Enhancing motor imagery practice using synchronous action observation

The effects of action observation and motor imagery on students' ability to identify anatomical locations: a randomised control trial

PURPOSE

Action observation (AO) and motor imagery (MI) are two forms of mental practice that can facilitate motor learning. We investigated if mental practice techniques (AO vs. combined AO+MI) can improve entry-level healthcare students' ability to locate anatomical structures in the immediate and short-term.

MATERIALS AND METHODS

Within a randomised control trial design, participants received a traditional anatomy lecture (Control, n = 13), or lecture plus AO (n = 13), or lecture plus combined AO+MI (n = 12). Mental practice involved either watching a physiotherapist's demonstration of (AO), or watching and imagining the feeling of (AO+MI) locating upper-limb anatomical points on a human model. Post intervention, participants located these points on a human model, assessed by diagnostic ultrasound, immediately and at one-week follow-up.

RESULTS

Immediately post, accuracy was greater for AO+MI (M = 2.0, 95% CI = 1.6-2.4) and AO (M = 2.13, 95% CI = 1.7-2.6), than Control (M = 1.43, 95% CI = 1.0-1.8; ps < 0.05). At the follow-up, AO+MI (M = 2.23, 95% CI = 1.8-2.7) was significantly more accurate than AO (M = 1.30, 95% CI = 0.8-1.8; p < 0.01).

CONCLUSIONS

While mental practice groups out-performed the Control immediately post, only the AO+MI group retained this advantage. Educators should therefore consider augmenting traditional anatomy lectures with mental practice as a low-cost resource for enhancing learning.

Stimulus specificity in combined action observation and motor imagery of typing

Combined action observation and motor imagery (AO + MI) can improve movement execution (ME) in healthy adults and certain patient populations. However, it is unclear how the specificity of the observation component during AO + MI influences ME. As generalised observation could result in more flexible AO + MI rehabilitation programmes, this study investigated whether observing typing of target words (specific condition) or non-matching words (general condition) during AO + MI would have different effects on keyboard typing in healthy young adults. In Experiment 1, 51 students imagined typing a target word while watching typing videos that were either specific to the target word or general. There were no differences in typing execution between AO + MI conditions, though participants typed more slowly after both AO + MI conditions compared with no observation or imagery. Experiment 2 repeated Experiment 1 in 20 students, but with a faster stimulus speed in the AO + MI conditions and increased cognitive difficulty in the control condition. The results showed that the slowed typing after AO + MI was likely due to a strong influence of task-switching between imagery and execution, as well as an automatic imitation effect. Both experiments demonstrate that general and specific AO + MI comparably affect ME. In addition, slower ME following both AO + MI and a challenging cognitive task provides support for the motor-cognitive model of MI.

AMEEGNet: attention-based multiscale EEGNet for effective motor imagery EEG decoding

Recently, electroencephalogram (EEG) based on motor imagery (MI) have gained significant traction in brain-computer interface (BCI) technology, particularly for the rehabilitation of paralyzed patients. But the low signal-to-noise ratio of MI EEG makes it difficult to decode effectively and hinders the development of BCI. In this paper, a method of attention-based multiscale EEGNet (AMEEGNet) was proposed to improve the decoding performance of MI-EEG. First, three parallel EEGNets with fusion transmission method were employed to extract the high-quality temporal-spatial feature of EEG data from multiple scales. Then, the efficient channel attention (ECA) module enhances the acquisition of more discriminative spatial features through a lightweight approach that weights critical channels. The experimental results demonstrated that the proposed model achieves decoding accuracies of 81.17, 89.83, and 95.49% on BCI-2a, 2b and HGD datasets. The results show that the proposed AMEEGNet effectively decodes temporal-spatial features, providing a novel perspective on MI-EEG decoding and advancing future BCI applications.

