The challenge of measuring physiological parameters during motor imagery engagement in patients after a stroke.

Introduction: It is suggested that eye movement recordings could be used as an objective evaluation method of motor imagery (MI) engagement. Our investigation aimed to evaluate MI engagement in patients after stroke (PaS) compared with physical execution (PE) of a clinically relevant unilateral upper limb movement task of the patients' affected body side. Methods: In total, 21 PaS fulfilled the MI ability evaluation [Kinaesthetic and Visual Imagery Questionnaire (KVIQ-10), body rotation task (BRT), and mental chronometry task (MC)]. During the experiment, PaS moved a cup to distinct fields while wearing smart eyeglasses (SE) with electrooculography electrodes integrated into the nose pads and electrodes for conventional electrooculography (EOG). To verify MI engagement, heart rate (HR) and oxygen saturation (SpO2) were recorded, simultaneously with electroencephalography (EEG). Eye movements were recorded during MI, PE, and rest in two measurement sessions to compare the SE performance between conditions and SE's psychometric properties. Results: MI and PE correlation of SE signals varied between r = 0.12 and r = 0.76. Validity (cross-correlation with EOG signals) was calculated for MI (r = 0.53) and PE (r = 0.57). The SE showed moderate test-retest reliability (intraclass correlation coefficient) with r = 0.51 (95% CI 0.26-0.80) for MI and with r = 0.53 (95% CI 0.29 - 0.76) for PE. Event-related desynchronization and event-related synchronization changes of EEG showed a large variability. HR and SpO2 recordings showed similar values during MI and PE. The linear mixed model to examine HR and SpO2 between conditions (MI, PE, rest) revealed a significant difference in HR between rest and MI, and between rest and PE but not for SpO2. A Pearson correlation between MI ability assessments (KVIQ, BRT, MC) and physiological parameters showed no association between MI ability and HR and SpO2. Conclusion: The objective assessment of MI engagement in PaS remains challenging in clinical settings. However, HR was confirmed as a reliable parameter to assess MI engagement in PaS. Eye movements measured with the SE during MI did not resemble those during PE, which is presumably due to the demanding task. A re-evaluation with task adaptation is suggested.

Intervention Platform for Action Observation and Motor Imagery Training After Stroke: Usability Test.

Action observation (AO) and motor imagery (MI) are considered as promising therapeutic approaches in the rehabilitation of patients after a stroke (PaS). Observing and mentally rehearsing motor movements stimulate the motor system in the brain and result in a positive effect on movement execution. To support patients in the early rehabilitation phase after a stroke, ANIMATE, a digital health intervention platform was developed. The platform guides the user through 6 activities of daily living by observing and imagining the corresponding movements. We conducted a scenario-based usability test with 9 PaS at a rehabilitation centre to identify existing usability issues. PaS found the app easy to use and they could interact with it without problems. Although they judged the app as useful, they stated to be not willing to use the app on a regular basis. Including features for customising ANIMATE regarding the individual rehabilitation goals and needs of PaS, as well as personalisation could help in increasing the motivation to use and the benefits of the platform.

Imagery ability assessments: a cross-disciplinary systematic review and quality evaluation of psychometric properties.

