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Tacchino A, Pedullà L, Podda J, Monti Bragadin M, Battaglia MA, Bisio A, Bove M, Brichetto G. Motor imagery has a priming effect on motor execution in people with multiple sclerosis. Front Hum Neurosci 2023; 17:1179789. [PMID: 37746058 PMCID: PMC10512728 DOI: 10.3389/fnhum.2023.1179789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Priming is a learning process that refers to behavioral changes caused by previous exposure to a similar stimulus. Motor imagery (MI), which involves the mental rehearsal of action representations in working memory without engaging in actual execution, could be a strategy for priming the motor system. This study investigates whether MI primes action execution in Multiple Sclerosis (MS). Here, 17 people with MS (PwMS) and 19 healthy subjects (HS), all right-handed and good imaginers, performed as accurately and quickly as possible, with a pencil, actual or mental pointing movements between targets of small (1.0 × 1.0 cm) or large (1.5 × 1.5 cm) size. In actual trials, they completed five pointing cycles between the left and right targets, whereas in mental trials, the first 4 cycles were imagined while the fifth was actually executed. The fifth cycle was introduced to assess the MI priming effect on actual execution. All conditions, presented randomly, were performed with both dominant (i.e., right) and non-dominant arms. Analysis of the duration of the first 4 cycles in both actual and mental trials confirmed previous findings, showing isochrony in HS with both arms and significantly faster mental than actual movements (anisochrony) in PwMS (p < 0.01) [time (s); HS right: actual: 4.23 ± 0.15, mental: 4.36 ± 0.16; left: actual: 4.32 ± 0.15, mental: 4.43 ± 0.18; PwMS right: actual: 5.85 ± 0.16, mental: 5.99 ± 0.21; left: actual: 6.68 ± 0.20, mental: 5.94 ± 0.23]; anisochrony in PwMS was present when the task was performed with the non-dominant arm. Of note, temporal analysis of the fifth actual cycle showed no differences between actual and mental trials for HS with both arms, whereas in PwMS the fifth actual cycle was significantly faster after the four actual cycles for the non-dominant arm (p < 0.05) [time (s); HS right: actual: 1.03 ± 0.04, mental: 1.03 ± 0.03; left: actual: 1.08 ± 0.04, mental: 1.05 ± 0.03; PwMS right: actual: 1.48 ± 0.04, mental: 1.48 ± 0.06; left: actual: 1.66 ± 0.05, mental: 1.48 ± 0.06]. These results seem to suggest that a few mental repetitions of an action might be sufficient to exert a priming effect on the actual execution of the same action in PwMS. This would indicate further investigation of the potential use of MI as a new motor-cognitive tool for MS neurorehabilitation.
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Affiliation(s)
- Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | | | - Mario Alberto Battaglia
- Department of Physiopathology, Experimental Medicine, and Public Health, University of Siena, Siena, Italy
| | - Ambra Bisio
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- Centro Polifunzionale di Scienze Motorie, University of Genoa, Genoa, Italy
| | - Marco Bove
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
- IRCCS Policlinico San Martino, Genoa, Italy
| | - Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
- AISM Rehabilitation Service, Italian Multiple Sclerosis Society, Genoa, Italy
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Seebacher B, Reindl M, Kahraman T. Factors and strategies affecting motor imagery ability in people with multiple sclerosis: a systematic review. Physiotherapy 2023; 118:64-78. [PMID: 36184292 DOI: 10.1016/j.physio.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 07/03/2022] [Accepted: 09/13/2022] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Austria; Department of Rehabilitation Research, Rehab Centre Münster, Austria.