Effects of Electrical Stimulation on Activation of Mirror Neuron Network in Healthy Adults during Motor Execution and Imitation: An fNIRS Study

BACKGROUND

Observation, execution, and imitation of target actions based on mirror neuron network (MNN) have become common physiotherapy strategies. Electrical stimulation (ES) is a common intervention to improve muscle strength and motor control in rehabilitation treatments. It is possible to enhance MNN's activation by combining motor execution (ME) and motor imitation (MI) with ES simultaneously. This study aims to reveal whether ES could impact cortical activation during ME and MI.

METHODS

We recruited healthy individuals and assigned them randomly to the control group (CG) or experiment group (EG). Participants in EG performed ME and MI tasks with ES, while participants in CG performed the same two tasks with sham ES. We utilized functional near-infrared spectroscopy (fNIRS) to detect brain activation of MNN during ME and MI with and without ES, a randomized block design experiment paradigm was designed. Descriptive analysis of oxy-hemoglobin (HbO) and deoxy-hemoglobin (HbR) were used to show the hemoglobin (Hb) concentration changes after different event onsets in both CG and EG, a linear mixed-effects model (LMM) of HbO data was employed to analyze the effect of ES on the activation of MNN.

RESULTS

A total of 102 healthy adults were recruited and 72 participants' data were analysed in the final report. The block averaged Hb data showed that HbO concentration increased and HbR concentration decreased in most MNN regions during ME and MI in both groups. The LMM results showed that ES can significantly improve the activation of inferior frontal gyrus, middle frontal gyrus, and precentral gyrus during MI, the supplementary motor area, inferior parietal lobule, and superior temporal gyri showed increased activation, but without statistical significance. Although the results did not reach statistical significance during ME, ES still showed positive effects on increased overall activations.

CONCLUSIONS

In this study, we present potential novel rehabilitation approaches that combines MNN strategies and low-frequency ES to enhance cortical activation. Our results revealed that ES has potential to increase activation of most MNN brain areas, providing evidence for related rehabilitative interventions and device development.

CLINICAL TRIAL REGISTRATION

This study was registered on the China Clinical Trial Registration Center (identifier: ChiCTR2200064082, registered 26, September 2022, https://www.chictr.org.cn/showproj.html?proj=178285).

Differences in Mu rhythm when seeing grasping/motor actions in a real context versus on screens

Mu rhythm (∼8-12 Hz) in the somatosensory cortex has traditionally been linked with doing and seeing motor activities. Here, we aimed to learn how the medium (physical or screened) in which motor actions are seen could impact on that specific brain rhythm. To do so, we presented to 40 participants the very same narrative content both in a one-shot movie with no cuts and in a real theatrical performance. We recorded subjects' brain activities with electroencephalographic (EEG) procedures, and analyzed Mu rhythm present in left (C3) and right (C4) somatosensory areas in relation to the 24 motor activities included in each visual stimulus (screen vs. reality) (24 motor and grasping actions x 40 participants x 2 conditions = 1920 trials). We found lower Mu spectral power in the somatosensory area after the onset of the motor actions in real performance than on-screened content, more pronounced in the left hemisphere. In our results, the sensorimotor Mu-ERD (event-related desynchronization) was stronger during the real-world observation compared to screen observation. This could be relevant in research areas where the somatosensory cortex is important, such as online learning, virtual reality, or brain-computer interfaces.

Examining the Equivalence Between Imagery and Execution-Does Imagery Comprise the Intended Spatial Trajectory?

The functional equivalence model suggests a common internal representation initiates both imagery and execution. This suggestion is supported by the mental chronometry effect, where there is a positive relation between task difficulty (as defined by the Index of Difficulty; ID) and imagined movement time. The present study extends this logic by examining whether imagery captures the spatial trajectory. Participants were initially tasked with the imagery and execution of a rapid aiming movement under different IDs. These initial attempts were adapted to configure auditory tones at early (25%) and late (75%) intervals for a separate set of imagery trials. If a tone had sounded, participants had to estimate post-trial where their imagined limb would have been located. The findings revealed increases in ID that coincided with increases in imagined and executed movement times. However, participant mean and standard deviation of estimated locations revealed limited differences between the early and late tones. Further inspection revealed some evidence for these estimated locations shifting further along in space following more rapid imagined movements. While equivalence is clearly evident within the temporal domain, there is comparatively little to suggest that this logic extends to the resolution required for simulating the spatial characteristics of movement.

