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

BACKGROUND: Although growing evidence has shown beneficial effects of motor imagery (MI) training in different populations including people with multiple sclerosis (pwMS), not all patients with neurological diseases may benefit from MI. OBJECTIVES: To investigate factors and strategies affecting and enhancing MI ability in pwMS. DATA SOURCES: MEDLINE/PubMed, PsycINFO, Cochrane Library, Scopus, EMBASE, EBSCOhost, Web of Science and REHABDATA databases, clinical trials registries, dissertation repositories, study bibliographies and internet search engines were searched through August 2021. STUDY SELECTION: Any study type but single case studies investigating factors or strategies contributing to MI ability in pwMS. STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias (RoB) was assessed using the Joanna Briggs Institute Checklist for Case-Control and Analytical Cross-Sectional Studies and Cochrane RoB-2.0 tool for randomised trials. A qualitative synthesis was performed summarising main results. RESULTS: Eight databases, 4 trial registries, 9 dissertation repositories, and 1 internet search engine were searched. Fourteen studies including 366 pwMS and 236 healthy controls were included. Most frequently, cognitive impairment was reported as a negative factor influencing MI ability in pwMS. Other negative factors were cognitive fatigue and disability. Inconsistent evidence was found on the contribution of MS phenotype, anxiety, and depression. Using a theory-based MI framework and familiarisation to MI and external cueing may enhance MI ability. LIMITATIONS: Eligible studies were highly heterogeneous. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: Cognitive impairment, cognitive fatigue and disability negatively influence MI ability in pwMS. Visual and/or auditory cueing of MI are strategies for facilitating MI ability. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020173081 CONTRIBUTION OF THE PAPER.

Feasibility of motor imagery and effects of activating and relaxing practice on autonomic functions in healthy young adults: A randomised, controlled, assessor-blinded, pilot trial.

INTRODUCTION: Motor imagery (MI) is the mental rehearsal of a motor task. Between real and imagined movements, a functional equivalence has been described regarding timing and brain activation. The primary study aim was to investigate the feasibility of MI training focusing on the autonomic function in healthy young people. Further aims were to evaluate participants' MI abilities and compare preliminary effects of activating and relaxing MI on autonomic function and against controls. METHODS: A single-blinded randomised controlled pilot trial was performed. Participants were randomised to the activating MI (1), relaxing MI (2), or control (3) group. Following a MI familiarisation, they practiced home-based kinaesthetic MI for 17 minutes, 5 times/week for 2 weeks. Participants were called once for support. The primary outcome was the feasibility of a full-scale randomised controlled trial using predefined criteria. Secondary outcomes were participants' MI ability using the Movement Imagery Questionnaire-Revised, mental chronometry tests, hand laterality judgement and semi-structured interviews, autonomic function. RESULTS: A total of 35 participants completed the study. The feasibility of a larger study was confirmed, despite 35% attrition related to the COVID-19 pandemic. Excellent MI capabilities were seen in participants, and significant correlations between MI ability measures. Interview results showed that participants accepted or liked both interventions. Seven major themes and insider recommendations for MI interventions emerged. No significant differences and negligible to medium effects were observed in MI ability or autonomic function between baseline and post-intervention measures or between groups. CONCLUSIONS: Results showed that neither activating nor relaxing MI seems to change autonomic function in healthy individuals. Further adequately powered studies are required to answer open questions remaining from this study. Future studies should investigate effects of different MI types over a longer period, to rule out habituation and assess autonomic function at several time points and simultaneously with MI.

A comparative study of the effects of yoga and clinical Pilates training on walking, cognition, respiratory functions, and quality of life in persons with multiple sclerosis: A quasi-experimental study.

OBJECTIVE: The purpose was to investigate the effects of yoga and clinical Pilates training on walking, respiratory muscle strength, cognition, and quality of life and compare the effects of two popular exercise methods in persons with multiple sclerosis (pwMS). METHODS: Twenty-eight pwMS (Pilates group = 16, yoga group = 12) received the program once a week for eight weeks in addition to home exercises. At baseline and the end of the training, participants underwent assessments. The outcome measures were walking speed, mobility, balance confidence, respiratory muscle strength, cognition, and quality of life. RESULTS: Following the program, there was no significant difference in mobility (p = 0.482), perceived walking quality (p = 0.325), respiratory muscle strength (maximum inspiratory pressure: p = 0.263, maximum expiratory pressure: p = 0.866), and cognition (Symbol Digit Modalities Test: p = 0.324, California Verbal Learning Test-II: p = 0.514, Brief Visuospatial Memory Test-Revised: p = 0.279) between the two groups. Improvements were higher in balance confidence (p = 0.006), walking speed (p = 0.004), and quality of life (p = 0.019) in the clinical Pilates group compared to the yoga group. CONCLUSION: This study showed positive effects in walking and respiratory aspects in pwMS who received yoga and clinical Pilates training. Pilates training was superior in improving walking speed, quality of life, and balance confidence compared to yoga training.

