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Title: Effects and mechanisms of rhythmic-cued motor imagery on walking, fatigue and quality of life in people with multiple sclerosis
Author: Seebacher, Barbara
ISNI:       0000 0004 7427 0919
Awarding Body: University of Brighton
Current Institution: University of Brighton
Date of Award: 2018
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BACKGROUND: walking impairment, fatigue and reduced (health-related, HR) quality of life (QoL) are key problems for people with multiple sclerosis (pwMS). Motor imagery (MI) and rhythmic cueing have been shown to improve motor function. It is unclear whether a combined rhythmic-cued MI treatment is effective in pwMS. AIMS: the aims of this thesis were to investigate the effects and mechanisms of differently cued and non-cued MI on walking, fatigue, (HR)QoL, MI ability and gait synchronisation with music beat in pwMS. Two randomised controlled trials and a reliability study were conducted, to examine the gait analysis instruments. METHODS: adults with mild to moderate MS were recruited at the MS-Clinic, Innsbruck Medical University, Austria and randomised to one of three groups. Participants practised MI of walking for 17 minutes, 6 times per week for 4 weeks. In Study 1, music-verbal-MI group participants performed music- and verbally-cued MI, metronome-verbal-MI group participants practiced metronome- and verbally-cued MI and participants in the control group received no intervention apart from their usual care, as all participants did. In Study 2, participants in the music-verbal-MI group practised music-cued MI with verbal cueing, participants in the music-MI group performed music-only cued MI and non-cued MI participants practised MI alone. Primary outcomes were walking speed and walking distance. Secondary outcomes were walking perception, fatigue, (HR)QoL, MI ability and sensorimotor synchronisation, of gait to a music beat. RESULTS: after rhythmic-cued MI, significant improvements in walking speed, distance and perception were observed when compared to no intervention or noncued MI. The greatest and clinically most significant improvements in fatigue and (HR)QoL were seen after music- and verbally-cued MI. All participants were able to perform MI and showed improved MI ability after the 4 week intervention. The gait analysis instruments used were shown to be reliable. Post-intervention, sensorimotor synchronisation was significantly more accurate in participants in the rhythmic-cued MI groups, as compared to those in the non-cued MI group. There were no adverse events, full compliance was observed and 217 participated in the whole study. CONCLUSIONS: as a stand-alone treatment, both non-cued and metronome- and verbally-cued MI significantly improved walking in pwMS. All types of rhythmic-cued MI significantly improved walking, fatigue and (HR)QoL in pwMS, but music- and verbally-cued MI was shown to be superior. After a familiarisation with rhythmic-cued MI, all participants showed high MI ability. This suggests that participants were undertaking MI and supports MI being a reasonable explanation for the improvements found. Sensorimotor synchronisation improved only after cued MI and might be another mechanism which contributed to participants’ walking improvements. This thesis, therefore, provides recommendations for physiotherapists on utilising rhythmic-cued MI, without physical practice, for the treatment of walking impairment and fatigue in pwMS.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available