The Kinesthetic and Visual Imagery Questionnaire (KVIQ) for Assessing Motor Imagery in Persons with Physical Disabilities: A Reliability and Construct Validity Study

Do menstrual symptoms affect motor imagery skills in young women?

PURPOSE

To examine the relationship between menstrual symptoms and motor imagery skills in young women.

METHODS

A total of 117 women between the ages of 18-40 were included in the study. Visual Analog Scale (VAS) for the menstrual pain intensity, the Menstrual Symptom Questionnaire (MSQ) for the menstrual-related symptoms, and the Kinesthetic and Visual Imagery Questionnaire-20 (KVIQ-20) for the motor imagery were used. All measurements were conducted on the first or second day of the menstruation, depending on when the subject declared subjectively experiencing most symptoms.

RESULTS

The relationship between menstruation symptoms and visual imagery (VI) and kinesthetic imagery (KI) skills was examined. A weak negative correlation was found between MSQ_negative effects/somatic complaints and KVIQ-20_KI (p = .040, r = -.199). The relationship between menstrual pain intensity and KVIQ-20 items was examined. The strongest relationship was found between VAS and KVIQ-20_knee_VI and KVIQ-20_hip_VI (p = 003, r = -.288; p = 005, r = -.270; p = 004, respectively). A weak negative correlation was also found between VAS and KVIQ-20_VI_total and KVIQ-20_KI_total (p = 0.004, r = -.275; p = 0.19, r = -.227, respectively).

DISCUSSION

This is the first study to examine menstrual symptoms in women in detail and reveal their relationship with motor imagery skills. Menstrual symptoms, especially negative effects/somatic complaints seen during menstruation, negatively affect kinesthetic imagery ability. In addition; chronic menstrual pain has a negative effect on both kinesthetic and visual imagery abilities. Considering the impairments in motor imagery skills due to negative effects/somatic complaints during menstruation and chronic menstrual pain, adding motor imagery training to treatment programs aimed at improving women's health may have positive effects.

Even with exposure to errors, motor imagery cannot update internal models

Recent evidence suggests that motor imagery is insufficient for updating internal models, essential for predicting and refining overt movement outcomes. The covert nature of motor imagery limits exposure to errors, perhaps preventing the updating of internal models. To explore this, 90 participants were exposed to a prism that shifted vision leftward, completing 20 physical pointing trials followed by either 230 more physical pointing trials [physical practice (PP)], 230 imagined pointing trials [physical practice motor imagery (PP-MI)], 230 unrelated task trials [physical practice control (PP-CTRL)], or no further trials [physical practice none (PP-None)]. We hypothesized that if exposure to errors is needed for motor imagery to update internal models, then PP-MI would exhibit aftereffects, characterized by pointing opposite to the prism shift (i.e., rightwards), similar to PP, but differing from PP-CTRL and PP-None. After prism exposure, all groups showed significant aftereffects (PP: 4.73° ± 2.12°, PP-MI: 2.62 ± 1.61, PP-CTRL: 2.58 ± 1.53, PP-None: 3.11 ± 1.68), however there were no significant differences in the magnitude of aftereffects between PP-MI, and PP-CTRL/PP-None. Our findings demonstrate that motor imagery alone is insufficient for updating internal models, even when participants are initially exposed to errors under a prism shift. This further reinforces that motor imagery is not a direct simulation of overt movement, as proposed by Motor Simulation Theory- the foundation for its use in rehabilitation. Deepening our understanding of how learning occurs through motor imagery is crucial for enhancing its effectiveness in practical applications like rehabilitation.

The effectiveness of graded motor imagery training on pain and functionality in patients with subacromial pain syndrome: A prospective, single-blind, randomized controlled trial

Background

Pain from subacromial pain syndrome (SAPS) can limit individuals' daily activities and reduce physical performance. The effectiveness of graded motor imagery (GMI) training for this condition remains unexplored. This prospective, randomized controlled trial aimed to determine the effects of GMI training in patients with chronic painful SAPS.

Methods

Forty-two patients with SAPS were randomly assigned to the GMI (n = 21) and the control (n = 21) groups. Primary measures were the visual analogue scale (VAS), and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Secondary measures were Active Range of Motion (AROM), muscle strength, lateralization performance and Kinesthetic and Visual Imagery Questionnaire (KVIQ). Evaluations occurred at baseline, postintervention (6 weeks), and after a 6-week follow up.

Results

The GMI group showed significantly greater improvements in both primary and secondary outcomes compared to the control group (p < 0.001). Significantly larger effect sizes were found in favor of the GMI group for VAS, DASH, abduction, external rotation AROM, muscle strength, lateralization performance, and KVIQ (ηp2 < 0.14, p < 0.05, for all).

Conclusions

The integration of GMI training into conventional physiotherapy for SAPS rehabilitation provides more effective clinical results in improving pain intensity and increasing functionality.

The effect of motor imagery on functionality, pain, kinesiophobia, and quality of life in patients with distal radius fractures: A randomized controlled double-blind study

BACKGROUND

Conventional physiotherapy plays a significant role in treating distal radius fractures (DRF), but pain and functional limitations can persist despite treatment. Therefore, additional interventions are needed to improve treatment efficacy. Motor imagery (MI) has been shown to improve pain, function, range of motion (ROM), and muscle strength in musculoskeletal rehabilitation, though studies on its effect on upper extremity injuries are limited.

PURPOSE

To investigate the effect of MI training applied with the telerehabilitation method on pain, kinesiophobia, and functionality in patients with DRF.

STUDY DESIGN

This was a double-blind randomized controlled trial with registration number NCT05360836.

METHODS

Thirty volunteer patients aged 18-65 years with DRF, who decided to be treated conservatively, were randomly allocated to either the conventional treatment (CT) group (n = 15; 40.28 ± 18.18 years) or the MI group (n = 15; 38.80 ± 14.12 years). The MI group received imagery treatment in addition to traditional rehabilitation, and the CT group received traditional rehabilitation (three times a week for 8 weeks). Disabilities of Arm, Shoulder and Hand was our primary outcome measure, while the secondary outcome measures included the Patient Rated Wrist Evaluation, Visual Analog Scale, Tampa Scale for Kinesiophobia, normal ROM in the wrist joint, grip strength of hand and finger, left-right discrimination, and quality of life.

RESULTS

The pain intensity, wrist functional status, muscle strength, active ROM, and quality of life were improved in both groups. Group comparisons showed statistically significant changes in Patient Rated Wrist Evaluation-function parameter, wrist extension active ROM, and hand grip strength in favor of the MI group (respectively, Δmean = -13.15, p = 0.034, effect size [ES] = 0.76, Δmean = -9.33, p = 0.019, ES = 0.91, Δmean = -10.96, p = 0.008, ES = 0.94).

CONCLUSIONS

Adding MI to conservative treatment after DRF improved function, wrist extension, and hand grip strength compared to CT alone.

Evaluating Motor Imagery Capabilities in Fatigued Versus Non-Fatigued Individuals With Multiple Sclerosis Without Cognitive Impairment

BackgroundMotor imagery is adversely affected by various factors in individuals with multiple sclerosis (MS). However, the impact of MS-related fatigue on motor imagery remains unclear. Our study aimed to compare motor imagery abilities between fatigued and non-fatigued individuals with MS without cognitive impairment.MethodsThis study included 73 individuals with MS, with Expanded Disability Status Scale scores from 0 to 4.5. Participants were divided into 2 groups based on Fatigue Severity Scale scores: ≥4 for Fatigued Group and <4 for Non-fatigued Group. Assessment of motor imagery vividness was done through Kinesthetic and Visual Imagery Questionnaire-20 (KVIQ-20). The Box and Block Test (BBT) and the Timed Up and Go (TUG) were employed for the temporal congruence component.ResultsThe mean ages of the Fatigued Group (30.4 ± 9.2 years) and the Non-fatigued Group (31.5 ± 9.8 years) were similar (P = .650). The fatigued Group exhibited significantly lower kinesthetic imagery scores on the KVIQ-20 (P = .028) and significantly lower performance in the BBT (upper extremities) mental chronometry test for both the most affected and least affected sides of the upper extremities (P = .007 and .028, respectively). Additionally, the Fatigued Group showed significantly lower performance in the TUG (lower extremities) mental chronometry test (P = .006).ConclusionIn fatigued individuals with MS, there is a greater impact on both temporal congruence components and kinesthetic motor imagery abilities. The difference in the temporal congruence component was observed in tests involving both TUG (lower extremities) and BBT (upper extremities), independent of the affected side.

Speed-accuracy trade-offs in action perception, motor imagery, and execution of hand movements in autistic and non-autistic adults

Action perception, execution, and imagery share motor-cognitive processes. Given prevalent sensory and motor coordination difficulties in autism, the processes of action perception and imagery may also be altered. This study investigated whether autistic adults can engage in motor imagery by testing potential differences in executing, perceiving, and imagining hand movements between autistic and non-autistic adults. Twenty autistic individuals and twenty age- and IQ-matched controls completed execution, imagination, and perception tasks using a Fitts' Law paradigm in an online session. For the execution and imagination tasks, participants performed or imagined making aiming movements between two targets. For the action perception task, participants indicated whether they could perform as accurately as the movements in presented videos. Target size and distance were manipulated into three difficulty levels and systematically varied across all tasks. Results showed Fitts' Law relationships for all tasks for both groups, with significant positive correlations between movement times and difficulty level. Movement times were longest in the imagination task and shortest in the perception task for both groups. These findings suggest motor imagery processes are relatively intact in autistic adults, highlighting that further investigation of motor imagery as a therapy for motor coordination difficulties in autistic individuals is warranted.