Theoretical explanations and the availability of information for learning via combined action observation and motor imagery: a commentary on Eaves et al. (2022)

The recent review by Eaves et al. (Psychological Research/Psychologische Forschung, 2022) outlines the research conducted to-date on combined action-observation and motor imagery (AOMI), and more specifically, its added benefit to learning. Of interest, these findings have been primarily attributed to the dual action simulation hypothesis, whereby AO and MI activate separable representations for action that may be later merged when they are congruent with one another. The present commentary more closely evaluates this explanation. What's more, we offer an alternative information-based argument where the benefit to learning may be served instead by the availability of key information. Along these lines, we speculate on possible future directions including the need for a transfer design.

Synchronous action observation and motor imagery may not always represent the optimal form of action simulation: a commentary on Eaves et al. (2022)

(Eaves et al., Psychological Research Psychologische Forschung, 2022) summary review, showing positive behavioural effects of AOMI interventions, is a welcome addition to the field. Several recent studies, however, have reported that AOMI may be no more beneficial than independent MI, and, for some tasks, may add no benefit beyond that obtained via physical practice. We discuss evidence to balance the narrative but support the pragmatic reasons why AOMI remains a suitable and appealing form of action simulation. We propose that further research interrogation of the discrete AOMI states through a more continuum-based approach could address some of the inconsistent data seen in AOMI research.

A commentary on Eaves et al. with a special focus on clinical neurorehabilitation

We very much appreciate the theoretical foundations and considerations of AO, MI, and their combination AO + MI by Eaves et al. In their exploratory review, the authors highlight the beneficial effects of the combined use of AO and MI, with a particular focus on synchronous AO and MI. From a neurorehabilitation perspective, different processes may apply to patients, particularly after a stroke. As suggested by Eaves et al., the cognitive load might prevent the use of synchronous AO + MI and the asynchronous application of AO and MI might be indicated. Furthermore, some aspects should be considered when applying AO + MI in rehabilitation: screening for the patients' cognitive capabilities and MI ability, and a familiarisation programme for AO and MI, before starting with an AO + MI training. With their review, Eaves et al. propose a number of research questions in the field of neurorehabilitation that urgently need to be addressed: the use of asynchronous vs. synchronous AOMI, observation and imagination with or without errors, or use of different MI perspectives and modes in different learning stages. This commentary provides some additional suggestions on patients' MI ability and cognitive level, MI familiarisation and detailed reporting recommendations to transfer Eaves et al. findings into clinical practice.

Imagery and motor learning: a special issue on the neurocognitive mechanisms of imagery and imagery practice of motor actions

Human beings are able to imagine actions with the aim to change movement coordination and to learn particular movements. Meta-analyses to date have shown that when individuals systematically engage in imagery of a motor action without overt behavior this can improve motor performance and facilitate motor learning. Despite a considerable body of research in neuroscience, psychology, and sport science, however, there is at present no consensus on the neurocognitive mechanisms of imagery, and the mechanisms that lead to learning via imagined action are still being debated. In particular, the differences between imagined and overt action, and respective learning effects, remain to be fully explained. The present collection of manuscripts is a result of compiling both theoretical advances in the field of motor control and motor learning and those in imagery research to better understand imagery and learning. It is structured alongside five position papers from leading experts in the field, each of which is followed by a series of short commentaries written by experts from various disciplines. This collection demonstrates (a) that conceptualizations of imagery are manifold, vary highly and depend on the perspective chosen, (b) that existing approaches to the neurocognitive mechanisms of imagery and imagery practice of motor actions draw on distinct motor control and learning perspectives, (c) that perspectives from the wider fields of motor control and learning stimulate new approaches to explain imagery and imagery practice, (d) and that future research is needed to investigate and compare different perspectives and conceptualizations of the neurocognitive mechanisms of imagery and imagery practice of motor actions.

