Implicit and explicit motor imagery ability after SCI: Moving the elbow makes the difference.

Cervical spinal cord injury (SCI) causes dramatic sensorimotor deficits that restrict both activity and participation. Restoring activity and participation requires extensive upper limb rehabilitation focusing elbow and wrist movements, which can include motor imagery. Yet, it remains unclear whether MI ability is impaired or spared after SCI. We investigated implicit and explicit MI ability in individuals with C6 or C7 SCI (SCIC6 and SCIC7 groups), as well as in age- and gender-matched controls without SCI. Inspired by previous studies, implicit MI evaluations involved hand laterality judgments, hand orientation judgments (HOJT) and hand-object interaction judgments. Explicit MI evaluations involved mental chronometry assessments of physically possible or impossible movements due to the paralysis of upper limb muscles in both groups of participants with SCI. HOJT was the paradigm in which implicit MI ability profiles differed the most between groups, particularly in the SCIC6 group who had impaired elbow movements in the horizontal plane. MI ability profiles were similar between groups for explicit MI evaluations, but reflected task familiarity with higher durations in the case of unfamiliar movements in controls or attempt to perform movements which were no longer possible in persons with SCI. Present results, obtained from a homogeneous population of individuals with SCI, suggest that people with long-term SCI rely on embodied cognitive motor strategies, similar to controls. Differences found in behavioral response pattern during implicit MI mirrored the actual motor deficit, particularly during tasks that involved internal representations of affected body parts.

Inter-Task Transfer of Prism Adaptation through Motor Imagery.

Prism adaptation (PA) is a useful method to investigate short-term sensorimotor plasticity. Following active exposure to prisms, individuals show consistent after-effects, probing that they have adapted to the perturbation. Whether after-effects are transferable to another task or remain specific to the task performed under exposure, represents a crucial interest to understand the adaptive processes at work. Motor imagery (MI, i.e., the mental representation of an action without any concomitant execution) offers an original opportunity to investigate the role of cognitive aspects of motor command preparation disregarding actual sensory and motor information related to its execution. The aim of the study was to test whether prism adaptation through MI led to transferable after-effects. Forty-four healthy volunteers were exposed to a rightward prismatic deviation while performing actual (Active group) versus imagined (MI group) pointing movements, or while being inactive (inactive group). Upon prisms removal, in the MI group, only participants with the highest MI abilities (MI+ group) showed consistent after-effects on pointing and, crucially, a significant transfer to throwing. This was not observed in participants with lower MI abilities and in the inactive group. However, a direct comparison of pointing after-effects and transfer to throwing between MI+ and the control inactive group did not show any significant difference. Although this interpretation requires caution, these findings suggest that exposure to intersensory conflict might be responsible for sensory realignment during prism adaptation which could be transferred to another task. This study paves the way for further investigations into MI's potential to develop robust sensorimotor adaptation.

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.

Stabilometric Correlates of Motor and Motor Imagery Expertise.

Motor Imagery (MI) reproduces cognitive operations associated with the actual motor preparation and execution. Postural recordings during MI reflect somatic motor commands targeting peripheral effectors involved in balance control. However, how these relate to the actual motor expertise and may vary along with the MI modality remains debated. In the present experiment, two groups of expert and non-expert gymnasts underwent stabilometric assessments while performing physically and mentally a balance skill. We implemented psychometric measures of MI ability, while stabilometric variables were calculated from the center of pressure (COP) oscillations. Psychometric evaluations revealed greater MI ability in experts, specifically for the visual modality. Experts exhibited reduced surface COP oscillations in the antero-posterior axis compared to non-experts during the balance skill (14.90%, 95% CI 34.48-4.68, p < 0.05). Experts further exhibited reduced length of COP displacement in the antero-posterior axis and as a function of the displacement area during visual and kinesthetic MI compared to the control condition (20.51%, 95% CI 0.99-40.03 and 21.85%, 95% CI 2.33-41.37, respectively, both p < 0.05). Predictive relationships were found between the stabilometric correlates of visual MI and physical practice of the balance skill, as well as between the stabilometric correlates of kinesthetic MI and the training experience in experts. Present results provide original stabilometric insights into the relationships between MI and expertise level. While data support the incomplete inhibition of postural commands during MI, whether postural responses during MI of various modalities mirror the level of motor expertise remains unclear.

Acute stress affects implicit but not explicit motor imagery: A pilot study.