Parkinson's disease impairs the controllability of imagined action sequences

Parkinson's Disease (PD) leads to deficits in motor control that may stem in part from impaired processing of action representations, which can be investigated using motor imagery. The controllability component of motor imagery in particular refers to the ability to precisely manipulate a motor image. Research measuring this component in PD via the Hand Laterality Judgment Task has generated inconsistent results. We sought to examine whether PD affects the controllability of motor imagery using a test that explicitly directs the use of motor imagery and involves complex action sequences. Thirty-nine people with PD on their regular medication regimen and thirty-eight controls completed the Test of Ability in Movement Imagery (TAMI). The PD group scored significantly worse than controls on the TAMI. Poorer cognitive function predicted lower TAMI scores for the PD group only. These results indicate that people with PD imagine action sequences less accurately than healthy older adults. It is possible that the disease impairs the ability to transfer sensorimotor information across sequential actions, an ability that is key to efficient motor behaviour. An alternative explanation is that motor dysfunction leads to less well-developed action representations for the actions featured in the TAMI, resulting in motor images that were of low fidelity to the target actions in the PD group. Given the documented effects of dopaminergic medication on the cognitive control process that support action sequencing, it would be of interest to determine if a similar pattern of results emerged in people with PD who are off medication.

Nature documentaries vs. quiet rest: no evidence for an impact on event-related desynchronization during motor imagery and neurofeedback

Motor imagery (MI) in combination with neurofeedback (NF) has emerged as a promising approach in motor neurorehabilitation, facilitating brain activity modulation and promoting motor learning. Although MI-NF has been demonstrated to enhance motor performance and cortical plasticity, its efficacy varies considerably across individuals. Various context factors have been identified as influencing neurophysiological outcomes in motor execution and MI, however, their specific impact on event-related desynchronization (ERD), a key neurophysiological marker in NF, remains insufficiently understood. Previous research suggested that declarative interference following MI-NF may serve as a context factor hindering the progression of ERD. Yet, no significant changes in ERD within the mu and beta (8-30 Hz) frequency bands were observed across blocks in either a declarative interference or a control condition. This raises the question of whether the absence of ERD modulation could be attributed to the break task that was common to both declarative interference and control condition: watching nature documentaries immediately after MI blocks. To investigate this, we conducted a follow-up study replicating the original methodology while collecting new data. We compared NF-MI-ERD between groups with and without nature documentaries as a post-MI condition. Participants completed three sessions of kinesthetic MI-NF training involving a finger-tapping task over two consecutive days, with quiet rest as the post-MI condition (group quiet rest). 64-channel EEG data were analyzed from 17 healthy participants (8 females, 18-35 years, M and SD: 25.2 ± 4.2 years). Data were compared to a previously recorded dataset (group documentaries), in which 17 participants (10 females, 23-32 years, M and SD: 25.8 ± 2.5 years) watched nature documentaries after MI blocks. The results showed no significant main effects for blocks or group, though a session-by-group interaction was observed. Post-hoc tests, however, did not reveal significant differences in ERD development between the groups across individual blocks. These findings do not provide evidence that nature documentaries used as a post-MI condition negatively affect across-block development of NF-MI-ERD. This study highlights the importance of exploring additional context factors in MI-NF training to better understand their influence on ERD development.

The use of brain-machine interface, motor imagery, and action observation in the rehabilitation of individuals with Parkinson's disease: A protocol study for a randomized clinical trial

BACKGROUND

Parkinson's disease (PD) is a neurodegenerative condition that impacts motor planning and control of the upper limbs (UL) and leads to cognitive impairments. Rehabilitation approaches, including motor imagery (MI) and action observation (AO), along with the use of brain-machine interfaces (BMI), are essential in the PD population to enhance neuroplasticity and mitigate symptoms.

OBJECTIVE

To provide a description of a rehabilitation protocol for evaluating the effects of isolated and combined applications of MI and action observation (AO), along with BMI, on upper limb (UL) motor changes and cognitive function in PD.

METHODS

This study provides a detailed protocol for a single-blinded, randomized clinical trial. After selection, participants will be randomly assigned to one of five experimental groups. Each participant will be assessed at three points: pre-intervention, post-intervention, and at a follow-up four weeks after the intervention ends. The intervention consists of 10 sessions, each lasting approximately 60 minutes.

EXPECTED RESULTS

The primary outcome expected is an improvement in the Test d'Évaluation des Membres Supérieurs de Personnes Âgées score, accompanied by a reduction in task execution time. Secondary outcomes include motor symptoms in the upper limbs, assessed via the Unified Parkinson's Disease Rating Scale - Part III and the 9-Hole Peg Test; cognitive function, assessed with the PD Cognitive Rating Scale; and occupational performance, assessed with the Canadian Occupational Performance Measure.

DISCUSSION

This study protocol is notable for its intensive daily sessions. Both MI and AO are low-cost, enabling personalized interventions that physiotherapists and occupational therapists can readily replicate in practice. While BMI use does require professionals to acquire an exoskeleton, the protocol ensures the distinctiveness of the interventions and, to our knowledge, is the first to involve individuals with PD.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05696925.

Reliable predictor of BCI motor imagery performance using median nerve stimulation

Objective.Predicting performance in brain-computer interfaces (BCIs) is crucial for enhancing user experience, optimizing training and identifying the most efficient BCI approach for each individual.Approach.This study explores the use of median nerve stimulation (MNS) as a predictor of motor imagery (MI)-BCI performance. MNS induces event related (de)synchronization (ERD/ERS) patterns in the brain that are similar to those generated during MI tasks, providing a non-invasive, user-independent, and easy-to-setup method for performance prediction.Main results.Our proposed predictor, based on the minimum value of the ERD induced by the MNS, not only exhibits a robust correlation with the MI-BCI performance accuracy (rho = -0.71,p<0.001), but also effectively predicts this performance with a significant correlation (rho = 0.61, mean absolute error = 9.0,p<0.01). These results demonstrate its validity as a reliable predictor of MI-BCI performance.Significance.By systematically analyzing patterns induced by MNS and correlating them with subsequent MI-BCI task performance, we aim to establish a robust predictive method of motor activity to each individual only based on MNS, making it possible, among other things, to passively predict BCI deficiency or proficiency, and to potentially adapt BCI parameters for an efficient BCI experience or BCI-based recovery.

Effect of Brain Computer Interface Training on Frontoparietal Network Function for Young People: A Functional Near-Infrared Spectroscopy Study

AIMS

Inattention in young people is one of the main reasons for their declining learning ability. Frontoparietal networks (FPNs) are associated with attention and executive function. Brain computer interface (BCI) training has been applied in neurorehabilitation, but there is a lack of research on its application to cognition. This study aimed to investigate the effect of BCI on the attention network in healthy young adults.

METHODS

Twenty-seven healthy people performed BCI training for 5 consecutive days. An attention network test (ANT) was performed at baseline and immediately after the fifth day of training and included simultaneous functional near-infrared spectroscopy recording.

RESULTS

BCI performance improved significantly after BCI training (p = 0.005). The efficiencies of the alerting and executive control networks were enhanced after BCI training (p = 0.032 and 0.003, respectively). The functional connectivity in the bilateral prefrontal cortices and the right posterior parietal cortex increased significantly after BCI training (p < 0.05).

CONCLUSION

Our findings suggested that repetitive BCI training could improve attention and induce lasting neuroplastic changes in FPNs. It might be a promising rehabilitative strategy for clinical populations with attention deficits. The right PPC may also be an effective target for neuromodulation in diseases with attention deficits.

Distinct Brain Connectivity Patterns in Sickle Cell Disease: A Biomarker for Chronic Pain Severity

Background: Central nervous system complications are common in sickle cell disease (SCD), and the defining associated biomarkers are becoming increasingly relevant for physicians in diagnostic and prognostic contexts. Recent studies have reported altered brain connectivity in pain processing, highlighting a new avenue for developing sensitive measures of SCD severity. Method: This cross-sectional study used graph theory concepts to analyze effective connectivity in individuals with SCD and healthy controls during rest and motor imagery tasks. The SCD group was further divided into two subgroups based on pain intensity (less pain or more pain) during the evaluation. Results: Individuals with SCD and chronic pain exhibited a distinct brain connectivity signature compared to healthy individuals and within pain sublevels. Conclusion: Chronic pain in SCD shows a unique brain connectivity pattern when compared to healthy subjects and across different pain levels. The results support the hypothesis that chronic pain condition is associated with decreased interhub connections and increased intrahub connections for specific brain rhythms. Furthermore, the small-world parameter can distinguish SCD individuals from controls and differentiate pain levels within SCD individuals, offering a promising biomarker for clinical assessment.

