A Different Point of View: The Evaluation of Motor Imagery Perspectives in Patients With Sensorimotor Impairments in A Longitudinal Study

Abstract

BackgroundMotor imagery (MI) has been successfully applied in neurological rehabilitation. Little is known about the spontaneous selection of the MI perspectives in patients with sensorimotor impairments. What MI perspective is selected: internal (first- person view), or external (third-person view)? The aim was to evaluate the MI perspective preference in patients after stroke (STR), with Multiple Sclerosis (MS) or Parkinson’s disease (PD).MethodsIn a longitudinal study including four measurement sessions over two weeks, MI ability and MI perspective preference in both visual and kinaesthetic imagery modalities were assessed using the Kinaesthetic and Visual Imagery Questionnaire including 20 items (KVIQ-20), mental rotation, and mental chronometry. Additionally, patients' activity level was assessed. Descriptive statistical analyses were performed regarding different age- (≤44, 45-63, 64≤) and activity levels (inactive, partially active, active), and KVIQ-20 movement classifications (axial, proximal, distal, upper and lower limb).ResultsIn total, 55 in- and outpatients (25 SRT, 25 MS, 5 PD; 25 females; mean age 58±14 years) were included. At the first measurement session, the mean mental rotation score was 27±4.1 out of 32. For mental chronometry, a congruency ratio of 1.0±0.3 was determined. The KVIQ-20 scores for the visual and kinaesthetic subscales were 62.4±16.2 and 58.2±17.2. The internal MI perspective was favoured in 66.5% on the visual subscale and in 72.7% on the kinaesthetic subscale. The external perspective was preferred in 30.3% on the visual subscale and in 26.5% on the kinaesthetic subscale. Over the four measurement sessions, patients became more consistent in their MI perspective selection. MI perspective changes occurred mainly during imagination of shoulder, arm and neck movements. During imagination of foot and finger movements their MI perspective was more constant. Results showed a tendency to use an external perspective in patients older than 64 years and in patients with a descreasing physical activity level. Axial and proximal movements were commonly imagined using the external perspective. ConclusionIt is recommended to evaluate the spontaneous MI perspective selection to design patient-specific MI training interventions. Distal movements (foot, finger) may be an indicator when evaluating the consistency of the MI perspective in patients with sensorimotor impairments. Trial registrationThis is a research project involving persons other than a clinical trial according to the Human Research Act other than clinical (non-clinical trial). Registered: EKNZ 2015-172, 19. Mai 2015

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

“…From title/abstract screening of 201 records and full-text screening of 54 records, 14 studies were eligible for the review and critically appraised [19][20][21][22][23][24][25][26][27][28][29][30][31][32] (Fig. 1).…”

“…This review included 11 case-control studies [19][20][21][22][23][24][25][26][27][28]30], 1 analytical cross-sectional study [31], and 2 RCTs [29,32]. In Table 1, the study design and population, MI ability and other assessments, and significant results are presented.…”

“…Their Expanded Disability Status Scale (EDSS) scores ranged from 0 to 8.0, with most studies having included pwMS with mild (EDSS 0-3.5) [21-24, 26-28, 30, 32] or mild-to-moderate (EDSS 0-5.0) [25,29] disability. Only one study explored J o u r n a l P r e -p r o o f pwMS with mild-to-severe (EDSS 2.0-7.5) disability [31], and two studies with moderate-tosevere (EDSS 4.0-8.0) disability [19,20]. Mean (95% confidence interval, CI) age and EDSS were 40 (37 to 44) years and 2.9 (2.0 to 3.7) points, respectively.…”

“…Factors and strategies affecting and enhancing the MI ability in pwMS were identified based on a statistically significant difference in MI ability between investigated groups (e.g., pwMS and healthy controls, HC) or significant correlations between MI ability measures and predetermined patient characteristics. High/low MI ability were determined according to predefined cut-off values on MI ability assessments or established definitions [19,25,29,31].…”

“…Other factors were a more severe disability [26,27] and cognitive fatigue [30]. Inconsistent evidence was found regarding the contributions of MS phenotype [19,27] depression [22,26] and anxiety [22,28], whereas so far, negative evidence was shown for associations between the MI ability and disease duration [19,26] or age [25,27,31]. Factors are presented in Table 5 (for details, see Supplementary File 3).…”