Motor imagery (MI) is the capacity to mentally perform one or a set of movements without concomitant overt action. MI training has been show to enhance the subsequent motor performance. While the benefits of MI to manage stress have been extensively documented, the reverse impact of stress on MI received far less attention. The present study thus aimed to evaluate whether acute stress might influence MI abilities. Thirty participants were assigned either to a stress or a control group. The Socially Evaluated Cold Pressor Test (SECPT) was used to induce stress, with heart rate, electrodermal activity, salivary cortisol, and self-report perceived levels of stress being monitored during the experiment. Stress induction was followed by both implicit (laterality judgment) and explicit (sequential pointing) MI tasks. Main results showed a deleterious impact of stress on implicit MI, while explicit MI was not altered. These exploratory findings provide a deeper understanding of stress effects on cognition, and practically support that under stressful conditions, as during a sport competition or rehabilitation contexts, explicit MI should be prioritized.

Effects of Action Observation and Action Observation Combined with Motor Imagery on Maximal Isometric Strength.

Action observation (AO) alone or combined with motor imagery (AO + MI) has been shown to engage the motor system. While recent findings support the potential relevance of both techniques to enhance muscle function, this issue has received limited scientific scrutiny. In the present study, we implemented a counterbalanced conditions design where 21 participants performed 10 maximal isometric contractions (12-s duration) of elbow flexor muscles against a force platform. During the inter-trial rest periods, participants completed i) AO of the same task performed by an expert athlete, ii) AO + MI, i.e. observation of an expert athlete while concurrently imagining oneself performing the same task, and iii) watching passively a video documentary about basketball shooting (Control). During force trials, we recorded the total force and integrated electromyograms from the biceps brachii and anterior deltoideus. We also measured skin conductance from two finger electrodes as an index of sympathetic nervous system activity. Both AO and AO + MI outperformed the Control condition in terms of total force (2.79-3.68%, p < 0.001). For all conditions, we recorded a positive relationship between the biceps brachii activation and the total force developed during the task. However, only during AO was a positive relationship observed between the activation of the anterior deltoideus and the total force. We interpreted the results with reference to the statements of the psycho-neuromuscular theory of mental practice. Present findings extend current knowledge regarding the priming effects of AO and AO + MI on muscle function, and may contribute to the optimization of training programs in sports and rehabilitation.

The therapeutic role of motor imagery during the acute phase after total knee arthroplasty: a pilot study.

PURPOSE: The aim of this study was to measure physical and functional outcomes during the acute postoperative recovery in patients who underwent total knee arthroplasty. Motor imagery has been shown to decrease pain and promote functional recovery after both neurological and peripheral injuries. Yet, whether motor imagery can be included as an adjunct effective method into physical therapy programs following total knee arthroplasty remains a working hypothesis that we aim to test in a pilot study. METHOD: Twenty volunteers were randomly assigned to either a motor imagery or a control group. Pain, range of motion, knee girth as well as quadriceps strength and Timed Up and Go Test time were the dependent variables during pre-test and post-test. RESULTS: The motor imagery group exhibited larger decrease of ipsilateral pain and knee girth, a slightly different evolution of range of motion and an increase of ipsilateral quadriceps strength compared to the control group. No effects of motor imagery on Timed Up and Go Test scores were observed. CONCLUSION: Implementing motor imagery practice into the course of physical therapy enhanced various physical outcomes during acute postoperative recovery after total knee arthroplasty. According to this pilot study, motor imagery might be relevant to promote motor relearning and recovery after total knee arthroplasty.Partial effect-sizes should be conducted in the future. Implications for rehabilitation   Adding motor imagery to physical therapy sessions during the acute period following total knee arthroplasty: • Enhances quadriceps strength. • Alleviates pain. • Enhances range of motion. • Does not have any effect on basic functional mobility. • Does not have any effect on knee girth.

Implementing Cognitive Training Into a Surgical Skill Course: A Pilot Study on Laparoscopic Suturing and Knot Tying.