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.

Feasibility study of a home-based graded motor imagery intervention (GraMI protocol) for amputees with phantom limb pain

INTRODUCTION

Phantom limb pain affects 64% of amputees. Graded Motor Imagery comprises three consecutive application techniques designed to reorganize maladaptive changes that have occurred after the amputation.

OBJECTIVE

To assess the feasibility of a home-based Graded Motor Imagery intervention, the GraMI protocol, for amputee people with phantom limb pain.

METHODS

Twenty individuals over 18 years of age with upper or lower limb amputation, experiencing phantom limb pain, who were pharmacologically stable, and had been discharged from the hospital were recruited. The experimental group followed the GraMI protocol. Primary outcomes included study processes, such as recruitment time and rate, adherence, compliance, and the acceptability of digital technologies as a treatment tool. Secondary outcomes assessed the impact on phantom limb pain, quality of life, functionality, and depressive symptoms.

RESULTS

On average, seven participants were recruited monthly over a three-month period. No losses were recorded throughout the nine weeks of intervention. Treatment adherence averaged 89.32%, and all participants demonstrated familiarity with the usability of digital technologies. No significant differences were observed between groups (p = .054). However, within the experimental group, intragroup analysis revealed a significant (p = .005) and clinically relevant reduction (>2 points) with a large effect size (0.89) in phantom limb pain.

CONCLUSION

Conducting a multicenter study with a home-based intervention using the GraMI protocol is feasible. Future clinical trials are needed to verify its effectiveness in managing phantom limb pain.

The Acute Effects of Motor Imagery Combined With Action Observation Breathing Exercise on Cardiorespiratory Responses, Brain Activity, and Cognition: A Randomized, Controlled Trial

Breath and brain activity have been integral to daily life since time immemorial. Cognition and cardiorespiratory responses are closely interlinked, necessitating further investigation into their dynamics. The potential benefits of combining motor imagery (MI) and action observation (AO) based breathing exercises in rehabilitation have not been fully explored. This study was aimed at assessing the acute effects of MI combined with AO on cognitive function and cardiorespiratory responses. Thirty-three healthy adults were randomized into MI combined with AO breathing (MI+AO), active respiratory exercise (ARE), and control groups, with equal distribution across groups. Electroencephalography (EEG) data were collected using a Muse EEG headband, and cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) while imagining activities were measured via the Kinesthetic and Visual Imagery Questionnaire (KVIQ). Significant improvements in the Timed Up and Go (TUG) test and systolic blood pressure were observed in the ARE group (p < 0.05), alongside improvements in MoCA and KVIQ scores (p < 0.05). EEG data revealed significant decreases in delta and theta power at the temporoparietal (TP) location in the ARE group (p < 0.05). These findings suggest that MI and AO, when combined with respiratory exercises, may serve as effective passive strategies to support cognition and cardiorespiratory function, particularly in individuals who struggle to actively participate in pulmonary rehabilitation. Trial Registration: ClinicalTrials.gov identifier: NCT06099483.

BandFocusNet: A Lightweight Model for Motor Imagery Classification of a Supernumerary Thumb in Virtual Reality

Objective: Human movement augmentation through supernumerary effectors is an emerging field of research. However, controlling these effectors remains challenging due to issues with agency, control, and synchronizing movements with natural limbs. A promising control strategy for supernumerary effectors involves utilizing electroencephalography (EEG) through motor imagery (MI) functions. In this work, we investigate whether MI activity associated with a supernumerary effector could be reliably differentiated from that of a natural one, thus addressing the concern of concurrency. Twenty subjects were recruited to participate in a two-fold experiment in which they observed movements of natural and supernumerary thumbs, then engaged in MI of the observed movements, conducted in a virtual reality setting. Results: A lightweight deep-learning model that accounts for the temporal, spatial and spectral nature of the EEG data is proposed and called BandFocusNet, achieving an average classification accuracy of 70.9% using the leave-one-subject-out cross validation method. The trustworthiness of the model is examined through explainability analysis, and influential regions-of-interests are cross-validated through event-related-spectral-perturbation (ERSPs) analysis. Explainability results showed the importance of the right and left frontal cortical regions, and ERSPs analysis showed an increase in the delta and theta powers in these regions during the MI of the natural thumb but not during the MI of the supernumerary thumb. Conclusion: Evidence in the literature indicates that such activation is observed during the MI of natural effectors, and its absence could be interpreted as a lack of embodiment of the supernumerary thumb.

Supplementary and Premotor Cortical Activation During Manual Dexterity Involving Motor Imagery in Multiple Sclerosis: A Functional Near-Infrared Spectroscopy Study

BACKGROUND

Investigating brain activation during motor imagery (MI) tasks in people with multiple sclerosis (pwMS) can increase the knowledge of the neural mechanisms underlying motor dysfunction in MS and, hopefully, aid in developing improved rehabilitation strategies.

OBJECTIVE

To investigate brain activation in the supplementary motor area and premotor cortex via functional near-infrared spectroscopy (fNIRS) during a hand manipulation task, and comparing MI with actual practice (AP) in pwMS.

METHODS

Each subject completed a sequence of 4 consecutive manual dexterity trials wearing an fNIRS device. The tasks included the following conditions: AP dominant hand, MI dominant hand, AP non-dominant hand, and MI non-dominant hand.

RESULTS

Twenty pwMS (mean Expanded Disability Status Scale = 4.75 [3.0-6.5]) and 20 healthy controls (HC) participated in the study. According to the fNIRS timeline course, a similar increase (compared with baseline) was observed in the relative oxygenated hemoglobin (HbO) concentration during the MI and AP tasks, which was immediately followed by a decrease (for either hand) in the pwMS and the HC groups. A difference in the relative HbO concentration between the HC and pwMS was detected solely when the 2 groups mentally replicated the manual dexterity task movements in the MI condition (dominant hand). The increase was higher in the HC group (P = .030).

CONCLUSIONS

Despite exhibiting manual dexterity difficulties, pwMS demonstrated comparable neural activation patterns as the HCs during MI tasks in regions associated with motor planning and complex movement control, thus, suggesting that deficits in manual dexterity among pwMS may not solely originate from impairments in the motor planning processes.

Differences in working memory function are associated with motor imagery-induced changes in spinal motor nerve excitability and subsequent motor skill changes

Verification of the effectiveness of motor imagery (MI) has mainly focused on the method of implementing MI, and few studies have assessed individual factors. This study examined the individual differences in MI effects from the viewpoint of the multiple components of working memory. Forty-six healthy subjects (mean age 20.8 years) performed the Stroop Test (central executive within working memory) and reverse chanting (phonological loop within working memory). Then, F-waves were measured at rest for 30 s, the Purdue Pegboard was performed with the non-dominant hand to evaluate finger dexterity (Peg score) before MI, F-waves were measured during 30 s of kinesthetic MI, and the Peg score was evaluated after MI. For statistical analysis, the amplitude F/M ratio and Peg score were used as dependent variables, and the subjects were divided into Good and Poor groups according to cognitive function. The results showed an interaction for the amplitude F/M ratio and Peg score when grouped by reverse inverse chanting. In the subsequent simple main effect analysis, the Peg score was significantly improved after MI in both groups. The amplitude F/M ratio was significantly increased during MI compared to the resting state only in the Poor phonological loop group. Conversely, there was no interaction when the groups were divided by Stroop interference. No relationship was found between individual differences in central executive and changes in hand finger dexterity and spinal motor nerve excitability induced by MI. However, there may be a relationship between individual differences in phonological loops and changes in MI-induced finger dexterity and spinal motor nerve excitability.

Error-related potentials during multitasking involving sensorimotor control: an ERP and offline decoding study for brain-computer interface

Humans achieve efficient behaviors by perceiving and responding to errors. Error-related potentials (ErrPs) are electrophysiological responses that occur upon perceiving errors. Leveraging ErrPs to improve the accuracy of brain-computer interfaces (BCIs), utilizing the brain's natural error-detection processes to enhance system performance, has been proposed. However, the influence of external and contextual factors on the detectability of ErrPs remains poorly understood, especially in multitasking scenarios involving both BCI operations and sensorimotor control. Herein, we hypothesized that the difficulty in sensorimotor control would lead to the dispersion of neural resources in multitasking, resulting in a reduction in ErrP features. To examine this, we conducted an experiment in which participants were instructed to keep a ball within a designated area on a board, while simultaneously attempting to control a cursor on a display through motor imagery. The BCI provided error feedback with a random probability of 30%. Three scenarios-without a ball (single-task), lightweight ball (easy-task), and heavyweight ball (hard-task)-were used for the characterization of ErrPs based on the difficulty of sensorimotor control. In addition, to examine the impact of multitasking on ErrP-BCI performance, we analyzed single-trial classification accuracy offline. Contrary to our hypothesis, varying the difficulty of sensorimotor control did not result in significant changes in ErrP features. However, multitasking significantly affected ErrP classification accuracy. Post-hoc analyses revealed that the classifier trained on single-task ErrPs exhibited reduced accuracy under hard-task scenarios. To our knowledge, this study is the first to investigate how ErrPs are modulated in a multitasking environment involving both sensorimotor control and BCI operation in an offline framework. Although the ErrP features remained unchanged, the observed variation in accuracy suggests the need to design classifiers that account for task load even before implementing a real-time ErrP-based BCI.

