSE athletes, and the P300 amplitude with correct feedback was larger than that with error feedback. The results indicate that high-CSE athletes can better cope with stressful events, adjust their behaviors in a timely manner according to the results of their coping, and focus more on processing positive information.

Altered individual behavioral and EEG parameters are related to the EDSS score in relapsing-remitting multiple sclerosis patients

Functional neuroanatomy of cognitive impairment in multiple sclerosis is currently still a challenge. During the progression of the disease, several cognitive mechanisms deteriorate thus diminishing the patient’s quality of life. A primary objective in the cognitive assessment of multiple sclerosis (MS) patients is to find reliable measures utilizing diverse neuroimaging techniques. Moreover, especially relevant in the clinical environment is finding technical approaches that could be applied to individual participants and not only for group analysis. A 64-channel electroencephalographic recording (EEG) was made with thirty participants divided into three groups of equivalent size (N = 10) (healthy control, low-EDSS (1–2.5) and moderate-EDSS (4–6)). Correlation analysis was applied to multiple measures: behavior, neuropsychological tests (Paced Auditory Serial Addition Test, 3 seconds (PASAT-3s) and the Symbol Digit Modality Test (SDMT)), Expanded Disability Status Scale (EDSS), even-related potential (P3) and event-related desynchronization (ERD) parameters and the correlation scores between individual participant’s P3/ERD maps and the healthy grand average P3/ERDmaps. Statistical analysis showed that diverse parameters exhibited significant correlations. A remarkable correlation was the moderate score found between SDMT and EDSS (r = −0.679, p = 0.0009). However, the strongest correlation was between the value of integrated measures (reaction time, P3 and ERD latency) and EDSS (r = 0.699, p = 0.0006). In regard to correlations for grand average maps between groups, the P3 component exhibited a lower score according to a more deteriorated condition (higher EDSS). In contrast, ERD maps remained stable with an increase of EDSS. Lastly, a Z-transformation of individual values of all variables included in the study exhibited heterogeneity in cognitive alterations in the multiple sclerosis participants.

Motor performance improvement through virtual reality task is related to fatigue and cognition in people with multiple sclerosis

BACKGROUND AND PURPOSE

People with multiple sclerosis (MS) who undergo rehabilitation need to perform new motor skills or relearn old motor skills. It is not clear whether people with MS retain the ability to improve motor performance or learning. Furthermore, factors that influence motor performance in people with MS need to be investigated. This study explored motor performance in people with MS using virtual reality (VR). The effect of fatigue and cognitive function on motor performance improvement in people with MS was investigated.

METHODS

Twenty MS participants and 20 controls were recruited into the study. To assess motor performance, each participant was asked to perform a VR game for five times (blocks). The main outcome was time to complete the VR game and number of recorded errors. To assess fatigue level and cognitive function, participants were asked to complete the Arabic versions of the Modified Fatigue Impact Scale (MFIS) and the Montréal Cognitive Assessment (MOCA), respectively.

RESULTS

MS participants and controls demonstrated a practice-related improvement in performance as shown by the main effect of block for each of the outcome measures (p < .001, time required to complete VR game; p < .001, errors recorded). Strong and significant negative correlations between recorded errors and MOCA (r = .75, p < .001) and between recorded errors and MFIS (r = .55, p = .011) were found in people with MS.

CONCLUSIONS

Ability to improve motor performance in people with MS is preserved and related to cognitive function and fatigue impact. Health-care professionals should be made aware of the negative impact of cognitive function and fatigue on motor performance. A multicomponent intervention that targets these factors is advisable. Future research, however, is required to determine the content and potential benefits of such an intervention in the MS population.

Motor imagery in multiple sclerosis: exploring applications in therapeutic treatment

Motor imagery (MI) is a promising rehabilitation technique that has received significant interest for use in persons with multiple sclerosis (MS). Through alterations in neural networks, MI has the potential to improve measures of walking speed, walking distance, and fatigue in people with MS. Further research is required to assess the validity of MI in conjunction with other therapeutic MS treatments and provide objective outcome measures of motor improvements.