Learning motor actions via imagery-perceptual or motor learning?

It is well accepted that repeatedly imagining oneself acting without any overt behavior can lead to learning. The prominent theory accounting for why imagery practice is effective, motor simulation theory, posits that imagined action and overt action are functionally equivalent, the exception being activation of the end effector. If, as motor simulation theory states, one can compile the goal, plan, motor program and outcome of an action during imagined action similar to overt action, then learning of novel skills via imagery should proceed in a manner equivalent to that of overt action. While the evidence on motor simulation theory is both plentiful and diverse, it does not explicitly account for differences in neural and behavioural findings between imagined and overt action. In this position paper, we briefly review theoretical accounts to date and present a perceptual-cognitive theory that accounts for often observed outcomes of imagery practice. We suggest that learning by way of imagery reflects perceptual-cognitive scaffolding, and that this 'perceptual' learning transfers into 'motor' learning (or not) depending on various factors. Based on this theory, we characterize consistently reported learning effects that occur with imagery practice, against the background of well-known physical practice effects and show that perceptual-cognitive scaffolding is well-suited to explain what is being learnt during imagery practice.

A theoretical perspective on action consequences in action imagery: internal prediction as an essential mechanism to detect errors

Acting in the environment results in both intended and unintended consequences. Action consequences provide feedback about the adequacy of actions while they are in progress and when they are completed and therefore contribute to monitoring actions, facilitate error detection, and are crucial for motor learning. In action imagery, no actual action takes place, and consequently, no actual action consequences are produced. However, imagined action consequences may replace actual action consequences, serving a similar function and facilitating performance improvements akin to that occurring with actual actions. In this paper, we conceptualize action imagery as a simulation based on internal models. During that simulation, forward models predict action consequences. A comparison of predicted and intended action consequences sometimes indicates the occurrence of action errors (or deviations from optimal performance) in action imagery. We review research indicating that action errors are indeed sometimes imagined in action imagery. These results are compatible with the view that action imagery is based on motor simulation but incompatible with the view that action imagery is solely based on abstract knowledge. The outlined framework seems suitable to cover a wide range of action imagery phenomena and can explain action imagery practice effects.

Effect of concurrent action observation, peripheral nerve stimulation and motor imagery on dexterity in patients after stroke: a pilot study

Research to improve and expand treatment options for motor impairment after stroke remains an important issue in rehabilitation as the reduced ability to move affected limbs is still a limiting factor in the selection of training content for stroke patients. The combination of action observation and peripheral nerve stimulation is a promising method for inducing increased excitability and plasticity in the primary motor cortex of healthy subjects. In addition, as reported in the literature, the use of action observation and motor imagery in conjunction has an advantage over the use of one or the other alone in terms of the activation of motor-related brain regions. The aim of the pilot study was thus to combine these findings into a multimodal approach and to evaluate the potential impact of the concurrent application of the three methods on dexterity in stroke patients. The paradigm developed accordingly was tested with 10 subacute patients, in whom hand dexterity, thumb-index pinch force and thumb tapping speed were measured for a baseline assessment and directly before and after the single intervention. During the 10-min session, patients were instructed to watch a repetitive thumb-index finger tapping movement displayed on a monitor and to imagine the sensations that would arise from physically performing the same motion. They were also repeatedly electrically stimulated at the wrist on the motorically more affected body side and asked to place their hand behind the monitor for the duration of the session to support integration of the displayed hand into their own body schema. The data provide a first indication of a possible immediate effect of a single application of this procedure on the dexterity in patients after stroke.

