Motor Imagery Set to Musical and Verbal Cues Helps Patients with Walking and Fatigue, Study Says

Mentally rehearsing an ease of walking to rhythmic cues — especially musical and verbal — improves walking speed and distance, and lessens feelings of fatigue in people with multiple sclerosis (MS), a study reports.

The study, “Effects and mechanisms of differently cued and non-cued motor imagery in people with multiple sclerosis: A randomised controlled trial” was published in the Multiple Sclerosis Journal, and highlighted by the Multiple Sclerosis Trust in a news release.

Studies have suggested that a physiotherapy approach called motor imagery (MI), which uses such cues, can help patients with walking difficulties and fatigue, and improve their quality of life.

Motor imagery involves imagining you are doing an activity without actually doing it. Research suggests that mentally rehearsing a movement activates the same brain areas as actual movement, which may result in the same plastic changes in the motor system as actual physical practice. These studies favor the view that this technique can help to develop neurological pathways that control motor function.

The technique is used by athletes to improve their performance, and by physiotherapists to help in the neurological rehabilitation of patients, like those recovering from a stroke.

Musical or verbal cues given a patient while that person imagines performing a task also help to reinforce the visualized movements.

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Studies showing that motor imagery can benefit MS patients, however, have not looked into an underlying mechanism for this effect.

Researchers at the Medical University of Innsbruck, in Austria, conducted a clinical trial to compare the effect of cued and non-cued motor imagery on walking, fatigue, and quality of life in MS patients.

They recruited 60 patients with mild to moderate disability (EDSS scores of 1.5 to 4.5); 59 completed the four-week, at-home study.

Patients were randomized to three different groups: a music- and verbal-cued motor imagery group, where people listened to verbal descriptions of imagined walking tasks as music played, with instructions matching the music’s rhythm, like “stamp-stamp” or “large step”; music-cued (music only) motor imagery; or non-cued (no music or instructions) motor imagery.

Participants were trained, and all at the study’s start showed an ability for motor imagery. Those with cues were given CDs to listen to in their home for 17 minutes a day, six times per week, throughout that month.  

Primary study goals were improvements in walking speed — assessed by the timed 25-foot walk — and walking distance — measured with the 6-minute walk test. Patient-reported fatigue levels and quality of life were addressed by questionnaires given before and after treatment.  

Patients were recorded walking in time with slow- and fast-paced music to evaluate their ability to synchronize movements with musical rhythm, an ability referred to as sensorimotor synchronization. 

Results showed that motor imagery improved both walking speed and distance in all groups. But the largest benefit was seen in those given both musical and verbal cues.

Personal assessments of fatigue and quality of life showed significant improvement using both types of cued motor imagery, but not for those trying motor imagery alone, “suggesting these findings are related to the effects of music and verbal cueing,” the researchers wrote. Here, again, the greatest improvement was seen when music and verbal cues were used together.

Verbal or music assistance was also seen as more effective in helping patients synchronize their gait to rhythm than the non-cued approach. 

The study concluded that motor imagery, especially that given with musical and verbal cues, can significantly improve “walking, fatigue, and quality of life” in MS patients.