Motor Imagery as a Function of Disease Severity in Multiple Sclerosis: An fMRI Study

Motor imagery (MI) is defined as mental execution without any actual movement. While healthy adults usually show temporal equivalence, i.e., isochrony, between the mental simulation of an action and its actual performance, neurological disorders are associated with anisochrony. Unlike in patients with stroke and Parkinson disease, only a few studies have investigated differences of MI ability in multiple sclerosis (MS). However, the relationship among disease severity, anisochrony and brain activation patterns during MI has not been investigated yet. Here, we propose to investigate MI in MS patients using fMRI during a behavioral task executed with dominant/non-dominant hand and to evaluate whether anisochrony is associated with disease severity. Thirty-seven right-handed MS patients, 17 with clinically isolated syndrome (CIS) suggestive of MS and 20 with relapsing-remitting MS (RR-MS) and 20 right-handed healthy controls (HC) underwent fMRI during a motor task consisting in the actual or imaged movement of squeezing a foam ball with the dominant and non-dominant hand. The same tasks were performed outside the MRI room to record the number of actual and imagined ball squeezes, and calculate an Index of performance (IP) based on the ratio between actual and imagined movements. IP showed that a progressive loss of ability in simulating actions (i.e., anisochrony) more pronounced for non-dominant hand, was found as function of the disease course. Moreover, anisochrony was associated with activation of occipito-parieto-frontal areas that were more extensive at the early stages of the disease, probably in order to counteract the changes due to MS. However, the neural engagement of compensatory brain areas becomes more difficult with more challenging tasks, i.e., dominant vs. non-dominant hand, with a consequent deficit in behavioral performance. These results show a strict association between MI performance and disease severity, suggesting that, at early stages of the disease, anisochrony in MI could be considered as surrogate behavioral marker of MS severity.

Effects of Intermittent Theta Burst Stimulation on Manual Dexterity and Motor Imagery in Patients with Multiple Sclerosis: A Quasi-Experimental Controlled Study

Background

Intermittent theta burst stimulation (iTBS) is a repetitive transcranial magnetic stimulation (rTMS) protocol that influences cortical excitability and motor function recovery.

Objectives

This study aimed to investigate the effects of iTBS on manual dexterity and hand motor imagery in multiple sclerosis (MS) patients.

Methods

Thirty-six MS patients were non-randomly assigned into sham (control) or iTBS groups. Then, iTBS was delivered to the primary motor cortex for ten days over two consecutive weeks. The patients’ manual dexterity was assessed using the nine-hole peg test (9HPT) and the Box and Block Test (BBT), while the hand motor imagery was assessed with the hand mental rotation task (HMRT).

Results

iTBS group showed a reduction in the time required to complete the 9HPT (mean difference = -3.05, P = 0.002), and an increase in the number of blocks transferred in one minute in the BBT (mean difference = 8.9, P = 0.001) when compared to the control group. Furthermore, there was no significant difference between the two groups in terms of the reaction time (P = 0.761) and response accuracy rate (P = 0.482) in the HMRT.

Conclusions

When iTBS was applied over the primary motor cortex, it significantly improved manual dexterity, but had no significant effect on the hand motor imagery ability in MS patients.

Long-Lasting Cortical Reorganization as the Result of Motor Imagery of Throwing a Ball in a Virtual Tennis Court

In order to characterize the neural signature of a motor imagery (MI) task, the present study investigates for the first time the oscillation characteristics including both of the time-frequency measurements, event related spectral perturbation and intertrial coherence (ITC) underlying the variations in the temporal measurements (event related potentials, ERP) directly related to a MI task. We hypothesize that significant variations in both of the time-frequency measurements underlie the specific changes in the ERP directly related to MI. For the MI task, we chose a simple everyday task (throwing a tennis ball), that does not require any particular motor expertise, set within the controlled virtual reality scenario of a tennis court. When compared to the rest condition a consistent, long-lasting negative fronto-central ERP wave was accompanied by significant changes in both time frequency measurements suggesting long-lasting cortical activity reorganization. The ERP wave was characterized by two peaks at about 300 ms (N300) and 1000 ms (N1000). The N300 component was centrally localized on the scalp and was accompanied by significant phase consistency in the delta brain rhythms in the contralateral central scalp areas. The N1000 component spread wider centrally and was accompanied by a significant power decrease (or event related desynchronization) in low beta brain rhythms localized in fronto-precentral and parieto-occipital scalp areas and also by a significant power increase (or event related synchronization) in theta brain rhythms spreading fronto-centrally. During the transition from N300 to N1000, a contralateral alpha (mu) as well as post-central and parieto-theta rhythms occurred. The visual representation of movement formed in the minds of participants might underlie a top-down process from the fronto-central areas which is reflected by the amplitude changes observed in the fronto-central ERPs and by the significant phase synchrony in contralateral fronto-central delta and contralateral central mu to parietal theta presented here.