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This study will investigate whether mentally simulating walking movements while watching others walk can improve walking performance in individuals with Multiple Sclerosis (MS). Participants will be divided into two groups: one group will watch walking videos and imagine themselves walking, while the other group will watch nature scenes. The study will measure muscle activity and walking patterns to assess the effects. The results may help support the use of mental practice techniques to improve mobility in people with MS.
This study aims to explore the impact of mental simulation of walking movements on walking performance in individuals with Multiple Sclerosis (MS). The participants will be randomly assigned to two groups: the experimental group will watch walking-related videos and engage in mental imagery exercises, imagining themselves walking, while the control group will watch nature scenes without any walking-related content.
Objectives:
To determine whether mental imagery can enhance walking ability and gait parameters in individuals with MS.
To measure the effect of mental simulation on muscle activity and walking patterns, including stride length, walking speed, and balance.
Study Procedure:
The study will consist of multiple sessions, where participants will first undergo baseline assessments of walking ability. Following this, they will engage in either the walking video and imagery task (experimental group) or the nature video viewing task (control group) for a predetermined period of time. Measurements of muscle activity using electromyography (EMG) and walking patterns will be recorded before and after the intervention.
Potential Impact:
The results from this study may provide insights into the use of mental practice techniques as a non-invasive intervention to improve mobility in individuals with MS, a population often affected by walking difficulties. Mental imagery could serve as an adjunct therapy to traditional physical rehabilitation methods.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Arm 1 | Experimental | Arm 1: Experimental Group: Action Observation + Motor Imagery |
|
| Arm 2 | Other | Arm 2: Control Group: Nature video |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Action Observation + Motor Imagery | Behavioral | Participants will watch videos showing walking actions and will be instructed to mentally simulate the movement. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Change in Tibialis Anterior and Gastrocnemius Medialis Muscle Activity Amplitude | Change in muscle activity amplitude (microvolts, µV) of tibialis anterior and gastrocnemius medialis during gait initiation measured by surface EMG. | Before and immediately after the intervention |
| Change in Tibialis Anterior and Gastrocnemius Medialis Muscle Activity Onset Latency | Change in onset latency (milliseconds, ms) of tibialis anterior and gastrocnemius medialis muscle activation during gait initiation measured by surface EMG. | Before and immediately after the intervention. |
| Change in Step Length | Change in step length (centimeters, cm) during gait initiation measured by the GAITRite system. | Before and immediately after the intervention |
| Change in Step Time | Change in step time (seconds, s) during gait initiation measured by the GAITRite system. | Before and immediately after the intervention |
| Change in Step Width | Change in step width (centimeters, cm) during gait initiation measured by the GAITRite system. | Before and immediately after the intervention |
| Change in Double Support Period | Change in double support period (percentage of gait cycle, %) during gait initiation measured by the GAITRite system. | Before and immediately after the intervention |
| Change in Gait Velocity |
| Measure | Description | Time Frame |
|---|---|---|
| Motor Imagery Vividness | Kinesthetic and visual imagery vividness will be assessed using the Kinesthetic and Visual Imagery Questionnaire-20 (KVIQ-20), which includes 10 visual and 10 kinesthetic items (20 total). Each item is rated on a 5-point Likert scale (1 = no image/sensation, 5 = vivid image/sensation). Higher scores indicate better imagery ability. | Baseline only |
| Measure | Description | Time Frame |
|---|---|---|
| Perceived Task Load | The NASA Task Load Index (NASA-TLX) will be used to measure mental and physical workload related to the task. The scale consists of six subscales: mental demand, physical demand, temporal demand, performance, effort, and frustration. Each subscale is rated on a 0-100 visual analog scale, and an overall workload score is obtained by averaging the six subscales. Higher scores indicate greater perceived workload. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Merve Ünal, Res. Asst. | Contact | +905386582787 | merveunal.144@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Yeliz Salcı, Assoc. Prof. | Hacettepe University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hacettepe University, Faculty of Physical Therapy and Rehabilitation | Recruiting | Ankara | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 25505880 | Result | Wright DJ, Williams J, Holmes PS. Combined action observation and imagery facilitates corticospinal excitability. Front Hum Neurosci. 2014 Nov 27;8:951. doi: 10.3389/fnhum.2014.00951. eCollection 2014. | |
| 30084706 | Result | Rocca MA, Meani A, Fumagalli S, Pagani E, Gatti R, Martinelli-Boneschi F, Esposito F, Preziosa P, Cordani C, Comi G, Filippi M. Functional and structural plasticity following action observation training in multiple sclerosis. Mult Scler. 2019 Oct;25(11):1472-1487. doi: 10.1177/1352458518792771. Epub 2018 Aug 7. |
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| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| ID | Term |
|---|---|
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D003711 | Demyelinating Diseases |
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Participants will be randomly assigned to either the experimental group (motor imagery + action observation) or the control group (nature video).