Exploring the impact of aging on motor imagery abilities: a systematic review with meta-analysis

Objective

Explore motor imagery (MI) abilities in healthy older adults compared with healthy younger adults.

Methods

A systematic review with meta-analysis.

Results

Twenty-seven cross-sectional studies were included. Meta-analyses explored MI abilities between healthy older and younger adults for the ability to generate kinesthetic (60-70 years: g = -0.24, 95%CI = -1.61, 1.13; 70-80 years: g = -1.29, 95%CI = -2.75, 0.17), and visual modality (g = -0.08, 95%CI = -0.71, 0.86); vividness in kinesthetic (g = 0.14, 95%CI = -0.13, 0.41), IV (g = 0.11, 95%CI = -0.16, 0.38), and EV modalities (g = 0.05, 95%CI = -0.15, 0.24); mental chronometry in timed-up and go (seconds = 0.63, 95%CI = -0.02, 1.27), and linear walk (seconds = 0.75, 95%CI = -0.55, 2.06); and MI-execution time congruence (performance overestimation) in linear walk (g = -0.02, 95%CI = -0.73, 0.69). Mental chronometry in upper limb movements was analyzed visually in forest plot indicating tendencies of greater time in older adults. Hand recognition in hand laterality judgment task visual analysis revealed a poorer accuracy, greater response time and lower efficiency in older adults.

Conclusion

Vividness of MI in kinesthetic and visual modalities appears to be preserved in older adults. Tendencies for greater time in mental chronometry were observed in older adults in TUG, linear walk and upper limb tasks. Implicit MI assessed with hand laterality showed older adults have lower accuracy, longer response times and lower efficiency. The ability to generate MI in kinesthetic and visual modalities presented imprecise results, and no clear conclusions could be drawn on MI-execution temporal congruence due to imprecision. Further research is needed to potentially clarify these findings.

Systematic review registration

PROSPERO: CRD42023384916.

Motor imagery does not effectively improve walking-related performance in older adults: A randomised controlled trial

BACKGROUND

Inaccurate perception of one's physical abilities is potentially related to age-related declines in motor planning and can lead to changes in walking. Motor imagery training is effective at improving balance and walking in older adults, but most research has been conducted on older adults following surgery or in those with a history of falls. Deficits in motor imagery ability are associated with reduced executive function in older adults with cognitive impairment.

OBJECTIVES

To determine whether walking-specific motor imagery training could improve walking performance (physical and imagined) in healthy older adults, and identify the relationship between actual and imagined movement, motor imagery accuracy and executive function across 5 different walking tasks in healthy older adults.

METHODS

A cohort of 53 community dwelling older adults took part in a 4-wk randomized controlled trial to assess the effect of motor imagery training on the physical and imagined performance of 5 walking-related tasks (3 narrow path walking tasks, Timed-up and go and step-over test), together with motor imagery clarity using the kinesthetic and visual imagery questionnaire (KVIQ-10). The association between physical performance, motor imagery accuracy and executive function were identified at baseline.

RESULTS

Four weeks of motor imagery training did not improve walking-specific performance (imagined or physical) compared to no-training. Motor imagery training did improve the visual clarity of imagined non-walking tasks. Executive function was significantly correlated with 2 out of 5 imagined walking tasks and 4 out of 5 physical walking tasks but was not associated with motor imagery accuracy.

CONCLUSION

Four weeks of motor imagery training is not effective at improving performance in walking-related tasks in healthy older adults. This lack of improvement may be due in part to the high functional ability of the cohort. Future research should assess the relationship between motor planning and executive function with more complex walking tasks.

TRIAL REGISTRATION

ANZCTR registration (ACTRN12619001784101).

Improved motor imagery skills after repetitive passive somatosensory stimulation: a parallel-group, pre-registered study

Introduction

Motor-imagery-based Brain-Machine Interface (MI-BMI) has been established as an effective treatment for post-stroke hemiplegia. However, the need for long-term intervention can represent a significant burden on patients. Here, we demonstrate that motor imagery (MI) instructions for BMI training, when supplemented with somatosensory stimulation in addition to conventional verbal instructions, can help enhance MI capabilities of healthy participants.

Methods

Sixteen participants performed MI during scalp EEG signal acquisition before and after somatosensory stimulation to assess MI-induced cortical excitability, as measured using the event-related desynchronization (ERD) of the sensorimotor rhythm (SMR). The non-dominant left hand was subjected to neuromuscular electrical stimulation above the sensory threshold but below the motor threshold (St-NMES), along with passive movement stimulation using an exoskeleton. Participants were randomly divided into an intervention group, which received somatosensory stimulation, and a control group, which remained at rest without stimulation.

Results

The intervention group exhibited a significant increase in SMR-ERD compared to the control group, indicating that somatosensory stimulation contributed to improving MI ability.

Discussion

This study demonstrates that somatosensory stimulation, combining electrical and mechanical stimuli, can improve MI capability and enhance the excitability of the sensorimotor cortex in healthy individuals.

A Gait Imagery-Based Brain-Computer Interface With Visual Feedback for Spinal Cord Injury Rehabilitation on Lokomat

OBJECTIVE

Motor Imagery (MI)-based Brain-Computer Interfaces (BCIs) have been proposed for the rehabilitation of people with disabilities, being a big challenge their successful application to restore motor functions in individuals with Spinal Cord Injury (SCI). This work proposes an Electroencephalography (EEG) gait imagery-based BCI to promote motor recovery on the Lokomat platform, in order to allow a clinical intervention by acting simultaneously on both central and peripheral nervous mechanisms.

METHODS

As a novelty, our BCI system accurately discriminates gait imagery tasks during walking and further provides a multi-channel EEG-based Visual Neurofeedback (VNFB) linked to (8-12 Hz) and (15-20 Hz) rhythms around Cz. VNFB is carried out through a cluster analysis strategy-based Euclidean distance, where the weighted mean MI feature vector is used as a reference to teach individuals with SCI to modulate their cortical rhythms.

RESULTS

The developed BCI reached an average classification accuracy of 74.4%. In addition, feature analysis demonstrated a reduction in cluster variance after several sessions, whereas metrics associated with self-modulation indicated a greater distance between both classes: passive walking with gait MI and passive walking without MI.

CONCLUSION

The results suggest that intervention with a gait MI-based BCI with VNFB may allow the individuals to appropriately modulate their rhythms of interest around Cz.

SIGNIFICANCE

This work contributes to the development of advanced systems for gait rehabilitation by integrating Machine Learning and neurofeedback techniques, to restore lower-limb functions of SCI individuals.

Cognitive effect of passively induced kinesthetic perception associated with virtual body augmentation modulates spinal reflex

The virtual movement of an augmented body, perceived as part of oneself, forms the basis of kinesthetic perception induced by visual stimulation (KINVIS). KINVIS is a visually induced virtual kinesthetic perception that clinically suppresses spasticity. The present study hypothesized that central neural network activity during KINVIS affects subcortical neural circuits. The present study aimed to elucidate whether reciprocal and presynaptic inhibition occurs during KINVIS. Seventeen healthy participants were recruited (mean age: 27.9 ± 3.6 yr), and their soleus Hoffmann-reflexes (H-reflexes) were recorded by peripheral nerve stimulation while perceiving the dorsiflexion kinesthetic illusion in the right-side foot (seated in a comfortable chair). Two control conditions were set to observe the same foot video without the kinesthetic illusion while focusing on the static foot image. Unconditioned H-reflex and two types of conditioned H-reflexes were measured: Ia (reciprocal inhibition) and D1 (presynaptic inhibition). Reciprocal Ia and D1 inhibition of the soleus muscle was significantly enhanced during the kinesthetic illusion compared with the condition without kinesthetic illusion (a post hoc analysis using the Bonferroni test: Ia inhibition, P = 0.002; D1 inhibition, P = 0.049). This study indicates that kinesthetic illusion elicits an inhibitory effect on the monosynaptic reflex loop of Ia afferents, potentially inhibiting the hyperexcitability of the stretch reflex. These findings demonstrate that brain activity associated with visually induced kinesthetic illusions acts on spinal inhibition circuits. These insights may be valuable in clinical rehabilitation practice, specifically for the treatment of spasticity.NEW & NOTEWORTHY Neural effects in visual-induced kinesthetic illusion expand into the spinal reflex. Kinesthetic illusion inhibits the monosynaptic reflex in an antagonistic muscle via reciprocal and presynaptic inhibition. Visually induced kinesthetic illusion is a suitable treatment for spasticity in patients with stroke.

The effects of telerehabilitation-based motor imagery training on motor imagery ability, motor function and physical performance in Duchenne muscular dystrophy

PURPOSE

To explore the effects of telerehabilitation-based motor imagery (Tele-MI) training on motor imagery ability (MI), motor function, and performance in children with Duchenne muscular dystrophy (DMD).