Motor imagery drives the effects of combined action observation and motor imagery on corticospinal excitability for coordinative lower-limb actions

Combined action observation and motor imagery (AOMI) facilitates corticospinal excitability (CSE) and may potentially induce plastic-like changes in the brain in a similar manner to physical practice. This study used transcranial magnetic stimulation (TMS) to explore changes in CSE for AOMI of coordinative lower-limb actions. Twenty-four healthy adults completed two baseline (BLH, BLNH) and three AOMI conditions, where they observed a knee extension while simultaneously imagining the same action (AOMICONG), plantarflexion (AOMICOOR-FUNC), or dorsiflexion (AOMICOOR-MOVE). Motor evoked potential (MEP) amplitudes were recorded as a marker of CSE for all conditions from two knee extensor, one dorsi flexor, and two plantar flexor muscles following TMS to the right leg representation of the left primary motor cortex. A main effect for experimental condition was reported for all three muscle groups. MEP amplitudes were significantly greater in the AOMICONG condition compared to the BLNH condition (p = .04) for the knee extensors, AOMICOOR-FUNC condition compared to the BLH condition (p = .03) for the plantar flexors, and AOMICOOR-MOVE condition compared to the two baseline conditions for the dorsi flexors (ps ≤ .01). The study findings support the notion that changes in CSE are driven by the imagined actions during coordinative AOMI.

Development and Validation of the Combined Action Observation and Motor Imagery Ability Questionnaire

Combined use of action observation and motor imagery (AOMI) is an increasingly popular motor-simulation intervention, which involves observing movements on video while simultaneously imagining the feeling of movement execution. Measuring and reporting participant imagery-ability characteristics are essential in motor-simulation research, but no measure of AOMI ability currently exists. Accordingly, the AOMI Ability Questionnaire (AOMI-AQ) was developed to address this gap in the literature. In Study 1, two hundred eleven participants completed the AOMI-AQ and the kinesthetic imagery subscales of the Movement Imagery Questionnaire-3 and Vividness of Motor Imagery Questionnaire-2. Following exploratory factor analysis, an 8-item AOMI-AQ was found to correlate positively with existing motor-imagery measures. In Study 2, one hundred seventy-four participants completed the AOMI-AQ for a second time after a period of 7-10 days. Results indicate a good test-retest reliability for the AOMI-AQ. The new AOMI-AQ measure provides a valid and reliable tool for researchers and practitioners wishing to assess AOMI ability.

No increase in corticospinal excitability during motor simulation provides a platform to explore the neurophysiology of aphantasia

This scientific commentary refers to 'Explicit and implicit motor simulations are impaired in individuals with aphantasia', by Dupont  et al. (https://doi.org/10.1093/braincomms/fcae072) in Brain Communications.

Event-Related EEG Desynchronization Reveals Enhanced Motor Imagery From the Third Person Perspective by Manipulating Sense of Body Ownership With Virtual Reality for Stroke Patients

Virtual reality (VR)-based rehabilitation training holds great potential for post-stroke motor recovery. Existing VR-based motor imagery (MI) paradigms mostly focus on the first-person perspective, and the benefit of the third-person perspective (3PP) remains to be further exploited. The 3PP is advantageous for movements involving the back or those with a large range because of its field coverage. Some movements are easier to imagine from the 3PP. However, the 3PP training efficiency may be unsatisfactory, which may be attributed to the difficulty encountered when generating a strong sense of ownership (SOO). In this work, we attempt to enhance a visual-guided 3PP MI in stroke patients by eliciting the SOO over a virtual avatar with VR. We propose to achieve this by inducing the so-called out-of-body experience (OBE), which is a full-body illusion (FBI) that people misperceive a 3PP virtual body as his/her own (i.e., generating the SOO to the virtual body). Electroencephalography signals of 13 stroke patients are recorded while MI of the affected upper limb is being performed. The proposed paradigm is evaluated by comparing event-related desynchronization (ERD) with a control paradigm without FBI induction. The results show that the proposed paradigm leads to a significantly larger ERD during MI, indicating a bilateral activation pattern consistent with that in previous studies. In conclusion, 3PP MI can be enhanced in stroke patients by eliciting the SOO through induction of the "OBE" FBI. This study offers more possibilities for virtual rehabilitation in stroke patients and can further facilitate VR application in rehabilitation.

