Development and Validation of the Combined Action Observation and Motor Imagery Ability Questionnaire

Combined use of action observation and motor imagery (AOMI) is an increasingly popular motor-simulation intervention, which involves observing movements on video while simultaneously imagining the feeling of movement execution. Measuring and reporting participant imagery-ability characteristics are essential in motor-simulation research, but no measure of AOMI ability currently exists. Accordingly, the AOMI Ability Questionnaire (AOMI-AQ) was developed to address this gap in the literature. In Study 1, two hundred eleven participants completed the AOMI-AQ and the kinesthetic imagery subscales of the Movement Imagery Questionnaire-3 and Vividness of Motor Imagery Questionnaire-2. Following exploratory factor analysis, an 8-item AOMI-AQ was found to correlate positively with existing motor-imagery measures. In Study 2, one hundred seventy-four participants completed the AOMI-AQ for a second time after a period of 7-10 days. Results indicate a good test-retest reliability for the AOMI-AQ. The new AOMI-AQ measure provides a valid and reliable tool for researchers and practitioners wishing to assess AOMI ability.

Towards efficient motor imagery interventions after lower-limb amputation

BACKGROUND

The therapeutic benefits of motor imagery (MI) are now well-established in different populations of persons suffering from central nervous system impairments. However, research on similar efficacy of MI interventions after amputation remains scarce, and experimental studies were primarily designed to explore the effects of MI after upper-limb amputations.

OBJECTIVES

The present comparative study therefore aimed to assess the effects of MI on locomotion recovery following unilateral lower-limb amputation.

METHODS

Nineteen participants were assigned either to a MI group (n = 9) or a control group (n = 10). In addition to the course of physical therapy, they respectively performed 10 min per day of locomotor MI training or neutral cognitive exercises, five days per week. Participants' locomotion functions were assessed through two functional tasks: 10 m walking and the Timed Up and Go Test. Force of the amputated limb and functional level score reflecting the required assistance for walking were also measured. Evaluations were scheduled at the arrival at the rehabilitation center (right after amputation), after prosthesis fitting (three weeks later), and at the end of the rehabilitation program. A retention test was also programed after 6 weeks.

RESULTS

While there was no additional effect of MI on pain management, data revealed an early positive impact of MI for the 10 m walking task during the pre-prosthetic phase, and greater performance during the Timed Up and Go Test during the prosthetic phase. Also, a lower proportion of participants still needed a walking aid after MI training. Finally, the force of the amputated limb was greater at the end of rehabilitation for the MI group.

CONCLUSION

Taken together, these data support the integration of MI within the course of physical therapy in persons suffering from lower-limb amputations.

Motor imagery, forward models and the cerebellum: a commentary on Rieger et al., 2023

In this commentary on Rieger et al., Psychological Research Psychologische Forschung, 2023, I discuss possible ways to test the hypothesis that action imagery is achieved by simulations of actions through an internal forward model. These include brain imaging, perturbation through TMS, and psychophysical tests of adaptation of intended reach actions.

Cortical Reorganization after Limb Loss: Bridging the Gap between Basic Science and Clinical Recovery

Despite the increasing incidence and prevalence of amputation across the globe, individuals with acquired limb loss continue to struggle with functional recovery and chronic pain. A more complete understanding of the motor and sensory remodeling of the peripheral and central nervous system that occurs postamputation may help advance clinical interventions to improve the quality of life for individuals with acquired limb loss. The purpose of this article is to first provide background clinical context on individuals with acquired limb loss and then to provide a comprehensive review of the known motor and sensory neural adaptations from both animal models and human clinical trials. Finally, the article bridges the gap between basic science researchers and clinicians that treat individuals with limb loss by explaining how current clinical treatments may restore function and modulate phantom limb pain using the underlying neural adaptations described above. This review should encourage the further development of novel treatments with known neurological targets to improve the recovery of individuals postamputation.Significance Statement In the United States, 1.6 million people live with limb loss; this number is expected to more than double by 2050. Improved surgical procedures enhance recovery, and new prosthetics and neural interfaces can replace missing limbs with those that communicate bidirectionally with the brain. These advances have been fairly successful, but still most patients experience persistent problems like phantom limb pain, and others discontinue prostheses instead of learning to use them daily. These problematic patient outcomes may be due in part to the lack of consensus among basic and clinical researchers regarding the plasticity mechanisms that occur in the brain after amputation injuries. Here we review results from clinical and animal model studies to bridge this clinical-basic science gap.

Motor imagery ability in baseball players with throwing yips

The motor imagery ability is closely related to an individual's motor performance in sports. However, whether motor imagery ability is diminished in athletes with yips, in whom motor performance is impaired, is unclear. Therefore, this cross-sectional study aimed to determine whether general motor imagery ability or vividness of motor imagery specific to throwing motion is impaired in baseball players with throwing yips. The study enrolled 114 college baseball players. They were classified into three groups: 33 players in the yips group, 26 in the recovered group (previously had yips symptoms but had resolved them), and 55 in the control group. They answered the revised version of the vividness of movement imagery questionnaire (VMIQ-2), which assesses general motor imagery ability. Furthermore, they completed a questionnaire that assesses both positive and negative motor imagery vividness specific to baseball throwing. In the former, they responded to their ability to vividly imagine accurately throwing a controlled ball, whereas in the latter, they responded to the vividness of their experience of negative motor imagery associated with baseball throwing, specifically the image of a wild throw. No significant difference in the VMIQ-2 was found among the three groups. While no significant difference in the vividness of positive motor imagery for ball throwing was found in either first-person visual or kinesthetic perspectives among the three groups, the yips group exhibited significantly higher vividness of negative motor imagery than the control group in both perspectives. These results indicate that negative motor imagery specific to baseball throwing may be associated with symptoms of yips. Therefore, interventions addressing psychological aspects, such as anxiety, which are potential causes of the generation of negative motor imagery, may be necessary to alleviate the symptoms of yips.