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
| | - Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Turkey
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Paolucci T, de Sire A, Agostini F, Bernetti A, Salomè A, Altieri M, Di Piero V, Ammendolia A, Mangone M, Paoloni M. Efficacy of interoceptive and embodied rehabilitative training protocol in patients with mild multiple sclerosis: A randomized controlled trial. Front Neurol 2022; 13:1095180. [PMID: 36619928 PMCID: PMC9812570 DOI: 10.3389/fneur.2022.1095180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The aim of this randomized controlled trial was to evaluate the effect of an embodied rehabilitative protocol, in improving interoceptive awareness respect balance and motor performance in patients with mild multiple sclerosis (pwMS). Methods In this study patients with relapsing-remitting multiple sclerosis were enrolled. The rehabilitative treatment group (TG) participated in an embodied physiotherapy program consisting of 8 one-hour sessions in groups of 4 patients at a time, 1 per week and 2 one-hour sessions of neuro-cognitive exercise in single session during the rehabilitation program. All pwMS underwent a clinical assessment to measure the interoception sense for the Multidimensional Assessment of Interoceptive Awareness scale, balance for the Tinetti Mobility test and stabilometry, quality of life for the Short Form Health Survey-12 and body image perception for Trunk Appearance Perception Scale and Body Image Scale. All previous scales and tests were performed at baseline (T0), at the end of treatment (T1) and after 2 months of follow up (T2). Results Sixty patients were enrolled and randomized into two groups: TG (n = 30), aged 43.0 ± 10.2 years, and a control/waiting list (WLG) group (n = 30), aged 40.7 ± 10.4 years. Statistically significant improvements in interoceptive awareness, body image perception, balance and quality of life were reported in TG versus WLG (p < 0.05). Discussion This study suggests that enhancing interoceptive awareness could improve postural balance. Future studies with a larger sample of patients will be needed to better quantify the effects of an embodied rehabilitation.
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Affiliation(s)
- Teresa Paolucci
- Department of Medical, Oral and Biotechnological Sciences (DSMOB), Physical Medicine and Rehabilitation Unit, G. D'Annunzio University, Chieti-Pescara, Chieti, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics', Sapienza University, Rome, Italy
- Department of Neurological and Rehabilitation Science, IRCCS San Raffaele, Rome, Italy
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics', Sapienza University, Rome, Italy
| | - Angela Salomè
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics', Sapienza University, Rome, Italy
| | - Marta Altieri
- Multiple Sclerosis Center, Sapienza University, Rome, Italy
| | | | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics', Sapienza University, Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics', Sapienza University, Rome, Italy
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Seebacher B, Helmlinger B, Pinter D, Ehling R, Hegen H, Ropele S, Reishofer G, Enzinger C, Brenneis C, Deisenhammer F. Effects of actual and imagined music-cued gait training on motor functioning and brain activity in people with multiple sclerosis: protocol of a randomised parallel multicentre trial. BMJ Open 2022; 12:e056666. [PMID: 35131834 PMCID: PMC8823210 DOI: 10.1136/bmjopen-2021-056666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Motor imagery (MI) refers to the mental rehearsal of a physical action without muscular activity. Our previous studies showed that MI combined with rhythmic-auditory cues improved walking, fatigue and quality of life (QoL) in people with multiple sclerosis (pwMS). Largest improvements were seen after music and verbally cued MI. It is unclear whether actual cued gait training achieves similar effects on walking as cued MI in pwMS. Furthermore, in pwMS it is unknown whether any of these interventions leads to changes in brain activation. The purpose of this study is therefore to compare the effects of imagined and actual cued gait training and a combination thereof on walking, brain activation patterns, fatigue, cognitive and emotional functioning in pwMS. METHODS AND ANALYSIS A prospective double-blind randomised parallel multicentre trial will be conducted in 132 pwMS with mild to moderate disability. Randomised into three groups, participants will receive music, metronome and verbal cueing, plus MI of walking (1), MI combined with actual gait training (2) or actual gait training (3) for 30 min, 4× per week for 4 weeks. Supported by weekly phone calls, participants will practise at home, guided by recorded instructions. Primary endpoints will be walking speed (Timed 25-Foot Walk) and distance (2 min Walk Test). Secondary endpoints will be brain activation patterns, fatigue, QoL, MI ability, anxiety, depression, cognitive functioning, music-induced motivation-to-move, pleasure, arousal and self-efficacy. Data will be collected at baseline, postintervention and 3-month follow-up. MRI reference values will be generated using 15 matched healthy controls. ETHICS AND DISSEMINATION This study follows the Standard Protocol Items: Recommendations for Interventional Trials-PRO Extension. Ethical approval was received from the Ethics Committees of the Medical Universities of Innsbruck (1347/2020) and Graz (33-056 ex 20/21), Austria. Results will be disseminated via national and international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00023978.