BACKGROUND: Over the last two centuries, researchers developed several assessments to evaluate the multidimensional construct of imagery. However, no comprehensive systematic review (SR) exists for imagery ability evaluation methods and an in-depth quality evaluation of their psychometric properties. METHODS: We performed a comprehensive systematic search in six databases in the disciplines of sport, psychology, medicine, education: SPORTDiscus, PsycINFO, Cochrane Library, Scopus, Web of Science, and ERIC. Two reviewers independently identified and screened articles for selection. COSMIN checklist was used to evaluate the methodological quality of the studies. All included assessments were evaluated for quality using criteria for good measurement properties. The evidence synthesis was summarised by using the GRADE approach. RESULTS: In total, 121 articles reporting 155 studies and describing 65 assessments were included. We categorised assessments based on their construct on: (1) motor imagery (n = 15), (2) mental imagery (n = 48) and (3) mental chronometry (n = 2). Methodological quality of studies was mainly doubtful or inadequate. The psychometric properties of most assessments were insufficient or indeterminate. The best rated assessments with sufficient psychometric properties were MIQ, MIQ-R, MIQ-3, and VMIQ-2 for evaluation of motor imagery ability. Regarding mental imagery evaluation, only SIAQ and VVIQ showed sufficient psychometric properties. CONCLUSION: Various assessments exist to evaluate an individual's imagery ability within different dimensions or modalities of imagery in different disciplines. However, the psychometric properties of most assessments are insufficient or indeterminate. Several assessments should be revised and further validated. Moreover, most studies were only evaluated with students. Further cross-disciplinary validation studies are needed including older populations with a larger age range. Our findings allow clinicians, coaches, teachers, and researchers to select a suitable imagery ability assessment for their setting and goals based on information about the focus and quality of the assessments. SYSTEMATIC REVIEWS REGISTER: PROSPERO CRD42017077004 .

Effect of Motor Imagery Training on Motor Learning in Children and Adolescents: A Systematic Review and Meta-Analysis.

Background: There is an urgent need to systematically analyze the growing body of literature on the effect of motor imagery (MI) training in children and adolescents. Methods: Seven databases and clinicaltrials.gov were searched. Two reviewers independently screened references and full texts, and extracted data (studies' methodology, MI elements, temporal parameters). Two studies were meta-analyzed providing the standard mean difference (SDM). Selected studies were evaluated with the risk of bias (RoB) and GRADE tools. Results: A total of 7238 references were retrieved. The sample size of the 22 included studies, published between 1995 and 2021, ranged from 18 to 136 participants, totaling 934 (nine to 18 years). Studies included healthy pupils, mentally retarded adolescents, children with motor coordination difficulties or with mild mental disabilities. The motor learning tasks focused on upper, lower and whole body movements. SMDs for the primary outcome of pooled studies varied between 0.83 to 1.87 (95% CI, I2, T2 varied 0.33-3.10; p = 0.001; 0-74%; 0-0.59). RoB varied between some concerns and high risk. GRADE rating was low. Conclusions: MI combined with physical practice (PP) might have a high potential for healthy and impaired children and adolescents. However, important reporting recommendations (PETTLEP, TIDieR, CONSORT) should be followed. The systematic review was registered with PROSPERO: CRD42021237361.

A different point of view: the evaluation of motor imagery perspectives in patients with sensorimotor impairments in a longitudinal study.

BACKGROUND: Motor 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 perspective is selected: internal (first-person view), or external (third-person view)? The aim was to evaluate the MI perspective preference in patients with sensorimotor impairments. METHODS: In a longitudinal study including four measurement sessions, 55 patients (25 stroke, 25 multiple sclerosis, 5 Parkinson's disease; 25 females; mean age 58 ± 14 years) were included. MI ability and perspective preference in both visual and kinaesthetic imagery modalities were assessed using the Kinaesthetic and Visual Imagery Questionnaire-20 (KVIQ-20), the body rotation task (BRT), and mental chronometry (MC). Additionally, patients' activity level was assessed. Descriptive analyses were performed regarding different age- (< 45, 45-64, > 64), activity levels (inactive, partially active, active), and KVIQ-20 movement classifications (axial, proximal, distal, upper and lower limb). A mixed-effects model was used to investiage the relationship between the primary outcome (MI perspective: internal, external) with the explanatory variables age, MI modality (visual, kinaesthetic), movement type (axial, proximal, distal), activity levels and the different assessments (KVIQ-20, BRT, MC). RESULTS: Imagery modality was not a significant predictor of perspective preference. Over the four measurement sessions, patients tended to become more consistent in their perspective selection, however, time point was not a significant predictor. Movement type was a significant predictor: imagination of distal vs. axial and proximal vs. axial movements were both associated with preference for external perspective. Patients with increased physical activity level tend to use internal imagery, however, this effect was borderline not statistically significant. Age was neither a significant precictor. Regarding the MI assessments, the KVIQ- 20 score was a significant predictor. The patients with higher test scores tend to use the external perspective. CONCLUSION: It 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.