Cortical activation during imagined walking for people with lower limb loss: a pilot study

Each year in Canada, a substantial number of adults undergo limb amputation, with lower limb amputation (LLA) the most prevalent. Enhancing walking ability is crucial for optimizing rehabilitation outcomes, promoting participation, and facilitating community reintegration. Overcoming challenges during the acute post-amputation phase and sub-acute rehabilitation necessitates alternative approaches, such as motor imagery and mental practice, to maximize rehabilitation success. However, the current evidence on activation patterns using motor imagery in individuals with LLA is limited. The primary objective was to assess the feasibility of observing brain activation during imagined walking in individuals with LLA utilizing 3T functional magnetic resonance imaging (fMRI). Eight individuals with LLA and 11 control subjects participated. Consistent with representations of the lower limbs, both control and amputee groups demonstrated bilateral activation in the medial surface of the primary motor and somatosensory cortices. However, individuals with lower limb amputations exhibited significantly greater activation during imagined walking, particularly in frontal regions and the medial surface of the primary motor and supplementary motor cortices. Furthermore, the volume of activation in the bilateral primary motor cortices was higher for participants with amputations compared to controls. The protocol developed in this study establishes a foundation for evaluating the effects of a gait training program that incorporates mental imagery alongside conventional rehabilitation practices, in contrast to standard care alone. This pilot investigation holds potential to enhance our understanding of brain plasticity in individuals with LLA and pave the way for more effective rehabilitation strategies to optimize functional recovery and community reintegration.

Interference of unilateral lower limb amputation on motor imagery rhythm and remodeling of sensorimotor areas

Purpose

The effect of sensorimotor stripping on neuroplasticity and motor imagery capacity is unknown, and the physiological mechanisms of post-amputation phantom limb pain (PLP) illness remain to be investigated.

Materials and methods

In this study, an electroencephalogram (EEG)-based event-related (de)synchronization (ERD/ERS) analysis was conducted using a bilateral lower limb motor imagery (MI) paradigm. The differences in the execution of motor imagery tasks between left lower limb amputations and healthy controls were explored, and a correlation analysis was calculated between level of phantom limb pain and ERD/ERS.

Results

The multiple frequency bands showed a significant ERD phenomenon when the healthy control group performed the motor imagery task, whereas amputees showed significant ERS phenomena in mu band. Phantom limb pain in amputees was negatively correlated with bilateral sensorimotor areas electrode powers.

Conclusion

Sensorimotor abnormalities reduce neural activity in the sensorimotor cortex, while the motor imagination of the intact limb is diminished. In addition, phantom limb pain may lead to over-activation of sensorimotor areas, affecting bilateral sensorimotor area remodeling.

Effect of skill proficiency on motor imagery ability between amateur dancers and non-dancers

Evidence has shown that athletes with high motor skill proficiency possess higher motor imagery ability than those with low motor skill proficiency. However, less is known whether this superiority in motor imagery ability emerges over amateur athletes. To address the issue, the present study aimed to investigate the individual differences in motor imagery ability between amateur dancers and non-dancers. Forty participants completed a novel dance movement reproduction task and measures of the vividness of visual imagery questionnaire (VVIQ) and the vividness of motor imagery questionnaire (VMIQ). The results showed that, relative to non-dancers, amateur dancers had higher ability of motor imagery to reproduce the lower-limb and upper-limb dance movements during the dance movement reproduction task. Besides, amateur dancers displayed higher abilities of the visual motor imagery and the kinesthetic imagery, but comparable visual imagery ability as the non-dancers. These findings suggest that the mental representation of motors but not the visual is affected by the motor skill levels, due to the motor imagery practice in sports amateurs.

The effects of body position and actual execution on motor imagery of locomotor tasks in people with a lower-limb amputation

Motor imagery (MI) is usually facilitated when performed in a congruent body position to the imagined movement, as well as after actual execution (AE). A lower-limb amputation (LLA) results in important structural and functional changes in the sensorimotor system, which can alter MI. In this study, we investigated the effects of body position and AE on the temporal characteristics of MI in people with LLA. Ten participants with LLA (mean age = 59.6 ± 13.9 years, four females) and ten gender- and age-matched healthy control participants (mean age = 60.1 ± 15.4 years, four females) were included. They performed two locomotor-related tasks (a walking task and the Timed Up and Go task) while MI times were measured in different conditions (in congruent/incongruent positions and before/after AE). We showed that MI times were significantly shorter when participants imagined walking in a congruent-standing position compared to an incongruent-sitting position, and when performing MI after actual walking compared to before, in both groups. Shorter MI times in the congruent position and after AE suggest an improvement of MI’s temporal accuracy (i.e. the ability to match AE time during MI) in healthy individuals but not in the LLA group.

Motor imagery and action observation following immobilization-induced hypoactivity: a narrative review

BACKGROUND

In sports, the risk of pathology or event that leads to an injury, a cessation of practice or even to an immobilization is high. The subsequent reduction of physical activity, or hypoactivity, induces neural and muscular changes that adversely affect motor skills and functional motor rehabilitation. Because the implementation of physical practice is difficult, if not impossible, during and immediately following injury or immobilization, complementary techniques have been proposed to minimize the deleterious impact of hypoactivity on neuromuscular function.

OBJECTIVE

The current narrative review aimed to discuss the contributions of motor imagery and action observation, which enhance motor (re)learning and induce neural adaptations in both healthy individuals and injured athletes.

METHODS

Online literature research for studies of the effects of motor imagery, action observation and their combination on hypoactivity, extracting relevant publications within the last decade (2009-2020).

RESULTS

From published studies and the authors' knowledge of both motor imagery and action observation, some elements are provided for developing applied protocols during and after the immobilization period. Such interventions consist of associating congruent action observation with kinesthetic motor imagery of different movements, organized in increasing difficulty. The aim is to maintain motor functions and promote motor relearning by activating sensorimotor cortical areas and corticomotor pathways of the injured effector.

CONCLUSION

This narrative review supports the implementation of combined motor imagery and action observation protocols in the context of sports rehabilitation.