METHODS

The research involved twenty-three children with DMD and twelve healthy children. DMD cohort were randomized into two groups: treatment [Tele-MI training and telerehabilitation-based physiotherapy program (Tele-PTP), n = 12] and control (Tele-PTP, n = 11). MI ability [Kinesthetic and Visual Imagery Questionnaire-10 (KVIQ-10), Motor Imagery Questionnaire for Children (MIQ-C), mental chronometry tests], motor function [Motor Function Measure (MFM), North Star Ambulation Assessment, Four Square Step Test] and timed performance were assessed at baseline and after 8-week training.

RESULTS

MI ability scores of DMD cohort were lower than healthy children. A large interaction effect was found for KVIQ-10 visual and total, MIQ-C internal visual and kinesthetic scores, and delta time of 10-meter walk test of mental chronometry (η2 > 0.14). The small-medium interaction effect was found in motor function and ambulation results (η2<0.14).

CONCLUSIONS

This study demonstrated that Tele-MI training improved MI ability of DMD cohort. The small-to-medium effects of Tele-MI training on motor function, particularly those involving the trunk, have demonstrated its potential as a complementary approach in rehabilitation to improve motor functions in children with DMD.

CLINICAL TRIAL REGISTRATION NUMBER AND URL

NCT06109103 (https://clinicaltrials.gov/study/NCT06109103?term=merve%20bora%20zereyak&rank=1).

Motor imagery ability in patients with functional dystonia

INTRODUCTION

Motor imagery (MI) involves recreating a movement mentally without physically performing the movement itself. MI has a positive impact on motor performance, motor learning and neural plasticity. We analysed the connection between motor imagination and altered movement execution in individuals with dystonia, a complex sensorimotor disorder. The aim of our study was to examine MI ability in patients with functional dystonia (FD) in comparison to organic dystonia (OD).

METHODS

Our case-control study involved 46 patients, 22 with FD and 24 with OD. The assessment consisted of specific questionnaire and standardized motor, cognitive and psychiatric scales. The KVIQ-20 was used to test MI in each patient.

RESULTS

Patients with FD scored lower on both global visual and kinaesthetic scales of the KVIQ-20 exam compared to patients with OD (63.1 ± 18.5 vs. 73.7 ± 13.2, and 54.9 ± 21.9 vs. 68.8 ± 18.2, respectively). Patients with FD also exhibited visual and/or kinaesthetic MI impairment in different body segments. The internal perspective when imagining movements was preferred in both patients with FD and OD.

CONCLUSION

FD patients showed global dysfunction of visual and kinaesthetic MI abilities. Techniques for MI improvements might have a potential role in dystonia rehabilitation.

Investigating unilateral and bilateral motor imagery control using electrocorticography and fMRI in awake craniotomy

BACKGROUND

The rapid development of neurosurgical techniques, such as awake craniotomy, has increased opportunities to explore the mysteries of the brain. This is crucial for deepening our understanding of motor control and imagination processes, especially in developing brain-computer interface (BCI) technologies and improving neurorehabilitation strategies for neurological disorders.

OBJECTIVE

This study aimed to analyze brain activity patterns in patients undergoing awake craniotomy during actual movements and motor imagery, mainly focusing on the motor control processes of the bilateral limbs.

METHODS

We conducted detailed observations of patients undergoing awake craniotomies. The experimenter requested participants to perform and imagine a series of motor tasks involving their hands and tongues. Brain activity during these tasks was recorded using functional magnetic resonance imaging (fMRI) and intraoperative electrocorticography (ECoG). The study included left and right finger tapping, tongue protrusion, hand clenching, and imagined movements corresponding to these actions.

RESULTS

fMRI revealed significant activation in the brain's motor areas during task performance, mainly involving bilateral brain regions during imagined movement. ECoG data demonstrated a marked desynchronization pattern in the ipsilateral motor cortex during bilateral motor imagination, especially in bilateral coordination tasks. This finding suggests a potential controlling role of the unilateral cerebral cortex in bilateral motor imagination.

CONCLUSION

Our study highlights the unilateral cerebral cortex's significance in controlling bilateral limb motor imagination, offering new insights into future brain network remodeling in patients with hemiplegia. Additionally, these findings provide important insights into understanding motor imagination and its impact on BCI and neurorehabilitation.

Cardiac cycle modulates alpha and beta suppression during motor imagery

Previous interoception research has demonstrated that sensory processing is reduced during cardiac systole, an effect associated with diminished cortical excitability, possibly due to heightened baroreceptor activity. This study aims to determine how phases of the cardiac cycle-systole and diastole-modulate neural sensorimotor activity during motor imagery (MI) and motor execution (ME). We hypothesised that MI performance, indexed by enhanced suppression of contralateral sensorimotor alpha (8-13 Hz) and beta (14-30 Hz) activity, would be modulated by the cardiac phases, with improved performance during diastole due to enhanced sensory processing of movement cues. Additionally, we investigated whether movement cues during systole or diastole enhance muscle activity. To test these hypotheses, 29 participants were instructed to perform or imagine thumb abductions, while we recorded their electroencephalography, electrocardiogram, and electromyogram (EMG) activity. We show that imaginary movements instructed during diastole lead to more pronounced suppression of alpha and beta activity in contralateral sensorimotor cortices, with no significant cardiac timing effects observed during ME as confirmed by circular statistics. Additionally, diastole was associated with significantly increased EMG on the side of actual and, to a lesser degree, imagined movements. Our study identifies optimal cardiac phases for MI performance, suggesting potential pathways to enhance MI-based assistive technologies.

Unlike overt movement, motor imagery cannot update internal models

In overt movement, internal models make predictions about the sensory consequences of a desired movement, generating the appropriate motor commands to achieve that movement. Using available sensory feedback, internal models are updated to allow for movement adaptation and in-turn better performance. Whether internal models are updated during motor imagery, the mental rehearsal of movement, is not well established. To investigate internal modelling during motor imagery, 66 participants were exposed to a leftwards prism shift while performing actual pointing movements (physical practice; PP), imagined pointing movements (motor imagery; MI), or no pointing movements (control). If motor imagery updates internal models, we hypothesized that aftereffects (pointing in the direction opposite the prism shift) would be observed in MI, like that of PP, and unlike that of control. After prism exposure, the magnitude of aftereffects was significant in PP (4.73° ± 1.56°), but not in MI (0.34° ± 0.96°) and control (0.34° ± 1.04°). Accordingly, PP differed significantly from MI and control. Our results show that motor imagery does not update internal models, suggesting that it is not a direct simulation of overt movement. Furthering our understanding of the mechanisms that underlie learning through motor imagery will lead to more effective applications of motor imagery.

Grasping rehabilitation using motor imagery with or without neurofeedback after tetraplegia: a study protocol for a bicentric randomised controlled trial

INTRODUCTION

Tetraplegia causes extensive sensorimotor deficits affecting activity, participation and quality of life. People with C6-C7 tetraplegia can learn to grasp objects by performing wrist extension movement (ie, tenodesis grasp), and motor imagery (MI) added to rehabilitation significantly improved tenodesis grasp. We hypothesise that this improvement can be further boosted by adding neurofeedback during MI. Thus, we design a randomised controlled trial investigating the effect of MI training on grasping ability in people with C6-C7 tetraplegia.

METHODS AND ANALYSIS

We will perform a bicentric, assessor-blinded, randomised controlled study. During rehabilitation, 21 inpatients with C6-C7 tetraplegia will be allocated to MI with neurofeedback (MI training with graphical display on a computer screen based on mu (8-13 Hz) and beta (18-25 Hz) frequency rhythms measured with 32-channel electroencephalography), MI alone (only MI training) and control (watching movies and visualisation of geometric shapes). All participants will receive three 45-min training sessions per week for 5 weeks.The primary outcome measure will be wrist extension angle immediately after the intervention during tenodesis grasp measured with a 3D motion analysis system (VICON). Secondary outcomes will include a range of measures: kinematic, grip strength, upper limb range of motion, upper limb strength (manual muscle test and hand-held dynamometer measure), dexterity (box and block test, 9-hole peg test, Jebsen test, capabilities of upper extremity questionnaire), quality of life (WHOQOL-Bref), daily life autonomy (Quadriplegic Index of Function), MI capacity and brain reorganisation (magnetoencephalography only available in Lyon, n=15). We will measure all outcomes five times: during weeks 1, 3 and 5 (baseline), week 11 (immediately after the intervention end) and week 18 (8 weeks after the intervention end).

ETHICS AND DISSEMINATION

Ethical approval was granted on 29 September 2017 (CPP Nord-Ouest-IV 17/25, N°2017-A00990-53). Dissemination will occur via presentation of results in scientific meetings and publication in peer-reviewed academic journals.

TRIAL REGISTRATION NUMBER

NCT03190863 (ClinicalTrials.gov).