Observing an expert's action swapped with an observer's face increases corticospinal excitability during combined action observation and motor imagery

This study aimed to examine whether observing an expert's action swapped with an observer's face increases corticospinal excitability during combined action observation and motor imagery (AOMI). Twelve young males performed motor imagery of motor tasks with different difficulties while observing the actions of an expert performer and an expert performer with a swapped face. Motor tasks included bilateral wrist dorsiflexion (EASY) and unilateral two-ball rotating motions (DIFF). During the AOMI of EASY and DIFF, single-pulse transcranial magnetic stimulation was delivered to the left primary motor cortex, and motor-evoked potentials (MEPs) were obtained from the extensor carpi ulnaris and first dorsal interosseous muscles of the right upper limb, respectively. Visual analogue scale (VAS) assessed the subjective similarity of the expert performer with the swapped face in the EASY and DIFF to the participants themselves. The MEP amplitude in DIFF was larger in the observation of the expert performer with the swapped face than that of the expert performer (P = 0.012); however, the corresponding difference was not observed in EASY (P = 1.000). The relative change in the MEP amplitude from observing the action of the expert performer to that of the expert performer with the swapped face was positively correlated with VAS only in DIFF (r = 0.644, P = 0.024). These results indicate that observing the action of an expert performer with the observer's face enhances corticospinal excitability during AOMI, depending on the task difficulty and subjective similarity between the expert performer being observed and the observer.

Guidelines for reporting action simulation studies (GRASS): Proposals to improve reporting of research in motor imagery and action observation

Researchers from multiple disciplines have studied the simulation of actions through motor imagery, action observation, or their combination. Procedures used in these studies vary considerably between research groups, and no standardized approach to reporting experimental protocols has been proposed. This has led to under-reporting of critical details, impairing the assessment, replication, synthesis, and potential clinical translation of effects. We provide an overview of issues related to the reporting of information in action simulation studies, and discuss the benefits of standardized reporting. We propose a series of checklists that identify key details of research protocols to include when reporting action simulation studies. Each checklist comprises A) essential methodological details, B) essential details that are relevant to a specific mode of action simulation, and C) further points that may be useful on a case-by-case basis. We anticipate that the use of these guidelines will improve the understanding, reproduction, and synthesis of studies using action simulation, and enhance the translation of research using motor imagery and action observation to applied and clinical settings.

What we imagine learning from watching others: how motor imagery modulates competency perceptions resulting from the repeated observation of a juggling action

Although motor learning can occur from observing others perform a motor skill (action observation; AO), observers' confidence in their own ability to perform the skill can be falsely increased compared to their actual ability. This illusion of motor competence (i.e., 'over-confidence') may arise because the learner does not gain access to sensory feedback about their own performance-a source of information that can help individuals understand their veridical motor capabilities. Unlike AO, motor imagery (MI; the mental rehearsal of a motor skill) is thought to be linked to an understanding of movement consequences and kinaesthetic information. MI may thus provide the learner with movement-related diagnostic information, leading to greater accuracy in assessing ability. The present study was designed to evaluate the effects of MI when paired with AO in assessments of one's own motor capabilities in an online observation task. Two groups rated their confidence in performing a juggling task following repeated observations of the action without MI (OBS group; n = 45) or with MI following observation (OBS+MI; n = 39). As predicted, confidence increased with repeated observation for both groups, yet increased to a greater extent in the OBS relative to the OBS+MI group. The addition of MI appeared to reduce confidence that resulted from repeated AO alone. Data support the hypothesis that AO and MI are separable and that MI allows better access to sensory information than AO. However, further research is required to assess changes in confidence that result from MI alone and motor execution.