The acts of opening and closing the eyes are of importance for congenital blindness: Evidence from resting-state fMRI

Volitional eye closure is observed only in conscious and awake humans, and is rare in animals. It is believed that eye closure can focus one's attention inward and facilitate activities such as meditation and mental imagery. Congenital blind individuals are also required to close their eyes for these activities. Resting-state functional magnetic resonance imaging (RS-fMRI) studies have found robust differences between the eyes-closed (EC) and eyes-open (EO) conditions in some brain regions in the sighted. This study analyzed data from 21 congenital blind individuals and 21 sighted controls by using amplitude of low-frequency fluctuation (ALFF) of RS-fMRI. The blind group and the sighted group shared similar pattern of differences between the EC and EO condition: ALFF was higher in the EC condition than the EO condition in the bilateral primary sensorimotor cortex, bilateral supplementary motor area, and inferior occipital cortex, while ALFF was lower in the EC condition than the EO condition in the medial prefrontal cortex, highlighting the "nature" effect on the difference between the EC and EO conditions. The results of other matrices such as fractional ALFF (fALFF) and regional homogeneity (ReHo) showed similar patterns to that of ALFF. Moreover, no significant difference was observed between the EC-EO pattern of the two subgroups of congenital blind (i.e., with and without light perception), suggesting that the EC-EO difference is irrespective of residual light perception which reinforced the "nature" effect. We also found between-group differences, i.e., more probably "nurture effect", in the posterior insula and fusiform. Our results suggest that the acts of closing and opening the eyes are of importance for the congenital blind, and that these actions and their differences might be inherent in the nature of humans.

The effects of visual impairment on motor imagery in children and adolescents

BACKGROUND

While the development of motor imagery (MI) has been extensively studied in sighted children, it is not clear how children with different severities of visual impairment (VI) represent motor actions by using the motor representations constructed through the remaining intact senses, especially touch.

AIMS

Mental chronometry and generation/manipulation of MI were examined in children with and without VI.

METHODS AND PROCEDURES

Participants included 64 youth with and without VI (33 without visual impairments, 14 moderate-to-severe, and 17 blind). Mental chronometry was assessed with the imagined Timed-Up-and-Go-Test (iTUG), and generation/manipulation of MI with the Controllability-of-Motor-Imagery-Test (CMI). In addition, the effect of working memory performance (Letter-Number-Sequencing) and physical activity upon MI were evaluated.

RESULTS

Mental duration for the iTUG was significantly shorter than the active durations. Results also provided evidence of better haptic representation than motor representation in all participants; however, only for the CMI-regeneration condition controls outperformed children with visual impairments and blindness (CVIB). Exercise and working memory performance showed a significant contribution only on a few MI tests.

CONCLUSION AND IMPLICATIONS

Our results suggest a possible relationship between motor performance, body representation deficits and visual impairment which needs to be addressed in the evaluation and treatment of CVIB. The design of new rehabilitation interventions that focus on strengthening adequate body perception and representation should be proposed and tested to promote motor development in CVIB.

Clinical evaluation of the revolutionizing prosthetics modular prosthetic limb system for upper extremity amputees

Individuals with upper extremity (UE) amputation abandon prostheses due to challenges with significant device weight-particularly among myoelectric prostheses-and limited device dexterity, durability, and reliability among both myoelectric and body-powered prostheses. The Modular Prosthetic Limb (MPL) system couples an advanced UE prosthesis with a pattern recognition paradigm for intuitive, non-invasive prosthetic control. Pattern recognition accuracy and functional assessment-Box & Blocks (BB), Jebsen-Taylor Hand Function Test (JHFT), and Assessment of Capacity for Myoelectric Control (ACMC)-scores comprised the main outcomes. 10 participants were included in analyses, including seven individuals with traumatic amputation, two individuals with congenital limb absence, and one with amputation secondary to malignancy. The average (SD) time since limb loss, excluding congenital participants, was 85.9 (59.5) months. Participants controlled an average of eight motion classes compared to three with their conventional prostheses. All participants made continuous improvements in motion classifier accuracy, pathway completion efficiency, and MPL manipulation. BB and JHFT improvements were not statistically significant. ACMC performance improved for all participants, with mean (SD) scores of 162.6 (105.3), 213.4 (196.2), and 383.2 (154.3), p = 0.02 between the baseline, midpoint, and exit assessments, respectively. Feedback included lengthening the training period to further improve motion classifier accuracy and MPL control. The MPL has potential to restore functionality to individuals with acquired or congenital UE loss.

Effects of Different Ratios of Physical and Mental Practice on Postural Control Improvement

Mental practice (MP) is a reliable alternative or complement to physical practice (PP) for the training of postural control. We address how MP should ideally be combined with PP. Participants were assigned to four experimental groups where MP/PP ratios during training varied from 0 to 100%. Performance improved only for demanding postural adjustments, regardless of MP/PP ratio, and learning was partially consolidated after a night of sleep. Findings reinforce the relevance of MP for the training of weight shifting and further suggest that MP alone can be as efficient as PP for the learning of certain complex postural adjustments.

Clinical assessment of motor imagery and physical function in mild stroke patients

[Purpose] The aim of this study was to clarify whether the motor imagery of walking and physical function are related in mild hemiplegic stroke patients. [Participants and Methods] Sixteen mild hemiplegic stroke patients were included in this study. We evaluated motor imagery with a 10-m walking, the estimation error and the kinesthetic and visual imagery questionnaire. Physical function was evaluated with the actual 10-m walk test time, Brunnstrom recovery stage, stroke impairment assessment set, and functional independent measure. The correlation coefficient was calculated using Spearman’s correlation coefficient for all evaluation methods. [Results] The 10-m walking motor imagery took an average of 23.36 ± 22.14 s. The actual 10-m walk test averaged 24.87 ± 21.41 s. The 10-m walking motor imagery and the 10-m walking speed were significantly correlated. There was a significant correlation between the 10-m walking motor imagery and the Brunnstrom recovery stage, stroke impairment assessment set, and functional independent measure. There were no significant correlations between the estimation error and all the assessments. [Conclusion] These results show that the motor imagery of walking is related to physical function in mild hemiplegic stroke patients.

Thumbs up: Imagined hand movements counteract the adverse effects of post-surgical hand immobilization. Clinical, behavioral, and fMRI longitudinal observations

Motor imagery (M.I.) training has been widely used to enhance motor behavior. To characterize the neural foundations of its rehabilitative effects in a pathological population we studied twenty-two patients with rhizarthrosis, a chronic degenerative articular disease in which thumb-to-fingers opposition becomes difficult due to increasing pain while the brain is typically intact. Before and after surgery, patients underwent behavioral tests to measure pain and motor performance and fMRI measurements of brain motor activity.