Mini-invasive surgery-for example, laparoscopy-has challenged surgeons' skills by extending their usual haptic space and displaying indirect visual feedback through a screen. This may require new mental abilities, including spatial orientation and mental representation. This study aimed to test the effect of cognitive training based on motor imagery (MI) and action observation (AO) on surgical skills. A total of 28 postgraduate residents in surgery took part in our study and were randomly distributed into 1 of the 3 following groups: (1) the basic surgical skill, which is a short 2-day laparoscopic course + MI + AO group; (2) the basic surgical skill group; and (3) the control group. The MI + AO group underwent additional cognitive training, whereas the basic surgical skill group performed neutral activity during the same time. The laparoscopic suturing and knot tying performance as well as spatial ability and mental workload were assessed before and after the training period. We did not observe an effect of cognitive training on the laparoscopic performance. However, the basic surgical skill group significantly improved spatial orientation performance and rated lower mental workload, whereas the 2 others exhibited lower performance in a mental rotation test. Thus, actual and cognitive training pooled together during a short training period elicited too high a strain, thus limiting potential improvements. Because MI and AO already showed positive outcomes on surgical skills, this issue may, thus, be mitigated according to our specific learning conditions. Distributed learning may possibly better divide and share the strain associated with new surgical skills learning.

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.

The influence of gate start position on physical performance and anxiety perception in expert BMX athletes.

The critical importance of the start phase in bicycle motocross (BMX) racing is increasingly acknowledged. Past experiments underlined that the internal lane of the starting gate provides a strong positional advantage. However, how lane position affects start performance and cognitive and somatic state anxiety remains unexplored. We examined the start performance and anxiety responses of youth national-level BMX riders in both experimental and ecological contexts. We used contextualization motor imagery routines to evaluate start performance and state anxiety from the internal and external lanes. Cycle ergometer measures revealed a better start performance from the external lane, but we did not record any lane effect on actual gate start times. Both somatic and cognitive anxiety scores were higher before racing from the internal compared to the external lane. Finally, state anxiety (i.e., somatic anxiety, worry and concentration disruptions) negatively predicted the start performance. Present findings provide original insights on psychological factors involved in BMX start performance, and might contribute to fruitful coping interventions and training programmes in sports overlapping the framework of "handicap races" taking the specific form of positional advantages/disadvantages at the start (e.g., ski/snowboard cross, athletics, swimming, motorsports, etc.).

Neurophysiological insights on flexibility improvements through motor imagery.

The efficacy of motor imagery (MI) practice to facilitate muscle stretching remains controversial and the underlying neurophysiological mechanisms unexplored. We evaluated the effects of MI practice during a sit-and-reach task. Healthy participants were randomly assigned to a MI practice (n=15) or Control (n=15) group and completed 2 blocks of 5 sit-and-reach trials. During the first block (B1), participants performed 5 maximal stretching trials of 10s. During the second block (B2), trials were divided into two consecutive parts: i) reproducing the maximum performance of B1 (10s, B2 part 1), and ii) attempting to outperform the maximum performance of B1 (10s, B2 part 2). Participants performed kinesthetic MI of hamstring stretching during B2 trials in the MI practice group. We recorded electromyography from the hamstring and rectus femoris of the dominant leg. We also processed skin conductance as an index of sympathetic activity. We measured greater performance improvements from B1 to B2 part 2 in the MI practice group compared to Control (p<0.05). Participants in the MI practice group exhibited reduced hamstring activation during both B2 part 1 (p<0.001) and B2 part 2 (p<0.001) compared to Control. Skin conductance revealed higher sympathetic activation during B2 part 2 compared to both B1 and B2 part 1 in the two groups. Thus, performing MI during actual movement is likely to improve stretching performance through reduced muscle activation. Such improvement may be grounded in a cortical gain over spinal reflexes.

Anodal tDCS over the primary motor cortex improves motor imagery benefits on postural control: A pilot study.

Performing everyday actions requires fine postural control, which is a major focus of functional rehabilitation programs. Among the various range of training methods likely to improve balance and postural stability, motor imagery practice (MIP) yielded promising results. Transcranial direct current stimulation (tDCS) applied over the primary motor cortex was also found to potentiate the benefits of MIP on upper-limb motor tasks. Yet, combining both techniques has not been tested for tasks requiring fine postural control. To determine the impact of MIP and the additional effects of tDCS, 14 participants performed a postural control task before and after two experimental (MIP + anodal or sham tDCS over the primary motor cortex) and one control (control task + sham tDCS) conditions, in a double blind randomized study. Data revealed a significant decrease of the time required to perform the postural task. Greater performance gains were recorded when MIP was paired with anodal tDCS and when the task involved the most complex postural adjustments. Altogether, findings highlight short-term effects of MIP on postural control and suggest that combining MIP with tDCS might also be effective in rehabilitation programs for regaining postural skills in easily fatigable persons and neurologic populations.