Motor imagery ability assessments in four disciplines: protocol for a systematic review.

INTRODUCTION: Motor imagery (MI) is a very popular and well-accepted technique in different disciplines. Originating from sport and psychology, MI is now also used in the field of medicine and education. Several studies confirmed the benefits of MI to facilitate motor learning and skill acquisition. The findings indicated that individual's MI ability might influence the effectiveness of MI interventions. Over the last two centuries, researchers have developed several assessments to evaluate MI's abstract construct. However, no systematic reviews (SR) exist for MI ability evaluation methods and their measurement properties. METHODS AND ANALYSIS: The SR will evaluate available MI ability assessments and their psychometric properties in four relevant disciplines: sports, psychology, medicine and education. This involves performing searches in SPORTDiscus, PsycINFO, Cochrane Library, Scopus, Web of Science and ERIC. Working independently, two reviewers will screen articles for selection. Then all raw information will be compiled in an overview table-including the articles' characteristics (eg, a study's setting or the population demographics) and the MI ability assessment (psychometric properties). To evaluate the articles' methodological quality, we will use the COSMIN checklist. Then we will evaluate all the included assessments' quality and perform a best-evidence synthesis. Results of this review will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. ETHICS AND DISSEMINATION: The SR is based on published data, and ethical approval is not required. This review will provide information on assessment performance and equipment, as well as its main focus and usefulness. Furthermore, we will present the methodological quality of all the included articles and assess the included instruments' quality. Ultimately, this will act as a valuable resource, providing an overview of MI ability assessments for individual clinical settings, treatment aims, and various populations. The SR's final report will be published in a peer-reviewed journal and presented at relevant conferences. PROSPERO REGISTRATION NUMBER: CRD42017077004.

Using an interactive virtual environment to integrate a digital Action Research Arm Test, motor imagery and action observation to assess and improve upper limb motor function in patients with neuromuscular impairments: a usability and feasibility study protocol.

INTRODUCTION: In the recent past, training systems using an interactive virtual environment have been introduced to neurorehabilitation. Such systems can be applied to encourage purposeful limb movements and will increasingly be used at home by the individual patient. Therefore, an integrated valid and reliable assessment tool on the basis of such a system to monitor the recovery process would be an essential asset. OBJECTIVES: The aim of the study is to evaluate usability, feasibility and validity of the digital version of the Action Research Arm Test using the Bi-Manu-Trainer system as a platform. Additionally, the feasibility and usability of the implementation of action observation and motor imagery tasks into the Bi-Manu-Trainer software will be evaluated. PATIENTS AND METHODS: This observational study is planned as a single-arm trial for testing the new assessment and the action observation and motor imagery training module. Therefore, 75 patients with Parkinson's disease, multiple sclerosis, stroke, traumatic brain injury or Guillain-Barré syndrome will be included. 30 out of the 75 patients will additionally take part in a 4-week training on the enhanced Bi-Manu-Trainer system. Primary outcomes will be the score on the System Usability Scale and the correlation between the conventional and digital Action Research Arm Test scores. Secondary outcomes will be hand dexterity, upper limb activities of daily living and quality of life. HYPOTHESIS: We hypothesise that the digital Action Research Arm Test assessment is a valid and essential tool and that it is feasible to incorporate action observation and motor imagery into Bi-Manu-Trainer practice. The results are expected to give recommendations for necessary modifications and might also contribute knowledge concerning the application of action observation and motor imagery tasks using a training system such as the Bi-Manu-Trainer. TRIAL REGISTRATION NUMBER: NCT03268304; Pre-results.

Muscle Activation During Grasping With and Without Motor Imagery in Healthy Volunteers and Patients After Stroke or With Parkinson's Disease.