After surgery, the affected hand was immobilized, and patients were enrolled in a M.I. training. The sample was split in those who had a high compliance with the program of scheduled exercises (T+, average compliance: 84%) and those with low compliance (T−, average compliance: 20%; cut-off point: 55%). We found that more intense M.I. training counteracts the adverse effects of immobilization reducing pain and expediting motor recovery. fMRI data from the post-surgery session showed that T+ patients had decreased brain activation in the premotor cortex and the supplementary motor area (SMA); meanwhile, for the same movements, the T− patients exhibited a reversed pattern. Furthermore, in the post-surgery fMRI session, pain intensity was correlated with activity in the ipsilateral precentral gyrus and, notably, in the insular cortex, a node of the pain matrix.

These findings indicate that the motor simulations of M.I. have a facilitative effect on recovery by cortical plasticity mechanisms and optimization of motor control, thereby establishing the rationale for incorporating the systematic use of M.I. into standard rehabilitation for the management of post-immobilization syndromes characteristic of hand surgery.

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Motor imagery training counteracts the effects of post-surgical hand immobilization.

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It also reduces pain and expedites motor recovery after immobilization.

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These effects were accompanied by significant fMRI signs of brain plasticity.

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The clinical-fMRI evidence advocates for the use of motor imagery in rehabilitation.

Descriptive pilot study of vividness and temporal equivalence during motor imagery training after quadriplegia

BACKGROUND

Motor imagery (MI) training is often used to improve physical practice (PP), and the functional equivalence between imagined and practiced movements is widely considered essential for positive training outcomes.

OBJECTIVE

We previously showed that a 5-week MI training program improved tenodesis grasp in individuals with C6-C7 quadriplegia. Here we investigated whether functional equivalence changed during the course of this training program.

METHODS

In this descriptive pilot study, we retrospectively analyzed data for 6 individuals with C6-C7 quadriplegia (spinal cord injured [SCI]) and 6 healthy age-matched controls who trained for 5 weeks in visual and kinesthetic motor imagery or visualization of geometric shapes (controls). Before training, we assessed MI ability by using the Kinesthetic and Visual Imagery Questionnaire (KVIQ). We analyzed functional equivalence by vividness measured on a visual analog scale (0-100) and MI/PP time ratios computed from imagined and physically practiced movement durations measured during MI training. These analyses were re-run considering that half of the participants with quadriplegia were good imagers and the other half were poor imagers based on KVIQ scores. To investigate generalization of training effects, we analyzed MI/PP ratios for an untrained pointing task before (3 baseline measures), immediately after, and 2 months after training.

RESULTS

During MI training, imagery vividness increased significantly. Only the good imagers evolved toward temporal equivalence during training. Good imagers were also the only participants who showed changes in temporal equivalence on the untrained pointing task.

CONCLUSION

This is the first study reporting improvement in functional equivalence during an MI training program that improved tenodesis grasp in individuals with C6-C7 quadriplegia. We recommend that clinical MI programs focus primarily on vividness and suggest that feedback about movement duration could potentially improve temporal equivalence, which could in turn lead to further improvement in PP.

Comparative Effects of Auditory Electromyographic Biofeedback for Participants Who Are Blind and Sighted

This study examined differences in auditory electromyographic biofeedback (AEB) effects between participants who were sighted and blind. Past research makes clear that AEB is effective for people who are blind, particularly because of their reported superiority in auditory processing, but no study has directly compared AEB efficacy between participants who are sighted and blind. A total of 11 participants who were sighted and 10 who were blind performed a motor task requiring 20 nonfatiguing muscle contractions at 20% maximal voluntary contraction (MVC) with or without AEB. AEB reduced the error (calculated as the absolute difference of two consecutive contractions) among both participant groups, and the error for the group without biofeedback was greater for the participants who were blind than that for the sighted participants (5.20% ± 2.05% MVC and 3.30% ± 1.26% MVC, respectively; p < .05). This finding was consistent with subjective rating data, also indicating a trend toward greater difficulty for participants who were blind when performing without biofeedback. Moreover, the AEB/no biofeedback condition showed fewer errors for the participants who were blind than for the participants who were sighted during the last part of the task ( p = .036), indicating that participants who were blind were better at maintaining the AEB effect. These data suggest that the poor motor performance of participants who were blind was greatly improved with AEB, suggesting important applications of AEB for assistive technologies, adapted sports, and activities of daily living.

The Effect of Prosthesis Use on Hand Mental Rotation After Unilateral Upper-Limb Amputation

Amputation of a limb induces changes in the so-called body schema, which might be influenced by the use of prosthetic devices. Changes in the body representation associated with prosthesis use could be investigated using a hand mental rotation task. However, direct neurophysiologic evidence for the effect of prosthesis use on hand mental rotation is still lacking. In this paper, we recruited two groups of unilateral upper-limb amputees, i.e., amputees using a prosthesis or with a history of prosthesis use (Pro group) and amputees without a prosthesis (non-Pro group), as well as a sample of matched healthy controls. Using concurrent behavioral and electrophysiological assessments, we found that Pro amputees were comparable to healthy controls in either behavior or event-related potentials (ERPs), while non-Pro amputees showed prolonged response time as well as divergent ERP patterns. The P200 amplitude of non-Pro amputees was significantly larger for the non-dominant hand pictures than that for the dominant hand pictures, while such a hand difference in P200 was not found in either healthy controls or Pro amputees. Furthermore, the typical angular modulation of the N200 amplitude in healthy controls and Pro amputees was not presented in non-Pro amputees. Our results suggest that prosthesis use could preserve mental rotation ability by maintaining the performance of motor imagery and visual perception of hands, which represents a preservation of the body schema.

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.

Altered microstructure rather than morphology in the corpus callosum after lower limb amputation

The corpus callosum (CC) has been implicated in the reorganization of the brain following amputation. However, it is unclear which regions of the CC are involved in this process. In this study, we explored the morphometric and microstructural changes in CC subregions in patients with unilateral lower limb amputation. Thirty-eight patients and 38 age- and gender-matched normal controls were included. The CC was divided into five regions, and the area, thickness and diffusion parameters of each region were investigated. While morphometric analysis showed no significant differences between the two groups, amputees showed significant higher values in axial diffusivity, radial diffusivity and mean diffusivity in region II of the CC, which connects the bilateral premotor and supplementary motor areas. In contrast, the mean fractional anisotropy value of the fibers generated by these cortical areas, as measured by tractography, was significantly smaller in amputees. These results demonstrate that the interhemispheric pathways contributing to motor coordination and imagery are reorganized in lower limb amputees.