Observation and imitation of object-directed hand movements in Parkinson's disease

Action observation and imitation may facilitate movement in Parkinson's disease (PD). People with PD have been found to imitate intransitive actions similarly to neurologically healthy older adults, but their imitation of object-directed hand movements has not previously been investigated using kinematic measures. The present study examined observation and imitation of object-directed hand movements in 18 participants with PD and 21 neurologically healthy age-matched control participants. Participants observed and immediately imitated sequences showing a human hand reaching for and transferring an object between horizontal positions. Both groups significantly modulated their finger movements, showing higher vertical amplitude when imitating elevated compared to direct trajectories. In addition, movements were lower in vertical amplitude and higher in velocity when imitating the reaching segment than the transfer segment. Eye-tracking revealed that controls made smaller saccades when observing predictable than unpredictable elevated movements, but no effects of predictability on eye movements were found for the PD group. This study provides quantitative evidence that people with mild to moderate PD can imitate object-directed hand movement kinematics, although their prediction of such movements may be reduced. These findings suggest that interventions targeting object-directed actions may capitalize on the ability of people with PD to imitate kinematic parameters of a demonstrated movement.

Inter-task transfer of force gains is facilitated by motor imagery

Introduction

There is compelling evidence that motor imagery (MI) contributes to improve muscle strength. While strong effects have been observed for finger muscles, only few experiments with moderate benefits were conducted within applied settings targeting large upper or lower limb muscles. The aim of the present study was therefore to extend the investigation of embedded MI practice designed to improve maximal voluntary strength on a multi-joint dynamic exercise involving the lower limbs. Additionally, we tested whether targeting the content of MI on another movement than that physically performed and involving the same body parts might promote inter-task transfer of strength gains.

Methods

A total of 75 participants were randomly assigned into three groups who underwent a physical training on back squat. During inter-trial recovery periods, a first MI group (n = 25) mentally rehearsed the back squat, while a second MI group (n = 25) performed MI of a different movement involving the lower limbs (deadlift). Participants from the control group (n = 25) completed a neutral cognitive task during equivalent time. Strength and power gains were assessed ecologically using a velocity transducer device at 4 different time periods.

Results

Data first revealed that participants who engaged in MI of the back squat improved their back squat performance (p < 0.03 and p < 0.01, respectively), more than the control group (p < 0.05), hence supporting the positive effects of MI on strength. Data further supported the inter-task transfer of strength gains when MI targeted a movement that was not physically trained (p = 0.05).

Discussion

These findings provide experimental support for the use of MI during physical training sessions to improve and transfer force development.

Enhancing upper-limb neurorehabilitation in chronic stroke survivors using combined action observation and motor imagery therapy

Introduction

For people who have had a stroke, recovering upper-limb function is a barrier to independence. When movement is difficult, mental practice can be used to complement physical therapy. In this within-participants study we investigated the effects of combined action observation and motor imagery (AO + MI) therapy on upper-limb recovery in chronic stroke survivors.

Methods

A Graeco-Latin Square design was used to counterbalance four mental practice conditions (AO + MI, AO, MI, Control) across four cup-stacking tasks of increasing complexity. Once a week, for five consecutive weeks, participants (n = 10) performed 16 mental practice trials under each condition. Each trial displayed a 1st person perspective of a cup-stacking task performed by an experienced model. For AO, participants watched each video and responded to an occasional color cue. For MI, participants imagined the effort and sensation of performing the action; cued by a series of still-images. For combined AO + MI, participants observed a video of the action while they simultaneously imagined performing the same action in real-time. At three time points (baseline; post-test; two-week retention test) participants physically executed the three mentally practiced cup-stacking tasks, plus a fourth unpractised sequence (Control), as quickly and accurately as possible.

Results

Mean movement execution times were significantly reduced overall in the post-test and the retention test compared to baseline. At retention, movement execution times were significantly shorter for combined AO + MI compared to both MI and the Control. Individual participants reported clinically important changes in quality of life (Stroke Impact Scale) and positive qualitative experiences of AO + MI (social validation).

Discussion

These results indicate that when physical practice is unsuitable, combined AO + MI therapy could offer an effective adjunct for neurorehabilitation in chronic stroke survivors.