Introduction: The present study assessed whether motor imagery (MI) produces electromyographic activation in specific muscles of the upper limb during a hand grasping and arm-lifting task in healthy volunteers, patients after stroke, or with Parkinson's disease. Electromyographic (EMG) activation was compared under three conditions: MI, physical execution (PE), and rest. The task is clinically relevant unilateral executed movement using open muscle chains. Methods: In a cross-sectional study EMG activation was measured in four muscles: M. deltoideus pars clavicularis, M. biceps brachii, M. extensor digitorum, M. flexor carpi radialis. MI ability was evaluated with mental rotation, mental chronometry and the Kinaesthetic and Visual Imagery Questionnaire. Cognitive performance was screened with the Mini-Mental State Examination. Results: Twenty-two participants (11 females, age 52.6 ±15.8, age range 21 to 72) were included: ten healthy volunteers, seven patients after stroke (time after stroke onset 16.3 ± 24.8 months), and five patients with Parkinson's disease (disease duration 60.4 ± 24.5 months). Overall Mini-Mental State Examination scores ranged between 27 and 30. An increased EMG activation during MI compared to rest condition was observed in M. deltoideus pars clavicularis and M. biceps brachii across all participants (p-value = 0.001, p = 0.007). Seven participants (two healthy volunteers, three patients after stroke and two patients with Parkinson's disease) showed a EMG activation during MI of the hand grasping and arm-lifting task in at least one of the target muscles. No correlation between EMG activation during MI and scores of three MI ability assessments were found. Conclusions: The findings suggest that MI can yield subliminal EMG activation. However, that might vary on individual basis. It remains unclear what parameters contribute to or inhibit an EMG activation during MI. Future investigations should determine factors that influence EMG activation, e.g. MI instructions, tasks to imagine, amount of MI training, and longitudinal changes after an MI training period.

Effects of acupuncture and computer-assisted cognitive training for post-stroke attention deficits: study protocol for a randomized controlled trial.

BACKGROUND: A majority of stroke survivors present with cognitive impairments. Attention disturbance, which leads to impaired concentration and overall reduced cognitive functions, is strongly associated with stroke. The clinical efficacy of acupuncture with Baihui (GV20) and Shenting (GV24) as well as computer-assisted cognitive training in stroke and post-stroke cognitive impairment have both been demonstrated in previous studies. To date, no systematic comparison of these exists and the potential beneficial effects of a combined application are yet to be examined. The main objective of this pilot study is to evaluate the effects of computer-assisted cognitive training compared to acupuncture on the outcomes of attention assessments. The second objective is to test the effects of a combined cognitive intervention that incorporates computer-assisted cognitive training and acupuncture (ACoTrain). METHODS/DESIGN: An international multicentre, single-blinded, randomised controlled pilot trial will be conducted. In a 1:1:1 ratio, 60 inpatients with post-stroke cognitive dysfunction will be randomly allocated into either the acupuncture group, the computer-assisted cognitive training group, or the ACoTrain group in addition to their individual rehabilitation programme. The intervention period of this pilot trial will last 4 weeks (30 minutes per day, 5 days per week, Monday to Friday). The primary outcome is the test battery for attentional performance. The secondary outcomes include the Trail Making Test, Test des Deux Barrages, National Institute of Health Stroke Scale, and Modified Barthel Index for assessment of daily life competence, and the EuroQol Questionnaire for health-related quality of life. DISCUSSION: This trial mainly focuses on evaluating the effects of computer-assisted cognitive training compared to acupuncture on the outcomes of attention assessments. The results of this pilot trial are expected to provide new insights on how Eastern and Western medicine can complement one another and improve the treatment of cognitive impairments in early stroke rehabilitation. Including patients with different cultural backgrounds allows a more generalisable interpretation of the results but also poses risks of performance bias. Using standardised and well-described assessments, validated for each region, is pivotal to allow pooling of the data. TRIAL REGISTRATION: Clinical Trails.gov ID: NCT02324959 (8 December 2014).