Sensorimotor dysfunction after limb fracture - An exploratory study

BACKGROUND

Chronic pain is often associated with sensorimotor dysfunction but little is known about the early impact of limb fracture on sensory and motor performance. This exploratory study sought to assess these changes in patients with recent wrist and ankle fractures. A secondary aim was to determine the incidence of Complex Regional Pain Syndrome (CRPS) and its clinical features.

METHODS

Fifty-three patients at a UK fracture centre underwent Quantitative Sensory Testing (QST), Motor Imagery (MI) and Body Perception Disturbance (BPD) assessments ≤5 weeks post-fracture (Time 1). Subjective evaluation of recovery and clinical examination for CRPS was conducted 5 weeks later (Time 2, 50 patients). Patient-reported outcomes of pain, psychological distress and limb function were collected at Times 1 and 2, and 6 months after T1 (Time 3, 36 patients, postal questionnaire).

RESULTS

Quantitative sensory testing at Time 1 demonstrated cold and pressure-pain hyperalgesia in the fractured limb compared to the non-fractured side (p < 0.05). Imagined movements were reported as significantly more difficult to perform on the fractured side (p < 0.001). There was evidence of BPD in the fractured limb, similar to that found in CRPS. The incidence of CRPS was 9.4%; however, individual signs and symptoms of the condition were commonly present (70% reported ≥ one symptom). Only 33% of patients reported to being 'back to normal' 6 months after fracture with 34% reporting ongoing pain.

CONCLUSIONS

Limb fracture is associated with changes in pain perceptions, motor planning, and disruption to body perception. Signs and symptoms of CRPS, ongoing pain and delayed recovery post-fracture are common. WHAT DOES THIS STUDY ADD?: In the immediate post-fracture period: Body perception disturbance is reported in the fractured limb. Imagined movements of the fractured limb are less vivid and associated with pain This study contributes to the incidence literature on CRPS.

Rhythmic cued motor imagery and walking in people with multiple sclerosis: a randomised controlled feasibility study

BACKGROUND

Novel physiotherapy approaches such as motor imagery and rhythmic auditory stimulation have been shown to improve walking in people with multiple sclerosis (MS). Rhythmic cued motor imagery was used in this study, whose objectives were to evaluate the feasibility of a larger randomised controlled trial (RCT) in people with MS and to obtain information on walking.

METHODS

Thirty adult people with MS who scored 1.5-4.5 on the Expanded Disability Status Scale were recruited at the MS Clinic Innsbruck, Austria. Participants were randomly allocated to one of three groups, all receiving usual care: 17 min of motor imagery, six times per week, for 4 weeks, with music (A) or metronome cues (B) and (C) controls. Primary outcomes were recruitment rates, retention, compliance, adverse events and fatigue (Modified Fatigue Impact Scale). Secondary outcomes were walking speed (Timed 25-Foot Walk) and walking distance (6-Minute Walk Test).

RESULTS

We achieved our recruitment target by recruiting 12 participants per month, a mean eligibility rate of 40.1 % (95 % confidence interval (CI) 35.8, 44.6 %) out of 2500 MS Centre patients, mean consent rate of 15.9 % (95 % CI 11.3, 21.7 %) plus 54.5 % (95 % CI 47.4, 61.4 %) of eligible patients who expressed their interest to participate. Retention of 100 %, no adverse events, good compliance, high acceptability of the interventions and no worsening of fatigue confirmed feasibility. The mean improvement in walking speed in both groups A and B was -0.9 s (95 % CI -1.3, -0.5), and mean worsening in group C was 0.4 s (95 % CI -0.3, 1.1). The mean improvement in walking distance in group A was 68.1 m (95 % CI 51.4, 84.7) and in group B 92.9 m (95 % CI 55.2, 130.5), and mean worsening in group C was -9.4 m (95 % CI -35.6, 16.9).

CONCLUSIONS

Results from our study showed that a full-scale RCT is feasible to investigate the effects of rhythmic cued motor imagery on walking in people with MS, with no changes to the interventions and assessments. Based on the walking improvements, a total sample size of 138 participants was calculated. Stratified blocked randomisation, allocation concealment and blinding will be used in the main study.

TRIAL REGISTRATION

ISRCTN: ISRCTN67054113.

Effect of task-specific execution on accuracy of imagined aiming movements

Ideomotor theory states that the neural codes that represent action and the perceptual consequences of those actions are tightly bound in a common code. For action imagination, bound action, and perceptual codes are thought to be internally activated at a sub-threshold level through action simulation. In support of this hypothesis, previous research revealed that imagined movement times (MTs) for reciprocal aiming movements were closer to actual execution MTs after the participants gained experience executing the task. The current study examined the task-specific nature of the effects of experience on imagination by determining if improvements in accuracy in the imagination of reciprocal aiming movements occur only with experience of the reciprocal aiming task or with any aiming task. To this end, one group of participants executed a reciprocal pointing task, whereas a second group executed a discrete aiming task with comparable accuracy requirements before and after imagining reciprocal aiming movements. Influence of task specificity on imagination was assessed by evaluating the changes in imagined MTs before and after execution. Consistent with previous findings, there was a reduction in imagined MTs following task execution. Critically, there was a significant time by group interaction revealing a significant pre/post reduction in imagined MTs for the group that executed the reciprocal aiming movements, but not for the group that executed the discrete aiming movements. These data support ideomotor accounts of action imagination because it appears that the imagination of a movement is affected by task-specific experience with that movement.

