Effects and Mechanisms of Rhythmic-Cued Motor Imagery on Walking, Fatigue and Quality of Life in People with Multiple Sclerosis

Abstract

BACKGROUND: walking impairment, fatigue and reduced (health-related, HR) quality
of life (QoL) are key problems for people with multiple sclerosis (pwMS). Motor
imagery (MI) and rhythmic cueing have been shown to improve motor function. It is
unclear whether a combined rhythmic-cued MI treatment is effective in pwMS.
AIMS: the aims of this thesis were to investigate the effects and mechanisms of
differently cued and non-cued MI on walking, fatigue, (HR)QoL, MI ability and gait
synchronisation with music beat in pwMS. Two randomised controlled trials and a
reliability study were conducted, to examine the gait analysis instruments.
METHODS: adults with mild to moderate MS were recruited at the MS-Clinic,
Innsbruck Medical University, Austria and randomised to one of three groups.
Participants practised MI of walking for 17 minutes, 6 times per week for 4 weeks. In
Study 1, music-verbal-MI group participants performed music- and verbally-cued MI,
metronome-verbal-MI group participants practiced metronome- and verbally-cued MI
and participants in the control group received no intervention apart from their usual
care, as all participants did. In Study 2, participants in the music-verbal-MI group
practised music-cued MI with verbal cueing, participants in the music-MI group
performed music-only cued MI and non-cued MI participants practised MI alone.
Primary outcomes were walking speed and walking distance. Secondary outcomes
were walking perception, fatigue, (HR)QoL, MI ability and sensorimotor
synchronisation, of gait to a music beat.
RESULTS: after rhythmic-cued MI, significant improvements in walking speed,
distance and perception were observed when compared to no intervention or noncued
MI. The greatest and clinically most significant improvements in fatigue and
(HR)QoL were seen after music- and verbally-cued MI. All participants were able to
perform MI and showed improved MI ability after the 4 week intervention. The gait
analysis instruments used were shown to be reliable. Post-intervention, sensorimotor
synchronisation was significantly more accurate in participants in the rhythmic-cued
MI groups, as compared to those in the non-cued MI group. There were no adverse
events, full compliance was observed and 217 participated in the whole study.
CONCLUSIONS: as a stand-alone treatment, both non-cued and metronome- and
verbally-cued MI significantly improved walking in pwMS. All types of rhythmic-cued
MI significantly improved walking, fatigue and (HR)QoL in pwMS, but music- and
verbally-cued MI was shown to be superior. After a familiarisation with rhythmic-cued
MI, all participants showed high MI ability. This suggests that participants were
undertaking MI and supports MI being a reasonable explanation for the improvements
found. Sensorimotor synchronisation improved only after cued MI and might be
another mechanism which contributed to participants’ walking improvements. This
thesis, therefore, provides recommendations for physiotherapists on utilising
rhythmic-cued MI, without physical practice, for the treatment of walking impairment
and fatigue in pwMS.

Date of Award	Jan 2018
Original language	English
Awarding Institution	University of Brighton
Supervisor	Raija Kuisma (Supervisor) & Angela Glynn (Supervisor)