Online and Offline Performance Gains Following Motor Imagery Practice: A Comprehensive Review of Behavioral and Neuroimaging Studies.

There is now compelling evidence that motor imagery (MI) promotes motor learning. While MI has been shown to influence the early stages of the learning process, recent data revealed that sleep also contributes to the consolidation of the memory trace. How such "online" and "offline" processes take place and how they interact to impact the neural underpinnings of movements has received little attention. The aim of the present review is twofold: (i) providing an overview of recent applied and fundamental studies investigating the effects of MI practice (MIP) on motor learning; and (ii) detangling applied and fundamental findings in support of a sleep contribution to motor consolidation after MIP. We conclude with an integrative approach of online and offline learning resulting from intense MIP in healthy participants, and underline research avenues in the motor learning/clinical domains.

Selective Efficacy of Static and Dynamic Imagery in Different States of Physical Fatigue.

There is compelling evidence that motor imagery contributes to improved motor performance, and recent work showed that dynamic motor imagery (dMI) might provide additional benefits by comparison with traditional MI practice. However, the efficacy of motor imagery in different states of physical fatigue remains largely unknown, especially as imagery accuracy may be hampered by the physical fatigue states elicited by training. We investigated the effect of static motor imagery (sMI) and dMI on free-throw accuracy in 10 high-level basketball athletes, both in a non-fatigued state (Experiment 1) and immediately after an incremental running test completed until exhaustion (20 m shuttle run-test-Experiment 2). We collected perceived exhaustion and heart rate to quantify the subjective experience of fatigue and energy expenditure. We found that dMI brought better shooting performance than sMI, except when athletes were physically exhausted. These findings shed light on the conditions eliciting optimal use of sMI and dMI. In particular, considering that the current physical state affects body representation, performing dMI under fatigue may result in mismatches between actual and predicted body states.

Anodal transcranial direct current stimulation enhances the effects of motor imagery training in a finger tapping task.

Motor imagery (MI) training and anodal transcranial direct current stimulation (tDCS) applied over the primary motor cortex can independently improve hand motor function. The main objective of this double-blind, sham-controlled study was to examine whether anodal tDCS over the primary motor cortex could enhance the effects of MI training on the learning of a finger tapping sequence. Thirty-six right-handed young human adults were assigned to one of three groups: (i) who performed MI training combined with anodal tDCS applied over the primary motor cortex; (ii) who performed MI training combined with sham tDCS; and (iii) who received tDCS while reading a book. The MI training consisted of mentally rehearsing an eight-item complex finger sequence for 13 min. Before (Pre-test), immediately after (Post-test 1), and at 90 min after (Post-test 2) MI training, the participants physically repeated the sequence as fast and as accurately as possible. An anova showed that the number of sequences correctly performed significantly increased between Pre-test and Post-test 1 and remained stable at Post-test 2 in the three groups (P < 0.001). Furthermore, the percentage increase in performance between Pre-test and Post-test 1 and Post-test 2 was significantly greater in the group that performed MI training combined with anodal tDCS compared with the other two groups (P < 0.05). As a potential physiological explanation, the synaptic strength within the primary motor cortex could have been reinforced by the association of MI training and tDCS compared with MI training alone and tDCS alone.

Neuroplasticity of imagined wrist actions after spinal cord injury: a pilot study.

Motor imagery (MI - i.e., the mental representation of an action without physically executing it) stimulates brain motor networks and promotes motor learning after spinal cord injury (SCI). An interesting issue is whether the brain networks controlling MI are being reorganized with reference to spared motor functions. In this pilot study, we tested using magnetoencephalography (MEG) whether changes in cortical recruitment during MI were related to the motor changes elicited by rehabilitation. Over a 1-year period of inclusion, C6 SCI participants (n = 4) met stringent criteria for inclusion in a rehabilitation program focused on the tenodesis prehension (i.e., a compensatory prehension enabling seizing of objects in spite of hand and forearm muscles paralysis). After an extended baseline period of 5 weeks including repeated MEG and chronometric assessments of motor performance, MI training was embedded to the classical course of physiotherapy for five additional weeks. Posttest MEG and motor performance data were collected. A group of matched healthy control participants underwent a similar procedure. The MI intervention resulted in changes in the variability of the wrist extensions, i.e., a key movement of the tenodesis grasp (p < .05). Interestingly, the extent of cortical recruitment, quantified by the number of MEG activation sources recorded within Brodmann areas 1-8 during MI of the wrist extension, significantly predicted actual movement variability changes across sessions (p < .001). However, no such relationship was present for movement times. Repeated measurements afforded a reliable statistical power (range .70-.97). This pilot study does not provide straightforward evidence of MI efficacy, which would require a randomized controlled trial. Nonetheless, the data showed that the relationship between action and imagery of spared actions may be preserved after SCI.