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Affiliation(s)
- Barbara Seebacher
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Münster, Austria
| | - Birgit Helmlinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
| | - Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Neurology, Research Unit for Neuronal Plasticity and Repair, Medical University of Graz, Graz, Austria
| | - Rainer Ehling
- Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Münster, Austria
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Harald Hegen
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Gernot Reishofer
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology; Division of Neuroradiology; Department of Radiology, Medical University of Graz, Graz, Austria
| | - Christian Brenneis
- Karl Landsteiner Institute for Interdisciplinary Rehabilitation Research, Münster, Austria
- Department of Neurology, Clinic for Rehabilitation Münster, Münster, Austria
| | - Florian Deisenhammer
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Motor Imagery of Walking in People Living with and without Multiple Sclerosis: A Cross-Sectional Comparison of Mental Chronometry. Brain Sci 2021; 11:brainsci11091131. [PMID: 34573154 PMCID: PMC8466525 DOI: 10.3390/brainsci11091131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 11/21/2022] Open
Abstract
Motor imagery represents the ability to simulate anticipated movements mentally prior to their actual execution and has been proposed as a tool to assess both individuals’ perception of task difficulty as well as their perception of their own abilities. People with multiple sclerosis (pwMS) often present with motor and cognitive dysfunction, which may negatively affect motor imagery. In this cross-sectional study, we explored differences in motor imagery of walking performance between pwMS (n = 20, age = 57.1 (SD = 8.6) years, 55% female) and age- and sex-matched healthy controls (n = 20, age = 58.1 (SD = 7.0) years, 60% female). Participants underwent mental chronometry assessments, a subset of motor imagery, which evaluated the difference between imagined and actual walking times across four walking tasks of increasing difficulty (i.e., large/narrow-width walkway with/without obstacles). Raw and absolute mental chronometry (A-MC) measures were recorded in single- (ST) and dual-task (DT) conditions. In ST conditions, pwMS had higher A-MC scores across all walking conditions (p ≤ 0.031, η2 ≥ 0.119), indicating lower motor imagery ability compared to healthy controls. During DT, all participants tended to underestimate their walking ability (3.38 ± 6.72 to 5.63 ± 9.17 s). However, after physical practice, pwMS were less able to adjust their imagined walking performance compared to healthy controls. In pwMS, A-MC scores were correlated with measures of balance confidence (ρ = −0.629, p < 0.01) and the self-reported expanded disability status scale (ρ = 0.747, p < 0.01). While the current study revealed that pwMS have lower motor imagery of walking performance compared to healthy individuals, further work is necessary to examine how the disassociation between mental chronometry and actual performance relates to quality of life and well-being.
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Agostini F, Pezzi L, Paoloni M, Insabella R, Attanasi C, Bernetti A, Saggini R, Mangone M, Paolucci T. Motor Imagery: A Resource in the Fatigue Rehabilitation for Return-to-Work in Multiple Sclerosis Patients-A Mini Systematic Review. Front Neurol 2021; 12:696276. [PMID: 34290665 PMCID: PMC8287528 DOI: 10.3389/fneur.2021.696276] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/11/2021] [Indexed: 01/13/2023] Open
Abstract
Fatigue is a multidimensional symptom with both physical and cognitive aspects, which can affect the quality of daily and working life activities. Motor Imagery (MI) represents an important resource for use during the rehabilitation processes, useful, among others, for job integration/reintegration, of neurological pathologies, such as Multiple Sclerosis (MS). To define the effective rehabilitation protocols that integrate MI for the reduction of fatigue in patients with MS (PwMS), a literary review was performed through August 2020. Five articles were included in the qualitative synthesis, including two feasibility pilot randomized control trials (RCTs) and 3 RCTs with good quality according to the PEDro score and a low risk of bias according to the Cochrane Collaboration tool. The literature suggested that MI, in association with rhythmic-auditory cues, may be an effective rehabilitation resource for reducing fatigue. Positive effects were observed on perceived cognitive and psychological fatigue. PwMS require greater compensatory strategies than healthy individuals, and the use of rhythmic-auditory cues may be useful for optimizing the cognitive processing of MI, which acts as an internal stimulus that is enhanced and made more vivid by outside cues. These findings provide evidence that MI is a promising rehabilitation tool for reducing fatigue in PwMS and return to work strategies.
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Affiliation(s)
- Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Letizia Pezzi
- Department of Medical and Oral Sciences and Biotechnologies, University G. d'Annunzio Chieti-Pescara, Chieti, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Roberta Insabella
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Carmine Attanasi
- Complex Operational Unit (UOC) Physical Medicine and Rehabilitation, Santa Caterina Novella Hospital, Galatina, Italy
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Raoul Saggini
- Department of Medical and Oral Sciences and Biotechnologies, University G. d'Annunzio Chieti-Pescara, Chieti, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Teresa Paolucci
- Department of Medical and Oral Sciences and Biotechnologies, University G. d'Annunzio Chieti-Pescara, Chieti, Italy
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Effectiveness of Motor Imagery on Motor Recovery in Patients with Multiple Sclerosis: Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020498. [PMID: 33435410 PMCID: PMC7827037 DOI: 10.3390/ijerph18020498] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
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.