Differential Hemodynamic Responses to Motor and Tactile Imagery: Insights from Multichannel fNIRS Mapping

Tactile and motor imagery are crucial components of sensorimotor functioning and cognitive neuroscience research, yet the neural mechanisms of tactile imagery remain underexplored compared to motor imagery. This study employs multichannel functional near-infrared spectroscopy (fNIRS) combined with image reconstruction techniques to investigate the neural hemodynamics associated with tactile (TI) and motor imagery (MI). In a study of 15 healthy participants, we found that MI elicited significantly greater hemodynamic responses (HRs) in the precentral area compared to TI, suggesting the involvement of different cortical areas involved in two different types of sensorimotor mental imagery. Concurrently, the HRs in S1 and parietal areas exhibited comparable patterns in both TI and MI. During MI, both motor and somatosensory areas demonstrated comparable HRs. However, in TI, somatosensory activation was observed to be more pronounced. Our results highlight the distinctive neural profiles of motor versus tactile imagery and indicate fNIRS technique to be sensitive for this. This distinction is significant for fundamental understanding of sensorimotor integration and for developing advanced neurotechnologies, including imagery-based brain-computer interfaces (BCIs) that can differentiate between different types of mental imagery.

Changes in corticospinal excitability during motor imagery by physical practice of a force production task: Effect of the rate of force development during practice

Transcranial magnetic stimulation studies have indicated that the physical practice of a force production task increases corticospinal excitability during motor imagery (MI) of that task. However, it is unclear whether this practice-induced facilitation of corticospinal excitability during MI depends on a repeatedly practiced rate of force development (RFD). We aimed to investigate whether corticospinal excitability during MI of an isometric force production task is facilitated only when imagining the motor task with the same RFD as the physically practiced RFD. Furthermore, we aimed to examine whether corticospinal excitability during MI only occurs immediately after physical practice or is maintained. Twenty-eight right-handed young adults practiced isometric ramp force production using right index finger abduction. Half of the participants (high group) practiced the force production with high RFD, and the other half (low group) practiced the force production with low RFD. Questionnaire scores indicating MI ability were similar in the two groups. We examined the force error relative to the target force during the force production task without visual feedback, and motor evoked potential (MEP) amplitudes of the first dorsal interosseous (FDI) and abductor pollicis brevis (APB) muscles during the MI of the force production task under practiced and unpracticed RFD conditions before, immediately after, and 20 min after physical practice. Our results demonstrated that the force error in both RFD conditions significantly decreased immediately after physical practice, irrespective of the RFD condition practiced. In the high group, the MEP amplitude of the FDI muscle during MI in the high RFD condition significantly increased immediately after practice compared to that before, whereas the MEP amplitude 20 min after practice was not significantly different from that before practice. Conversely, the MEP amplitude during MI in the high RFD condition did not change significantly in the low group, and neither group had significant changes in MEP amplitude during MI in the low RFD condition. The facilitatory effect of corticospinal excitability during MI with high RFD observed only immediately after physical practice in the high RFD condition may reflect short-term functional changes in the primary motor cortex induced by physical practice.

Evaluating the real-world usability of BCI control systems with augmented reality: a user study protocol

Brain-computer interfaces (BCI) enable users to control devices through their brain activity. Motor imagery (MI), the neural activity resulting from an individual imagining performing a movement, is a common control paradigm. This study introduces a user-centric evaluation protocol for assessing the performance and user experience of an MI-based BCI control system utilizing augmented reality. Augmented reality is employed to enhance user interaction by displaying environment-aware actions, and guiding users on the necessary imagined movements for specific device commands. One of the major gaps in existing research is the lack of comprehensive evaluation methodologies, particularly in real-world conditions. To address this gap, our protocol combines quantitative and qualitative assessments across three phases. In the initial phase, the BCI prototype's technical robustness is validated. Subsequently, the second phase involves a performance assessment of the control system. The third phase introduces a comparative analysis between the prototype and an alternative approach, incorporating detailed user experience evaluations through questionnaires and comparisons with non-BCI control methods. Participants engage in various tasks, such as object sorting, picking and placing, and playing a board game using the BCI control system. The evaluation procedure is designed for versatility, intending applicability beyond the specific use case presented. Its adaptability enables easy customization to meet the specific user requirements of the investigated BCI control application. This user-centric evaluation protocol offers a comprehensive framework for iterative improvements to the BCI prototype, ensuring technical validation, performance assessment, and user experience evaluation in a systematic and user-focused manner.

Vibration-Induced Illusory Movement Task Can Induce Functional Recovery in Patients With Subacute Stroke

In recent years, mental practice (MP), which involves repetitive motor imagery (MI), has been applied in rehabilitation to actively enhance exercise performance. MP is a method that involves repetitive MI, consciously evoking the intentions and content of the exercise without actual exercise. Combining actual exercise with MP promotes the development of exercise skills. However, it is possible that the MI recall ability differs greatly between individuals, affecting the therapeutic effect. In contrast, the vibration-induced illusory movement (VIM) task acts as a method to induce a motor illusion by somatosensory stimuli without actual motor. VIM, actual movement, and MI are thought to share a common neural basis in the brain. Therefore, it was hypothesized that the VIM task would complement the differences in MI recall in individual patients with hemiplegic stroke and may be a new treatment to enhance MI recall. Accordingly, in this study, we investigated the therapeutic effects of the VIM task in patients with hemiplegic stroke. In Study I, the therapeutic effect of the VIM task in 14 patients with post-stroke hemiplegia was evaluated by motor function assessment. In Study II, treatment effects were investigated by examining the ability of the same group of patients to recall MI and by neurophysiological examination of the electroencephalogram (EEG) during MI recall in four patients who consented to the study. Motor function and MI were assessed four times: before the intervention, after occupational therapy, after the VIM task (which used the motor illusion induced by tendon vibration), and one month after acceptance of therapy. Compared with occupational therapy, the VIM task showed a statistically significant improvement in upper limb function and MI ability. In addition, we found an increase in event-related desynchronization intensity during MI in the affected hemisphere only after the VIM task. It is possible that the VIM task facilitates motor function and MI. VIM task implementation of MI recall variability between individuals, which is a problem in mental practice, possible to increase the effectiveness of the brain-machine interface.

Implicit and explicit motor imagery ability after SCI: Moving the elbow makes the difference

Cervical spinal cord injury (SCI) causes dramatic sensorimotor deficits that restrict both activity and participation. Restoring activity and participation requires extensive upper limb rehabilitation focusing elbow and wrist movements, which can include motor imagery. Yet, it remains unclear whether MI ability is impaired or spared after SCI. We investigated implicit and explicit MI ability in individuals with C6 or C7 SCI (SCIC6 and SCIC7 groups), as well as in age- and gender-matched controls without SCI. Inspired by previous studies, implicit MI evaluations involved hand laterality judgments, hand orientation judgments (HOJT) and hand-object interaction judgments. Explicit MI evaluations involved mental chronometry assessments of physically possible or impossible movements due to the paralysis of upper limb muscles in both groups of participants with SCI. HOJT was the paradigm in which implicit MI ability profiles differed the most between groups, particularly in the SCIC6 group who had impaired elbow movements in the horizontal plane. MI ability profiles were similar between groups for explicit MI evaluations, but reflected task familiarity with higher durations in the case of unfamiliar movements in controls or attempt to perform movements which were no longer possible in persons with SCI. Present results, obtained from a homogeneous population of individuals with SCI, suggest that people with long-term SCI rely on embodied cognitive motor strategies, similar to controls. Differences found in behavioral response pattern during implicit MI mirrored the actual motor deficit, particularly during tasks that involved internal representations of affected body parts.

The lateralized effects of Parkinson's Disease on motor imagery: Evidence from mental chronometry

Alterations to the content of action representations may contribute to the movement challenges that characterize Parkinson's Disease (PD). One way to investigate action representations is through motor imagery. As PD motor symptoms typically have a unilateral onset, disease-related deficits related to action representations may follow a similarly lateralized pattern. The present study examined if temporal accuracy of motor imagery in individuals with PD differed according to the side of the body involved in the task. Thirty-eight participants with PD completed a mental chronometry task using their more affected and less affected side. Participants had significantly shorter mental versus physical movement times for the more affected. Higher imagery vividness in the kinaesthetic domain predicted shorter mental versus physical movement times for the more affected side, as did lower imagery vividness in the visual domain and poorer cognitive function. These results indicate that people with PD imagine movements differently when the target actions their more affected versus less affected side. It is additionally possible that side-specific deficits in the accurate processing of kinaesthetic information lead to an increased reliance on visual processes and cognitive resources to successfully execute motor imagery involving the more affected side.

