Walking improves with mental rehearsal


8 November 2018

The study in brief

Motor imagery (MI) is a technique where you visualise yourself doing an activity without actually moving.  This technique is used by athletes to improve their performance and also by physiotherapists to help people regain movements. 

This study assessed walking in people with mild to moderate disability (EDSS 1.5 to 4.5) before and after practising MI for four weeks. Participants were divided into three groups to test the effect of adding additional cues or prompts: MI alone, MI combined with rhythmic music, and MI with music plus additional simple instructions. 

All of the groups had improvements in walking speed and walking distance, with the biggest improvements seen in the group which practised MI combined with music and instructions. Fatigue and quality of life improved significantly using cued MI, with the greatest changes seen after MI plus music and instructions. Both types of cued MI also resulted in better synchronization of walking to fast and slow music.

The study shows that, if your walking is mildly impaired, mentally rehearsing walking could improve actual walking and this effect can be enhanced if you imagine walking while listening to rhythmic music with additional verbal cues.

The study in more detail

Background

Motor imagery (MI) is a technique where you visualise yourself doing an activity without actually 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 develop the nerve pathways that control a movement. This technique is commonly used by athletes to rehearse movements and skills to improve their performance.

Physiotherapists also use this technique to help people regain movements.  Providing additional prompts, or cues, to the motor imagery, such as listening to rhythmic music and verbal instructions, help to reinforce the imagined movements.  This study compared differently cued and non-cued MI on walking, fatigue and quality of life to get a better idea of how motor imagery might be working.

How this study was carried out

60 people with MS with mild to moderate levels of disability (EDSS 1.5 – 4.5) were recruited from an MS clinic in Austria.  They were assigned to three different groups:

  • MVMI - music and verbally cued MI – given CDs that contained verbal instructions to imagine walking tasks, together with instrumental music and, in time with the music,  simple instructions such as “stamp-stamp” or “large step”
  • MMI - music cued MI - given CDs that contained verbal instructions to imagine walking tasks, together with instrumental music
  • MI - MI alone - given CDs that contained verbal instructions to imagine walking tasks

Participants were given training and then asked to use the CDs to practise MI at home while sitting down for 17 minutes a day, six times per week for 4 weeks.  The main measures were walking speed (timed 25 foot walk) and walking distance (6 minute walk test) before and after the 4 weeks of treatment.  Participants also completed questionnaires to assess their fatigue levels and quality of life before and after treatment.  Finally, participants were videoed walking in time to fast and slow paced music to test their ability to synchronise movements with music.

What was found

All of the groups had significant improvements in walking speed and walking distance, with the biggest improvements seen in the MVMI group.  Fatigue and quality of life improved significantly using cued MI, with the greatest changes seen after MVMI.  Both types of cued MI also resulted in better synchronization of walking to fast and slow music with more uniform step length and timing.

What does it mean?

Mentally rehearsing walking improves actual walking and this effect is enhanced when you imagine walking while listening to rhythmic music with additional verbal cues. 

The researchers acknowledge that the study only collected data before and after the 4 weeks of practising motor imagery; there was no follow-up data.  This means that it is not possible to tell whether a single four week course of motor imagery would have a long lasting effect or whether regular practise would be necessary to maintain improvements.

Seebacher B, et al.
Effects and mechanisms of differently cued and non-cued motor imagery in people with multiple sclerosis: A randomised controlled trial.
Mult Scler. 2018 Aug 14. [Epub ahead of print]
Abstract - PubMed website

More about walking difficulties

Many people with MS have some difficulties with walking. Walking problems vary considerably from one person with MS to another. Common difficulties are:

  • Unsteadiness on walking or turning
  • Slower, shorter steps
  • Less confidence
  • Needing support from walls, furniture or other people
  • Tripping and stumbling
  • A heavy feeling in the legs when stepping forward
  • Weakness of the leg when weight is on it
  • Difficulty placing the foot on the ground

A symptom called foot drop can be experienced by some people with MS.

In MS, many of these problems are initially caused by the slowed or altered nerve conduction, which results in muscle weakness, spasm or spasticity (muscle stiffness) and sensory changes. However, other MS symptoms can have a large impact on walking, such as difficulties with balance, pain, tremor, dizziness and visual problems. For example, vision that is double, blurred or has altered depth perception can make it difficult to place your feet or judge steps and kerbs.

The best way forward depends on what is causing the walking difficulties. A health professional, such as a GP, MS nurse or physiotherapist can advise. Treatment may involve physiotherapy or drug treatments to alleviate specific underlying symptoms such as spasticity.

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