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Canepa P, Sbragi A, Saino F, Biggio M, Bove M, Bisio A. Thinking Before Doing: A Pilot Study on the Application of Motor Imagery as a Learning Method During Physical Education Lesson in High School. Front Sports Act Living 2020; 2:550744. [PMID: 33345114 PMCID: PMC7739805 DOI: 10.3389/fspor.2020.550744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022] Open
Abstract
Motor imagery (MI), i. e., the mental simulation of an action without its actual execution, is a promising technique to boost motor learning via physical practice in rehabilitation, sport, and educational fields. The purpose of the present pilot study was to test the feasibility and the effectiveness of the application of MI as learning methodology place alongside conventional teaching technique as employed for physical education lessons. Thirty-three high school students from two classes were enrolled for instruction in the underhand serve in volleyball. One group, the motor imagery group (MIG) carried out the physical exercise along with the kinesthetic MI of the action, while the other group (the control group) was limited to the merely physical exercise. The training period lasted 8 weeks. MI duration and the duration of real movement (ME), the isochrony index (differences between real and imagined movements duration), and the number of balls which passed over the net (NBN) were evaluated before and after training. Results showed a significant improvement in the isochrony index for the MIG group exclusively; namely, MI duration became more similar to ME duration. Moreover, in MIG a significantly negative relationship appeared between the percentage change in the isochrony index and the difference between NBN before and after training. These findings suggest improvement in sensorimotor representation of the action, which lies at the basis of enhanced motor performance. The present study constitutes initial proof of concept on the application of MI as learning technique applicable to physical education lesson at high school.
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Affiliation(s)
- Patrizio Canepa
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Antonella Sbragi
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
| | - Filippo Saino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
| | - Monica Biggio
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
| | - Marco Bove
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino, Istituto di Ricovero e Cura a Carattere Scientifico, Genova, Italy
| | - Ambra Bisio
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Genoa, Italy
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Soler B, Ramari C, Valet M, Dalgas U, Feys P. Clinical assessment, management, and rehabilitation of walking impairment in MS: an expert review. Expert Rev Neurother 2020; 20:875-886. [PMID: 32729742 DOI: 10.1080/14737175.2020.1801425] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION One of the most common and life-altering consequences of Multiple Sclerosis (MS) is walking impairment. The distance, speed, and Gait pattern functions are components of the International Classification of Functioning, Disability, and Health (ICF) and are also predictors of dependency in terms of daily living activities in patients with MS (pwMS). AREAS COVERED This article provides an overview of walking impairment in pwMS, with focus on the assessment of gait and the rehabilitation approaches. EXPERT OPINION The authors recommend that pwMS undergo gait assessment integrating the ICF perspective using validated clinical outcome measures that cover spatiotemporal gait parameters. Moreover, assessment of walking speed with short walking capacity tests such as the timed 25-foot walk (T25FW) or the 10-m walk test (10 MWT) and tests for walking distance with middle distance tests such as the 2-min walk test (2MWT) and the 6-min walk test (6MWT). This review further highlights strategies that may restore walking function including pharmacological symptomatic treatment and non-pharmacological rehabilitation approaches such as exercise and task-specific training providing an appraisal of mobility targeted therapies to be considered when planning multidisciplinary comprehensive-care of pwMS. Finally, new and novel strategies such as motor imagery and rhythmic auditory stimulation have been developed to improve walking speed and distance in pwMS.
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Affiliation(s)
- Bernardita Soler
- Neurology Service, Hospital Doctor Sótero Del Río , Santiago, Chile.,Neurology Department, Pontificia Universidad Católica De Chile , Santiago, Chile
| | - Cintia Ramari
- Faculty of Physical Education, University of Brasília , Brasília, Brazil
| | - Maxime Valet
- Cliniques universitaires Saint-Luc, Service de Médecine Physique et Réadaptation , Brussels, Belgium.,Université catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuromusculoskeletal lab (NMSK) , Brussels, Belgium
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University , Aarhus, Denmark
| | - Peter Feys
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University , Hasselt, Belgium
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