Laterality of brain activity during motor imagery is modulated by the provision of source level neurofeedback

Motor imagery (MI) may be effective as an adjunct to physical practice for motor skill acquisition. For example, MI is emerging as an effective treatment in stroke neurorehabilitation. As in physical practice, the repetitive activation of neural pathways during MI can drive short- and long-term brain changes that underlie functional recovery. However, the lack of feedback about MI performance may be a factor limiting its effectiveness. The provision of feedback about MI-related brain activity may overcome this limitation by providing the opportunity for individuals to monitor their own performance of this endogenous process. We completed a controlled study to isolate neurofeedback as the factor driving changes in MI-related brain activity across repeated sessions. Eighteen healthy participants took part in 3 sessions comprised of both actual and imagined performance of a button press task. During MI, participants in the neurofeedback group received source level feedback based on activity from the left and right sensorimotor cortex obtained using magnetoencephalography. Participants in the control group received no neurofeedback. MI-related brain activity increased in the sensorimotor cortex contralateral to the imagined movement across sessions in the neurofeedback group, but not in controls. Task performance improved across sessions but did not differ between groups. Our results indicate that the provision of neurofeedback during MI allows healthy individuals to modulate regional brain activity. This finding has the potential to improve the effectiveness of MI as a tool in neurorehabilitation.

Training the motor cortex by observing the actions of others during immobilization

Limb immobilization and nonuse are well-known causes of corticomotor depression. While physical training can drive the recovery from nonuse-dependent corticomotor effects, it remains unclear if it is possible to gain access to motor cortex in alternative ways, such as through motor imagery (MI) or action observation (AO). Transcranial magnetic stimulation was used to study the excitability of the hand left motor cortex in normal subjects immediately before and after 10 h of right arm immobilization. During immobilization, subjects were requested either to imagine to act with their constrained limb or to observe hand actions performed by other individuals. A third group of control subjects watched a nature documentary presented on a computer screen. Hand corticomotor maps and recruitment curves reliably showed that AO, but not MI, prevented the corticomotor depression induced by immobilization. Our results demonstrate the existence of a visuomotor mechanism in humans that links AO and execution which is able to effect cortical plasticity in a beneficial way. This facilitation was not related to the action simulation, because it was not induced by explicit MI.

Using a motor imagery questionnaire to estimate the performance of a Brain-Computer Interface based on object oriented motor imagery

OBJECTIVES

The primary objective was to test whether motor imagery (MI) questionnaires can be used to detect BCI 'illiterate'. The second objective was to test how different MI paradigms, with and without the physical presence of the goal of an action, influence a BCI classifier.

METHODS

Kinaesthetic (KI) and visual (VI) motor imagery questionnaires were administered to 30 healthy volunteers. Their EEG was recorded during a cue-based, simple imagery (SI) and goal oriented imagery (GOI).

RESULTS

The strongest correlation (Pearson r(2)=0.53, p=1.6e-5) was found between KI and SI, followed by a moderate correlation between KI and GOI (r(2)=0.33, p=0.001) and a weak correlation between VI and SI (r(2)=0.21, p=0.022) and VI and GOI (r(2)=0.17, p=0.05). Classification accuracy was similar for SI (71.1 ± 7.8%) and GOI (70.5 ± 5.9%) though corresponding classification features differed in 70% participants. Compared to SI, GOI improved the classification accuracy in 'poor' imagers while reducing the classification accuracy in 'very good' imagers.

CONCLUSION

The KI score could potentially be a useful tool to predict the performance of a MI based BCI. The physical presence of the object of an action facilitates motor imagination in 'poor' able-bodied imagers.

SIGNIFICANCE

Although this study shows results on able-bodied people, its general conclusions should be transferable to BCI based on MI for assisted rehabilitation of the upper extremities in patients.

Neuroplasticity and functional recovery in multiple sclerosis

The development of therapeutic strategies that promote functional recovery is a major goal of multiple sclerosis (MS) research. Neuroscientific and methodological advances have improved our understanding of the brain's recovery from damage, generating novel hypotheses about potential targets and modes of intervention, and laying the foundation for development of scientifically informed recovery-promoting strategies in interventional studies. This Review aims to encourage the transition from characterization of recovery mechanisms to development of strategies that promote recovery in MS. We discuss current evidence for functional reorganization that underlies recovery and its implications for development of new recovery-oriented strategies in MS. Promotion of functional recovery requires an improved understanding of recovery mechanisms that can be modulated by interventions and the development of robust measurements of therapeutic effects. As imaging methods can be used to measure functional and structural alterations associated with recovery, this Review discusses their use to obtain reliable markers of the effects of interventions.

Motor imagery in stroke patients, or plegic patients with spinal cord or peripheral diseases

OBJECTIVES

When motor imagery (MI) is impaired in stroke patients, it is not clear, whether this is caused by the central lesion with a disruption of networks or this may be due to inactivity/lack of practice following hemiparesis. To answer this question, we investigated MI in two groups of patients: stroke patients and patients with no central lesion, who suffered high-grade tetraparesis caused by myopathy or spinal muscular atrophy.

MATERIALS AND METHODS

The first study measured MI in 31 sub-acute and chronic stroke patients with hand paresis. We used self-assessment questionnaires [Kinaesthetic and Visual Imagery Questionnaire (KVIQ), the Vividness of Motor Imagery Questionnaire (VMIQ)] as well as a new chronometric test (mental version and normal/physical version of Box and Block Test). The second study assessed MI in 10 patients without a central lesion, but with severe tetraparesis of peripheral origin. They were incapable of performing the requested task physically.

RESULTS

MI in patients was better (i) for the third-person (VMIQ(3.P) ) compared to the first-person perspective (VMIQ(1.P) ), (ii) in patients without sensory impairment compared to those with impaired proprioception, (iii) in patients with light paresis compared to severe paresis and (iv) for the non-affected than the affected hand (KVIQ-10). Patients with severe tetraparesis were able to imagine another person's knee bends, but were not capable of imagining themselves performing knee bends.

CONCLUSIONS

MI may be hampered on the affected side in severely paretic patients, particularly in the presence of impaired proprioception. Remarkably, the second study illustrates that motor experiences shape MI. This confirms the close relationship between MI and movement execution. The study advocates the careful use of test batteries for assessment of MI when investigating mental training in clinical trials. Not all patients might benefit to the same extent from MI training. This is possibly contingent on intact proprioception and preserved MI.

Patient-centered integrated motor imagery delivered in the home with telerehabilitation to improve walking after stroke

BACKGROUND AND PURPOSE

This case report describes the clinical reasoning process used to examine a person after stroke and intervene with a novel integrated motor imagery treatment designed for the rehabilitation of walking and delivered in the home through telerehabilitation. The integrated motor imagery treatment consisted of patient-centered goal setting and physical practice combined with motor and motivational imagery.

CASE DESCRIPTION

The patient was a 38-year-old woman who had had a diffuse left subarachnoid hemorrhagic stroke 10 years earlier. She lived independently in an assisted living complex and carried a straight cane during long walks or in unfamiliar environments. Examination revealed a slow gait speed, reduced walking endurance, and decreased balance confidence. Although she was in the chronic phase, patient-centered integrated motor imagery was predicted to improve her community mobility. Treatment sessions of 45 to 60 minutes were held 3 times per week for 4 weeks. The practiced tasks included transitioning from sitting to standing, obstacle clearance, and navigation in interior and exterior environments; these tasks were first executed and then imagined at ratios of 1:5. Task execution allowed the creation of a scene based on movement observation. Imagery scenarios were customized to address the patient's goals and observed movement problems. Motivational elements of arousal, problem solving, and reward were embedded in the imagery scenarios. Half of the sessions were provided on site, and the remaining sessions were delivered remotely. Seven sessions were delivered by the clinician in the home, and 5 sessions were delivered using telerehabilitation.

OUTCOMES

Improvements in motor imagery ability, gait parameters, and balance were observed after training. Most gains were retained at the 3-month follow-up. Compared with on-site delivery, the telerehabilitation sessions resulted in less therapist travel time and cost, as well as shorter therapy sessions.

DISCUSSION

The delivery of integrated motor imagery practice for walking recovery was feasible both on site and remotely.

Practical research-based guidance for motor imagery practice in neurorehabilitation

PURPOSE

The purpose of this appraisal is to offer guidance to clinicians on applying motor imagery in neurorehabilitation and provide guidance to support this process.

METHOD

We used evidence from a variety of fields as well as clinical experience with motor imagery to develop guidance for employing motor imagery during neurorehabilitation.

RESULTS

Motor imagery is a relatively new intervention for neurorehabilitation supported by evidence from areas such as cognitive neuroscience and sports psychology. Motor imagery has become a very popular intervention modality for clinicians but there is insufficient information available on how to administer it in clinical practice and make deliberate decisions during its application.

CONCLUSIONS

We provide evidence-based guidance for employing motor imagery in neurorehabilitation and use the principles of motor learning as the framework for clinical application.

Former hand territory activity increases after amputation during intact hand movements, but is unaffected by illusory visual feedback

BACKGROUND

In healthy adults, hand movements are controlled largely by the contralateral primary motor cortex. Following amputation, however, movements of the intact hand are accompanied by increased activity in the sensorimotor cortices of both cerebral hemispheres.

OBJECTIVE

The authors tested whether use of the intact hand reactivates the cortical territory formerly devoted to the now missing hand and whether these effects can be augmented by motor imagery (MI) and/or exposure to illusory visual "feedback" (VF) of the absent hand created with a mirror.

METHODS

Functional magnetic resonance imaging (fMRI) was used to delineate the boundaries of normative sensorimotor hand representations in healthy controls. Brain activity from 11 unilateral hand amputees was recorded while they performed aurally paced thumb-finger sequencing movements with their intact hands under 4 conditions: (1) motor execution of the intact hand alone (ME), (2) ME with corresponding MI of the amputated hand, (3) ME with VF of the amputated hand, and (4) ME with MI and VF.

RESULTS

Intact hand movements increased activity specifically within the former sensorimotor hand territory during all conditions, an effect that may be attributable to decreased levels of interhemispheric inhibition and/or use-dependent functional reorganization following amputation. This effect was not significantly increased by the addition of VF and/or MI of the amputated hand. However, in amputees, MI was associated with an expansion of this ipsilateral response into parietal, premotor, and presupplementary motor areas.

CONCLUSION

Active engagement of the intact hand may be critical for therapies seeking to stimulate the former hand territory.

Reduced upper limb sensation impairs mental chronometry for motor imagery after stroke: clinical and electrophysiological findings

BACKGROUND

Motor imagery (MI) is increasingly recognized as a treatment option after stroke, but not all stroke patients are able to perform MI.

OBJECTIVE

To examine if severe somatosensory deficits would affect MI ability.

METHODS

The Box and Block Test (BBT) was used to evaluate mental chronometry as 1 component of MI. Two groups of stroke patients and an age-matched healthy control group (CG) were studied. Patient group 1 (n = 10, PG1) had a severe somatosensory impairment on the affected side and PG2 (n = 10) had pure motor strokes. All subjects first performed the BBT in a mental and in a real version. The time needed to move 15 blocks from 1 side of the box to the other was measured. To compare the groups independently of their performance level, a (real performance--MI)/(real performance) ratio was calculated. Corticospinal excitability was measured by transcranial magnetic stimulation at rest and while the subjects performed an imagined pinch grip.

RESULTS

The CG performed the BBT faster than both patient groups, and PG1 was slower than PG2. MI ability was impaired in PG1 but only for the affected hand. Transcranial magnetic stimulation data showed an abnormally low MI-induced corticospinal excitability increase for the affected hand in PG1, but not in PG2.

CONCLUSIONS

Severe somatosensory deficits impaired mental chronometry. A controlled study is necessary to clarify if these patients benefit at all from MI as an additional treatment.

Best practice for motor imagery: a systematic literature review on motor imagery training elements in five different disciplines

BACKGROUND

The literature suggests a beneficial effect of motor imagery (MI) if combined with physical practice, but detailed descriptions of MI training session (MITS) elements and temporal parameters are lacking. The aim of this review was to identify the characteristics of a successful MITS and compare these for different disciplines, MI session types, task focus, age, gender and MI modification during intervention.

METHODS

An extended systematic literature search using 24 databases was performed for five disciplines: Education, Medicine, Music, Psychology and Sports. References that described an MI intervention that focused on motor skills, performance or strength improvement were included. Information describing 17 MITS elements was extracted based on the PETTLEP (physical, environment, timing, task, learning, emotion, perspective) approach. Seven elements describing the MITS temporal parameters were calculated: study duration, intervention duration, MITS duration, total MITS count, MITS per week, MI trials per MITS and total MI training time.