Characterization and classification of kinesthetic motor imagery levels

Objective.Kinesthetic Motor Imagery (KMI) represents a robust brain paradigm intended for electroencephalography (EEG)-based commands in brain-computer interfaces (BCIs). However, ensuring high accuracy in multi-command execution remains challenging, with data from C3 and C4 electrodes reaching up to 92% accuracy. This paper aims to characterize and classify EEG-based KMI of multilevel muscle contraction without relying on primary motor cortex signals.Approach.A new method based on Hurst exponents is introduced to characterize EEG signals of multilevel KMI of muscle contraction from electrodes placed on the premotor, dorsolateral prefrontal, and inferior parietal cortices. EEG signals were recorded during a hand-grip task at four levels of muscle contraction (0%, 10%, 40%, and 70% of the maximal isometric voluntary contraction). The task was executed under two conditions: first, physically, to train subjects in achieving muscle contraction at each level, followed by mental imagery under the KMI paradigm for each contraction level. EMG signals were recorded in both conditions to correlate muscle contraction execution, whether correct or null accurately. Independent component analysis (ICA) maps EEG signals from the sensor to the source space for preprocessing. For characterization, three algorithms based on Hurst exponents were used: the original (HO), using partitions (HRS), and applying semivariogram (HV). Finally, seven classifiers were used: Bayes network (BN), naive Bayes (NB), support vector machine (SVM), random forest (RF), random tree (RT), multilayer perceptron (MP), and k-nearest neighbors (kNN).Main results.A combination of the three Hurst characterization algorithms produced the highest average accuracy of 96.42% from kNN, followed by MP (92.85%), SVM (92.85%), NB (91.07%), RF (91.07%), BN (91.07%), and RT (80.35%). of 96.42% for kNN.Significance.Results show the feasibility of KMI multilevel muscle contraction detection and, thus, the viability of non-binary EEG-based BCI applications without using signals from the motor cortex.

The short-term effects of Jin's three needles in conjunction with mirror therapy on brain function in patients with upper limb disability following an ischemic stroke were evaluated using ReHo analysis

BACKGROUND

Jin's three needle (JTN) is a commonly utilized treatment for ischemic stroke in China. Mirror therapy (MT) is also gradually transitioning from treating limb discomfort to restoring motor function in the damaged limb. Investigations into the 2 treatments' mechanisms of action are still ongoing. We used functional magnetic resonance imaging (fMRI) technique in this study to examine the effects of JTN combined with mirror therapy MT on brain function in patients with upper limb dysfunction in ischemic stroke, as well as potential central mechanisms. The goal was to provide a solid evidence-based medical basis to support the continued use of JTN combination MT.

METHODS

This study will be a single-blind, randomized, and controlled experiment. Randomization was used to assign 20 patients who met the study's eligibility requirements to the JTN + MT treatment group or the JTN control group. Each intervention will last for 4 weeks, with 6 days of treatment per week. The JTN acupuncture points are 3 temporal acupuncture points on the opposite side of the wounded limb, 3 hand acupuncture points on the injured upper limb, 3 shoulder acupuncture points, Renzhong and Baihui, The (JTN + MT) group simultaneously takes MT for 30 minutes. fMRI of the brain using BOLD and T1-weighted images was done both before and after therapy. Brain areas exhibiting changes in regional homogeneity during the pre and posttreatment periods were analyzed.

RESULTS

By the end of the treatment course, Jin three-needle therapy plus MT activated more relevant brain functional regions and increased cerebral blood oxygen perfusion than Jin three-needle therapy alone (P <.05).

CONCLUSION

In patients with upper limb impairment following an ischemic stroke, JTN with MT may improve brain function reconstruction in the relevant areas.

Motor imagery ability of children with duchenne muscular dystrophy: Reliability and validity of kinesthetic and Visual Imagery Questionnaire-10, and its association with cognitive status

PURPOSE

To investigate validity and reliability of the Kinesthetic and Visual Imagery Questionnaire-10 (KVIQ-10) in children with Duchenne Muscular Dystrophy (DMD), to compare the motor imagery (MI) ability with age-matched controls, and to examine the relationship between MI ability and cognitive status.

METHODS

The research involved 38 children who were diagnosed with DMD, as well as 20 healthy controls aged between 7 and 18 years. The KVIQ-10 was assessed for its test-retest reliability, internal consistency, construct and concurrent validity. The Motor Imagery Questionnaire for Children (MIQ-C) was selected as the gold standard test for concurrent validity. Cognitive function was assessed using the Modified Mini Mental Test (MMMT) and Montreal Cognitive Assessment (MoCA).

RESULTS

KVIQ-10 showed excellent test-retest reliability (ICC>0.90) and high internal consistency (Cronbach's alpha>0.70). A moderate-to-strong association was found between KVIQ-10 and MIQ-C subscales (p < 0.001). KVIQ-10 and MIQ-C subscores were statistically lower in the DMD group (p ≤ 0.05). A correlation was found between MoCA and KVIQ-10 in children with DMD (p ≤ 0.05).

CONCLUSIONS

The KVIQ-10 is a reliable and valid measure to assess the MI ability of children with DMD whose imagery ability was determined to be impaired.

CLINICAL TRIAL REGISTRATION NUMBER AND URL

NCT05559710 (https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05559710?term=NCT05559710&draw=2&rank=1).

Tactile versus motor imagery: differences in corticospinal excitability assessed with single-pulse TMS

Tactile Imagery (TI) remains a fairly understudied phenomenon despite growing attention to this topic in recent years. Here, we investigated the effects of TI on corticospinal excitability by measuring motor evoked potentials (MEPs) induced by single-pulse transcranial magnetic stimulation (TMS). The effects of TI were compared with those of tactile stimulation (TS) and kinesthetic motor imagery (kMI). Twenty-two participants performed three tasks in randomly assigned order: imagine finger tapping (kMI); experience vibratory sensations in the middle finger (TS); and mentally reproduce the sensation of vibration (TI). MEPs increased during both kMI and TI, with a stronger increase for kMI. No statistically significant change in MEP was observed during TS. The demonstrated differential effects of kMI, TI and TS on corticospinal excitability have practical implications for devising the imagery-based and TS-based brain-computer interfaces (BCIs), particularly the ones intended to improve neurorehabilitation by evoking plasticity changes in sensorimotor circuitry.

The Development and Evaluation of the Kinesthetic Motor Imagery of Pelvic Floor Muscle Contraction Questionnaire (KMI-PFQ) in Spanish Women

Practitioners have begun using motor imagery (MI) for preventing and treating some pelvic floor disorders. Due to requirements for imagining before performing a MI intervention and because there are few instruments available for assessing this specific ability in the pelvic floor musculature, we sought to develop and test a new MI questionnaire, the Kinesthetic Motor Imagery of Pelvic Floor Muscle Contraction Questionnaire (KMI-PFQ). We focused in this study on the development and analysis of the instrument's factorial structure and internal reliability in a participant sample of 162 healthy Spanish women (M age = 20.1, SD = 2.2 years). We developed and evaluated the KMI-PFQ's psychometric properties, finding it to have good internal consistency, with Cronbach's α = .838, ω coefficient = .839, and an intraclass correlation coefficient = .809, with two factors ("ability" and "mental effort") explaining 58.36% of response variance. The standard error of measurement was 3.58, and the minimal detectable change was 9.92. No floor or ceiling effects were identified. There was also good convergent validity as seen by statistically significant positive correlations between KMI-PFQ scores and the revised-Movement Image Questionnaire and Vividness of Visual Imagery Questionnaire. There were no statistically significant correlations between KMI-PFQ scores and the Orientation to Life Questionnaire. The KMI-PFQ is a valid and reliable instrument for measuring kinesthetic ability to feel/imagine pelvic floor muscle contractions in healthy Spanish women.

Gait Training-Based Motor Imagery and EEG Neurofeedback in Lokomat: A Clinical Intervention With Complete Spinal Cord Injury Individuals

Robotic systems, such as Lokomat® have shown promising results in people with severe motor impairments, who suffered a stroke or other neurological damage. Robotic devices have also been used by people with more challenging damages, such as Spinal Cord Injury (SCI), using feedback strategies that provide information about the brain activity in real-time. This study proposes a novel Motor Imagery (MI)-based Electroencephalogram (EEG) Visual Neurofeedback (VNFB) system for Lokomat® to teach individuals how to modulate their own μ (8-12 Hz) and β (15-20 Hz) rhythms during passive walking. Two individuals with complete SCI tested our VNFB system completing a total of 12 sessions, each on different days. For evaluation, clinical outcomes before and after the intervention and brain connectivity were analyzed. As findings, the sensitivity related to light touch and painful discrimination increased for both individuals. Furthermore, an improvement in neurogenic bladder and bowel functions was observed according to the American Spinal Injury Association Impairment Scale, Neurogenic Bladder Symptom Score, and Gastrointestinal Symptom Rating Scale. Moreover, brain connectivity between different EEG locations significantly ( [Formula: see text]) increased, mainly in the motor cortex. As other highlight, both SCI individuals enhanced their μ rhythm, suggesting motor learning. These results indicate that our gait training approach may have substantial clinical benefits in complete SCI individuals.

Case Report: Phantom limb pain relief after cognitive multisensory rehabilitation

Introduction

Relieving phantom limb pain (PLP) after amputation in patients resistant to conventional therapy remains a challenge. While the causes for PLP are unclear, one model suggests that maladaptive plasticity related to cortical remapping following amputation leads to altered mental body representations (MBR) and contributes to PLP. Cognitive Multisensory Rehabilitation (CMR) has led to reduced pain in other neurologic conditions by restoring MBR. This is the first study using CMR to relieve PLP.