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The study will be single-blinded. Participants will not be informed of their group assignment.
| Nature Video | Behavioral | Participants will watch a video of nature scenes. |
|
Change in gait velocity (centimeters per second, cm/s) during gait initiation measured by the GAITRite system. |
| Before and immediately after the intervention |
| Change in Cadence | Change in cadence (steps per minute, steps/min) during gait initiation measured by the GAITRite system. | Before and immediately after the intervention |
| Mental Chronometry Ratio | The ratio between imagined and actual Timed Up and Go (TUG) performance time (both measured in seconds, s) will be calculated. During imagined trials, participants will press a button to mark the start and end of the imagined movement sequence. A ratio closer to 1 indicates better temporal congruence between imagined (iTUG) and executed TUG performance. | Baseline only |
| Limb Laterality Recognition Performance | Right-left discrimination ability will be evaluated using the Recognise Foot App™ developed by the NOI Group™. Both accuracy (percentage of correct responses, %) and response time (milliseconds, ms) will be recorded. | Baseline only |
| Cognitive Status | General cognitive functioning will be screened using the Standardized Mini-Mental State Examination (SMMSE). The test is scored on a 30-point scale (0-30). Scores ≥24 indicate normal cognitive functioning. | Baseline only |
| Fatigue Level | Fatigue severity specific to MS will be measured with the Fatigue Severity Scale (FSS). The FSS consists of 9 items rated on a 7-point Likert scale (1 = strongly disagree; 7 = strongly agree). The final score is calculated as the mean of all items (range: 1-7), with higher scores indicating greater fatigue severity. | Baseline only |
| Anxiety and Depression | Emotional state will be assessed using the Hospital Anxiety and Depression Scale (HADS). The scale consists of 14 items divided into two subscales: anxiety (7 items) and depression (7 items). Each item is scored from 0 to 3, yielding subscale scores ranging from 0 to 21. Higher scores indicate greater levels of anxiety or depression. | Baseline only |
| Disability Level | Expanded Disability Status Scale (EDSS) scoring will be performed using the standardized Neurostatus-EDSS format. This scale evaluates functional systems such as motor ability, balance, vision, and sensory function to quantify disability level in individuals with multiple sclerosis. Scores range from 0 to 10 in 0.5-point increments, where 0 indicates normal neurological status and 10 represents death due to MS. Higher scores reflect greater disability. | Baseline only |
| Visual Acuity | Participants' visual acuity will be assessed using the Snellen chart under standard conditions. The test will be conducted with or without corrective lenses depending on the participant's usual visual aid usage. Visual acuity will be recorded as a Snellen fraction (e.g., 20/20, 20/40), where larger denominators indicate poorer visual performance. | Baseline only |
| Immediately after the intervention |
| 33435410 | Result | Gil-Bermejo-Bernardez-Zerpa A, Moral-Munoz JA, Lucena-Anton D, Luque-Moreno C. Effectiveness of Motor Imagery on Motor Recovery in Patients with Multiple Sclerosis: Systematic Review. Int J Environ Res Public Health. 2021 Jan 9;18(2):498. doi: 10.3390/ijerph18020498. |
| 36349570 | Result | Chye S, Valappil AC, Wright DJ, Frank C, Shearer DA, Tyler CJ, Diss CE, Mian OS, Tillin NA, Bruton AM. The effects of combined action observation and motor imagery on corticospinal excitability and movement outcomes: Two meta-analyses. Neurosci Biobehav Rev. 2022 Dec;143:104911. doi: 10.1016/j.neubiorev.2022.104911. Epub 2022 Nov 5. |
| 37708821 | Result | Salamci M, Salci Y, Topuz S, Yalcin AI, Acar Ozen P, Tuncer A. Gait initiation in multiple sclerosis patients with and without functional loss. Mult Scler Relat Disord. 2023 Nov;79:104990. doi: 10.1016/j.msard.2023.104990. Epub 2023 Sep 4. |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |