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Using the imagination to practice walking movements: could it improve walking and fatigue?

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Summary

Motor imagery (MI) is a technique where somebody thinks about moving their body in a certain way without actually moving. This technique is commonly used by athletes to rehearse movements and skills to improve their performance.

This study investigated the use of MI in people with MS, by combining it with music with a strong beat or a metronome to see if walking could be improved just through these mental practice sessions. Participants in the test groups received MI training session CDs and were instructed to practice for 17 minutes a day, six days a week for four weeks.

When compared to participants in the control group those in the groups who had performed MI to a beat (music or metronome) could walk significantly faster and further, as well as having improved fatigue and quality of life.

The study demonstrates that using mental imagery and practice to a beat could be a safe and effective way of managing and improving walking difficulties in people with MS.

Background

Motor imagery (MI) is a technique where somebody thinks about moving their body in a certain way without actually moving. It can be done in two ways either the person visualises themselves moving or they imagine ‘feeling’ their body moving. There is evidence to show that mentally practicing a task uses similar brain areas as actually doing the task, so imagining you are doing it can help build up and strengthen the nerve pathways that control a movement. This technique is commonly used by athletes to rehearse movements and skills to improve their performance.

Physiotherapists often use MI to help retrain a function in people with neurological conditions but they can also help improve walking by using a technique called rhythmic auditory stimulation. This uses rhythm cues such as music with a strong beat, to synchronise the nerve signals producing then steps of walking with the beat.

This study combined rhythm cues and MI to see if they had any effect on walking in people with MS.

How this study was carried out

112 people with MS were recruited from an MS clinic in Austria and 101 completed the study. To take part in the study all had to be aged over 18 years old, have an EDSS score of between 1.5 and 4.5 and be German speakers. Participants were randomly allocated to one of three groups:

  • Group A – music and MI: participants in this group received CDs that contained verbal instructions to imagine walking tasks, however these were set to a metronome beat.
  • Group B – metronome and MI: again participants in this group received CDs that contained verbal instructions to imagine walking tasks and these were set to instrumental music which had a strong beat.
  • Group C – Control: participants in this group received their usual treatment.

Participants in groups A and B, were instructed to use their CDs at home to do MI practice while sat down with their eyes closed for 17 minutes a day, six days a week for four weeks and record each session they performed in a diary. The walking tasks they had to imagine included pacing, walking fast, taking large steps and stamping.

The main aim of the study was to investigate if these approaches could improve walking, but secondary to that was seeing if they could also improve fatigue symptoms and quality of life. Participants were assessed before and after the four week study period, through walking assessments such as the timed 25-foot walk, and questionnaires to assess their fatigue levels and measure of their quality of life.

What was found

When compared to participants in the control group those in groups A and B who had performed the MI to a beat could walk significantly faster and further. Both of the MI groups also had improved quality of life test scores and cognitive fatigue improved, meaning they did not mentally tire for longer, although physical fatigue only improved in the music group.

What does it mean?

The study shows that rhythm cues together with MI can improve walking, quality of life and fatigue in people with MS.

The research did have several limitations. Although benefits were seen at the end of the four week study period, the researchers did not follow the participants up over a longer time period, to see if the effects observed were long lasting. Additionally the participants knew if they were in the control group or one of the treatment groups, so this may have affected how motivated they were to do the tasks.

Nonetheless these results are encouraging and demonstrate that using mental imagery and practice to a beat could be a safe and effective way of managing and improving walking difficulties in people with MS. The authors are now conducting a follow up study to investigate using different types of MI in people with MS to explore the benefits further.

Seebacher B, Kuisma R, Glynn A, Berger T.
The effect of rhythmic-cued motor imagery on walking, fatigue and quality of life in people with multiple sclerosis: A randomised controlled trial.
Mult Scler. 2016 Apr 7. pii: 1352458516644058. [Epub ahead of print]
Abstract

More about walking difficulties

Many people with MS have some difficulties with walkingbut walking problems vary considerably from one person with MS to another. Common difficulties include: unsteadiness on walking or turning, tripping, stumbling, weakness of the leg when weight is on it and difficulty placing the foot on the ground. Other MS symptoms can also make walking more difficult, such as vision problems, balance problems and pain. Having trouble walking can mean people with MS are more vulnerable to tripping and falling. It can also use up more energy, making fatigue worse, and people may alter how they walk to try and compensate for the difficulty they are having. This alteration in walking can result in bad posture which can lead to pain and strains.

If you are experiencing walking difficulties, you can speak to your MS nurse or GP who may refer you to physiotherapy services. The best way forward depends on what is causing the difficulties. Treatment may involve physiotherapy or drug treatments to alleviate specific underlying symptoms such as spasticity or pain.

Fatigue

Fatigue is believed to be the most common symptom in MS, but there are a number of ways that it can be managed. If you are experiencing fatigue, you might like to read about techniques for managing fatigue in the A-Z of MS or in Living with fatigue which can be read online, downloaded as a pdf or ordered as a printed version.

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