Methods

A 26-year-old woman experienced excruciating PLP after amputation of the third proximal part of the leg, performed after several unsuccessful treatments (i.e., epidural stimulator, surgeries, analgesics) for debilitating neuropathic pain in the left foot for six years with foot deformities resulting from herniated discs. The PLP was resistant to pain medication and mirror therapy. PLP rendered donning a prosthesis impossible. The patient received 35 CMR sessions (2×/day during weekdays, October-December 2012). CMR provides multisensory discrimination exercises on the healthy side and multisensory motor imagery exercises of present and past actions in both limbs to restore MBR and reduce PLP.

Results

After CMR, PLP reduced from 6.5-9.5/10 to 0/10 for neuropathic pain with only 4-5.5/10 for muscular pain after exercising on the Numeric Pain Rating Scale. McGill Pain Questionnaire scores reduced from 39/78 to 5/78, and Identity (ID)-Pain scores reduced from 5/5 to 0/5. Her pain medication was reduced by at least 50% after discharge. At 10-month follow-up (9/2013), she no longer took Methadone or Fentanyl. After discharge, receiving CMR as outpatient, she learned to walk with a prosthesis, and gradually did not need crutches anymore to walk independently indoors and outdoors (9/2013). At present (3/2024), she no longer takes pain medication and walks independently with the prosthesis without assistive devices. PLP is under control. She addresses flare-ups with CMR exercises on her own, using multisensory motor imagery, bringing the pain down within 10-15 min.

Conclusion

The case study seems to support the hypothesis that CMR restores MBR which may lead to long-term (12-year) PLP reduction. MBR restoration may be linked to restoring accurate multisensory motor imagery of the remaining and amputated limb regarding present and past actions.

Effects of Action Observation Plus Motor Imagery Administered by Immersive Virtual Reality on Hand Dexterity in Healthy Subjects

Action observation and motor imagery (AOMI) are commonly delivered through a laptop screen. Immersive virtual reality (VR) may enhance the observer's embodiment, a factor that may boost AOMI effects. The study aimed to investigate the effects on manual dexterity of AOMI delivered through immersive VR compared to AOMI administered through a laptop. To evaluate whether VR can enhance the effects of AOMI, forty-five young volunteers were enrolled and randomly assigned to the VR-AOMI group, who underwent AOMI through immersive VR, the AOMI group, who underwent AOMI through a laptop screen, or the control group, who observed landscape video clips. All participants underwent a 5-day treatment, consisting of 12 min per day. We investigated between and within-group differences after treatments relative to functional manual dexterity tasks using the Purdue Pegboard Test (PPT). This test included right hand (R), left hand (L), both hands (B), R + L + B, and assembly tasks. Additionally, we analyzed kinematics parameters including total and sub-phase duration, peak and mean velocity, and normalized jerk, during the Nine-Hole Peg Test to examine whether changes in functional scores may also occur through specific kinematic patterns. Participants were assessed at baseline (T0), after the first training session (T1), and at the end of training (T2). A significant time by group interaction and time effects were found for PPT, where both VR-AOMI and AOMI groups improved at the end of training. Larger PPT-L task improvements were found in the VR-AOMI group (d: 0.84, CI95: 0.09-1.58) compared to the AOMI group from T0 to T1. Immersive VR used for the delivery of AOMI speeded up hand dexterity improvements.

Towards efficient motor imagery interventions after lower-limb amputation

BACKGROUND

The therapeutic benefits of motor imagery (MI) are now well-established in different populations of persons suffering from central nervous system impairments. However, research on similar efficacy of MI interventions after amputation remains scarce, and experimental studies were primarily designed to explore the effects of MI after upper-limb amputations.

OBJECTIVES

The present comparative study therefore aimed to assess the effects of MI on locomotion recovery following unilateral lower-limb amputation.

METHODS

Nineteen participants were assigned either to a MI group (n = 9) or a control group (n = 10). In addition to the course of physical therapy, they respectively performed 10 min per day of locomotor MI training or neutral cognitive exercises, five days per week. Participants' locomotion functions were assessed through two functional tasks: 10 m walking and the Timed Up and Go Test. Force of the amputated limb and functional level score reflecting the required assistance for walking were also measured. Evaluations were scheduled at the arrival at the rehabilitation center (right after amputation), after prosthesis fitting (three weeks later), and at the end of the rehabilitation program. A retention test was also programed after 6 weeks.

RESULTS

While there was no additional effect of MI on pain management, data revealed an early positive impact of MI for the 10 m walking task during the pre-prosthetic phase, and greater performance during the Timed Up and Go Test during the prosthetic phase. Also, a lower proportion of participants still needed a walking aid after MI training. Finally, the force of the amputated limb was greater at the end of rehabilitation for the MI group.

CONCLUSION

Taken together, these data support the integration of MI within the course of physical therapy in persons suffering from lower-limb amputations.

Anodal transcranial direct current stimulation does not enhance the effects of motor imagery training of a sequential finger-tapping task in young adults

When applied over the primary motor cortex (M1), anodal transcranial direct current stimulation (a-tDCS) could enhance the effects of a single motor imagery training (MIt) session on the learning of a sequential finger-tapping task (SFTT). This study aimed to investigate the effect of a-tDCS on the learning of an SFTT during multiple MIt sessions. Two groups of 16 healthy young adults participated in three consecutive MIt sessions over 3 days, followed by a retention test 1 week later. They received active or sham a-tDCS during a MIt session in which they mentally rehearsed an eight-item complex finger sequence with their left hand. Before and after each session, and during the retention test, they physically repeated the sequence as quickly and accurately as possible. Both groups (i) improved their performance during the first two sessions, showing online learning; (ii) stabilised the level they reached during all training sessions, reflecting offline consolidation; and (iii) maintained their performance level one week later, showing retention. However, no significant difference was found between the groups, regardless of the MSL stage. These results emphasise the importance of performing several MIt sessions to maximise performance gains, but they do not support the additional effects of a-tDCS.

Association between visuo-spatial working memory and gait motor imagery

Although motor imagery and working memory (WM) appear to be closely linked, no previous studies have demonstrated direct evidence for the relationship between motor imagery and WM abilities. This study investigated the association between WM and gait motor imagery and focused on the individual differences in young adults. This study included 33 participants (mean age: 22.2 ± 0.9 years). We used two methods to measure the ability of different WM domains: verbal and visuo-spatial WM. Gait motor imagery accuracy was assessed via the mental chronometry paradigm. We measured the times participants took to complete an actual and imagined walk along a 5 m walkway, with three different path widths. The linear mixed effects model analysis revealed that visuo-spatial WM ability was a significant predictor of the accuracy of gait motor imagery, but not of verbal WM ability. Specifically, individuals with lower visuo-spatial WM ability demonstrated more inaccuracies in the difficult path-width conditions. However, gait motor imagery was not as accurate as actual walking even in the easiest path width or in participants with high visuo-spatial WM ability. Further, visuo-spatial WM ability was significantly correlated with mental walking but not with actual walking. These results suggest that visuo-spatial WM is related to motor imagery rather than actual movement.

Effectiveness of synchronous action observation and mental practice on upper extremity motor recovery after stroke

The purpose of this quasi-experimental pretest-posttest control group study was to examine the effect of group synchronous action observation/mental practice intervention compared to usual rehabilitation care on upper extremity motor recovery after stroke. The intervention group (n = 25) received usual care, consisting of a minimum of 3 hours of rehabilitation services per day, 5 days a week, plus group synchronous action observation/mental practice sessions 3 times per week and the control group (n = 26) received usual care. Outcome measures included the Kinesthetic and Visual Imagery Questionnaire Short Version (KVIQ-10), the Fugl-Meyer Assessment (FMA-UE) of affected upper extremity motor function only and The Box and Block Test (BBT). Although there were no statistically significant differences in upper extremity motor function between the two groups, a subgroup analysis of the intervention group identified statistically significant (FMA-UE: p < .001; BBT: p = .04) and Minimally Important Clinical Differences on upper extremity motor recovery between patients with behaviors demonstrating more versus less commitment to the intervention. Group synchronous action observation/mental practice is a promising intervention for patients demonstrating commitment to actively participating in the intervention to improve outcomes on upper extremity motor recovery after stroke.

Motor imagery ability scores are related to cortical activation during gait imagery

Motor imagery (MI) is the mental execution of actions without overt movements that depends on the ability to imagine. We explored whether this ability could be related to the cortical activity of the brain areas involved in the MI network. To this goal, brain activity was recorded using high-density electroencephalography in nineteen healthy adults while visually imagining walking on a straight path. We extracted Event-Related Desynchronizations (ERDs) in the θ, α, and β band, and we measured MI ability via (i) the Kinesthetic and Visual Imagery Questionnaire (KVIQ), (ii) the Vividness of Movement Imagery Questionnaire-2 (VMIQ), and (iii) the Imagery Ability (IA) score. We then used Pearson's and Spearman's coefficients to correlate MI ability scores and average ERD power (avgERD). Positive correlations were identified between VMIQ and avgERD of the middle cingulum in the β band and with avgERD of the left insula, right precentral area, and right middle occipital region in the θ band. Stronger activation of the MI network was related to better scores of MI ability evaluations, supporting the importance of testing MI ability during MI protocols. This result will help to understand MI mechanisms and develop personalized MI treatments for patients with neurological dysfunctions.