RESULTS

Both independent reviewers found 96% congruity, which was tested on a random sample of 20% of all references. After selection, 133 studies reporting 141 MI interventions were included. The locations of the MITS and position of the participants during MI were task-specific. Participants received acoustic detailed MI instructions, which were mostly standardised and live. During MI practice, participants kept their eyes closed. MI training was performed from an internal perspective with a kinaesthetic mode. Changes in MI content, duration and dosage were reported in 31 MI interventions. Familiarisation sessions before the start of the MI intervention were mentioned in 17 reports. MI interventions focused with decreasing relevance on motor-, cognitive- and strength-focused tasks. Average study intervention lasted 34 days, with participants practicing MI on average three times per week for 17 minutes, with 34 MI trials. Average total MI time was 178 minutes including 13 MITS. Reporting rate varied between 25.5% and 95.5%.

CONCLUSIONS

MITS elements of successful interventions were individual, supervised and non-directed sessions, added after physical practice. Successful design characteristics were dominant in the Psychology literature, in interventions focusing on motor and strength-related tasks, in interventions with participants aged 20 to 29 years old, and in MI interventions including participants of both genders. Systematic searching of the MI literature was constrained by the lack of a defined MeSH term.

The moving phantom: motor execution or motor imagery?

Amputees who have a phantom limb often report the ability to move this phantom voluntarily. In the literature, phantom limb movements are generally considered to reflect motor imagery rather than motor execution. The aim of this study was to investigate whether amputees distinguish between executing a movement of the phantom limb and imagining moving the missing limb. We examined the capacity of 19 upper-limb amputees to execute and imagine movements of both their phantom and intact limbs. Their behaviour was compared with that of 18 age-matched normal controls. A global questionnaire-based assessment of imagery ability and timed tests showed that amputees can indeed distinguish between motor execution and motor imagery with the phantom limb, and that the former is associated with activity in stump muscles while the latter is not. Amputation reduced the speed of voluntary movements with the phantom limb but did not change the speed of imagined movements, suggesting that the absence of the limb specifically affects the ability to voluntarily move the phantom but does not change the ability to imagine moving the missing limb. These results suggest that under some conditions, for example amputation, the predicted sensory consequences of a motor command are sufficient to evoke the sensation of voluntary movement. They also suggest that the distinction between imagined and executed movements should be taken into consideration when designing research protocols to investigate the analgesic effects of sensorimotor feedback.

Motor excitability during movement imagination and movement observation in psychogenic lower limb paresis

BACKGROUND

Patients with a psychogenic paresis have difficulties performing voluntary movements. Typically, diagnostic interventions are normal. We tested whether patients with a psychogenic lower limb paresis exhibit abnormal motor excitability during motor imagery or movement observation.

METHODS

Transcranial magnetic stimulation (TMS) with single and paired pulses was used to explore motor excitability at rest, during imagination of ankle dorsiflexions and during watching another person perform ankle dorsiflexions. Results obtained in ten patients with a flaccid psychogenic leg paresis were compared with a healthy age-matched control group. In addition, results of two patients with a psychogenic fixed dystonia of the leg are presented.

RESULTS

During rest, motor excitability evaluated by motor thresholds, size of motor-evoked potentials (MEP) by single pulse TMS, intracortical inhibition and intracortical facilitation tested by paired-pulse TMS were similar in patients and healthy subjects. MEPs recorded in five patients during movement observation were also comparable across the two groups. During motor imagery, patient MEPs were significantly smaller than in the control group and smaller than during rest, indicating an inhibition.

CONCLUSION

In patients with motor conversion disorder, the imagination of own body movements induces a reduction of corticospinal motor excitability whereas it induces an excitability increase in healthy subjects. This discrepancy might be the electrophysiological substrate of the inability to move voluntarily. Watching another person perform movements induces a normal excitability increase, indicating a crucial role of the perspective and suggesting that focusing the patient's attention on a different person might become a therapeutic approach.

Guided Motor Imagery in Healthy Adults and Stroke: Does Strategy Matter?

Background. Motor imagery (MI) enhances physical performance and skill acquisition in healthy and neurorehabilitation populations, yet little is known about the use of strategies to guide MI. Objectives. To examine the relative effectiveness of visual, auditory, and combined (visual + auditory) cueing of an imagined finger abduction task on corticomotor excitability. Methods. A total of 15 young (20-35 years) and 15 older people (over 55 years) and 10 people with chronic stroke, who could make voluntary movements of selected muscles, participated. Motor evoked potentials (MEPs, primary outcome) were measured following transcranial magnetic stimulation applied while participants imagined abducting their index finger under guidance of cueing strategies. Amplitudes of the MEPs from the first dorsal interosseous (FDI), abductor pollicis brevis (APB), and abductor digiti minimi (ADM) muscles were compared with rest, contrasted with MEPs elicited during active task performance, and expressed relative to rest to reflect facilitation. Results. Cued MI enhanced MEPs in all groups, preferentially to the target FDI muscle. In stroke, APB was also facilitated. ADM was least affected by cueing. Analyses of simple effects of condition on FDI MEPs in each group revealed that visual cueing was most effective in young people, whereas auditory cueing was most effective in healthy older people and when directed at the nonparetic side in stroke ( P < .04). On the paretic side, strategies were equally effective. In all cases, MEPs were largest during physical performance. Conclusions. Cued MI augments corticomotor excitability associated with healthy and paretic muscles related to the imagined task. Age should be considered when selecting a cueing strategy for maximum effectiveness.

Visuomotorische Imaginationstherapie in der Neglektrehabilitation – Grundlagen, Vorgehen und Falldarstellungen

Mentales Training findet vermehrt in der neurologischen Rehabilitation Einsatz. Neglekpatienten mit repräsentationalen Störungen, u. a. des eigenen Körpers, könnten von einer visuomotorischen Imaginationstherapie profitieren. Das therapeutische Vorgehen für die praktische Anwendung in der Neglektrehabilitation wird vorgestellt bezüglich (1) Patientenauswahl, (2) Testdiagnostik, (3) Messung der Imaginationsfähigkeit, (4) Psychoedukation, (5) Setting, (6) Therapiemanual, (7) Frequenz und Komplexitätsgrade, (8) Therapieprotokoll, (9) Elektromyographie sowie (10) Eigentraining. Zwei Fallbeispiele verdeutlichen wie eine visuomotorische Imaginationstherapie selbst im chronischen Krankheitsstadium zu Funktionsverbesserungen führen und bei subakutem personalem Neglekt die Körperwahrnehmung beeinflusst werden kann.