The effects of Clinical Pilates training on walking, balance, fall risk, respiratory, and cognitive functions in persons with multiple sclerosis: A randomized controlled trial.

CONTEXT: Multiple sclerosis (MS) is a chronic progressive and neurodegenerative disease. Exercise programs are needed to maintain and increase functional status in persons with MS (pwMS). Pilates exercises designed by a physiotherapist can enhance participation and functionality in pwMS. OBJECTIVE: The aim of this study was to investigate the effects of Clinical Pilates training on balance, walking, fall risk, respiratory, and cognitive functions in pwMS compared with an active comparator (home exercise training). DESIGN: This study was a randomized controlled study. SETTINGS: This study was designed by researchers at Dokuz Eylül University, Izmir, Turkey. PARTICIPANTS: Forty-two pwMS were included in this randomized controlled trial. MAIN OUTCOME MEASURES: Walking, core stability, balance confidence, respiratory muscle strength, and cognitive functions were assessed before and after the program. INTERVENTIONS: The participants were randomly divided into two groups. The Pilates exercises group (n = 21) received therapy weekly for 8 weeks along with a home exercise program. The home exercise group (n = 21) was given standardized exercises reflecting routine clinical practice. The program compliance was monitored by telephone calls once a week. RESULTS: There were no significant differences in walking speed (p = 0.096), perceived walking ability (p = 0.165), and fear of falling (p = 0.385) between the Pilates and home exercise groups. Clinical Pilates training was superior to the home exercise program in walking endurance (p = 0.001), postural stability (p = 0.028), core stability (p = 0.016), respiratory (maximum inspiratory pressure: p = 0.037, maximum expiratory pressure: p = 0.008), and cognitive functions (p = 0.001-0.007). Clinical Pilates training may be preferred as an alternative method to improve balance, walking, respiratory, and cognitive functions in pwMS.

Feasibility of a 6-Month Yoga Program to Improve the Physical and Psychosocial Status of Persons with Multiple Sclerosis and their Family Members.

CONTEXT: To the best of our knowledge, there has been no study on yoga that includes both persons with multiple sclerosis (MS) and their family members. Because yoga has therapeutic effects in both persons with MS and healthy persons, we hypothesized that it would be an effective method to improve not only the physical and psychosocial status but also the time persons with MS and their family members spend together. OBJECTIVE: To examine the feasibility of a 6-month (long-term) yoga program to improve the physical and psychosocial status of persons with MS and their family members. DESIGN: Uncontrolled clinical trial. SETTING: The protocol was developed at the Department of Neurology, Faculty of Medicine, and School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey. PARTICIPANTS: Persons with MS and healthy family members. MAIN OUTCOME MEASURES: Walking, balance, fatigue, health-related quality of life, depression, pain, and kinesiophobia. INTERVENTIONS: Yoga training was given once a week (at least 1h) for 6 months. The same assessors who assessed at baseline also performed the same assessments immediately after the end of the training (i.e., after 6 months). RESULTS: In total, 44 participants (27 persons with MS and 17 healthy family members) participated in the study. Twelve persons with MS and three healthy family members completed the 6-month yoga intervention. The completion rate for persons with MS and healthy subjects was 44.4% and 17.6%, respectively. In persons with MS, the mental dimension of health-related quality of life, walking speed, fatigue, and depression levels significantly improved after the yoga program (p < .05). However, there was no significant change in the self-reported walking impact, balance, pain, physical dimension of health-related quality of life, and kinesiophobia levels in the persons with MS (p > .05). This study suggests that a 6-month yoga program can improve the mental dimension of health-related quality of life, walking speed, fatigue, and depression in the persons with MS. However, the 6-month yoga program does not appear to be a feasible method to increase the time that persons with MS spend together with their family members.