Impact of neurologic deficits on motor imagery: a systematic review of clinical evaluations.

Motor imagery (MI, the mental representation of an action without engaging in its actual execution) is a therapeutically relevant technique to promote motor recovery after neurologic disorders. MI shares common neural and psychological bases with physical practice. Interestingly, both acute and progressive neurologic disorders impact brain motor networks, hence potentially eliciting changes in MI capacities. How experimental neuroscientists and medical practitioners should assess and take into account these changes in order to design fruitful interventions is largely unresolved. Understanding how the psychometric, behavioral and neurophysiological correlates of MI are impacted by neurologic disorders is required. To address this brain-behavior issue, we conducted a systematic review of MI data in stroke, Parkinson's disease, spinal cord injury, and amputee participants. MI evaluation methods are presented. Redundant MI profiles, primarily based on psychometric and behavioral evaluations, emerged in each clinical population. When present, changes in the psychometric and behavioral correlates of MI were highly congruent with the corresponding motor impairments. Neurophysiological recordings yielded specific changes in cerebral activations during MI, which mirrored structural and functional reorganizations due to neuroplasticity. In this view, MI capacities may not be deteriorated per se by neurologic diseases resulting in chronic motor incapacities, but adjusted to the current state of the motor system. Literature-driven orientations for future clinical research are provided.

The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome.

PURPOSE: Motor imagery (MI) has been used as a complementary therapeutic tool for motor recovery after central nervous system disease and peripheral injuries. However, it has never been used as a preventive tool. We investigated the use of MI in the rehabilitation of stage II shoulder impingement syndrome. For the first time, MI is used before surgery. METHOD: Sixteen participants were randomly assigned to either a MI or control group. Shoulder functional assessment (Constant score), range of motion and pain were measured before and after intervention. RESULTS: Higher Constant score was observed in the MI than in the control group (p=0.04). Participants in the MI group further displayed greater movement amplitude (extension (p<0.001); flexion (p=0.025); lateral rotation (p<0.001). Finally, the MI group showed greater pain decrease (p=0.01). CONCLUSION: MI intervention seems to alleviate pain and enhance mobility, this is probably due to changes in muscle control and consequently in joint amplitude. MI might contribute to postpone or even protect from passing to stage III that may require surgery. Implications for Rehabilitation Adding motor imagery training to classical physical therapy in a stage II impingement syndrome: Helps in alleviating pain Enhances shoulder mobility Motor imagery is a valuable technique that can be used as a preventive tool before the stage III of the impingement syndrome.

Motor inhibition during motor imagery: a MEG study with a quadriplegic patient.

The neurophysiological substrates underlying motor imagery are now well established. However, the neural processes of motor inhibition while mentally rehearsing an action are poorly understood. This concern has received limited experimental investigations leading to divergent conclusions. Whether motor command suppression is mediated by specific brain structures or by intracortical facilitation/inhibition is a matter of debate. Interestingly, although motor commands are inhibited during motor imagery (MI) in healthy participants, spinal cord injury may result in weakened motor inhibition. Using magentoencephalography, we observed that mental and actual execution of a goal-directed pointing task elicited similar primary motor cortex activation in a C6-C7 quadriplegic patient, thus confirming the hypothesis of weakened motor inhibition during MI. In an age-matched healthy control participant, however, primary motor area activation during MI was significantly reduced compared to physical practice. Brain activation during actual movement resulted in enhanced recruitment of premotor areas in the patient. In the healthy participant, we found functional relationships between the primary motor area and peri-rolandic sites including the primary sensory area and the supplementary motor area during MI. This neural network was not activated when the quadriplegic patient performed MI. We assume that the primary sensory area and the supplementary motor area may be part of a functional network underlying motor inhibition during MI. These data provide insights into brain function changes due to neuroplasticity after spinal cord injury and evidence cortical substrates underlying weakened motor inhibition during MI after deafferentation and deefferentation.