The Rehabilitative Effects of Guided Motor Imagery on Gait and Balance in Older Adults

 This doesn't refer to any protocol that will prevent falls so go ask your doctor for one. It better exist or your doctor is not worth it.

The Rehabilitative Effects of Guided Motor Imagery on Gait and Balance in Older Adults

  INTRODUCTION

Falls are a leading cause of injury, disability, nursing home admission, and death among older adults (Bohl, Gill, Shumway-Cook, Tinetti). Each year about one-third of community-dwelling adults, 65 years of age or older, fall at least once. Among those aged 80 years or older, the percentage is 50% (Inouye). As a result, identifying cost-effective interventions to reduce the risk of falls among older adults continues to be a focus of intense inquiry (Bruce, Matchar)Strengthening exercises, balance training, and gait training are evidence-based interventions used by physical therapists to reduce fall-risk (Matchar). However, the efficacy of motor imagery (MI) has been investigated as another means of improving functional performance.MI is the cognitive practice of a physical skill in the absence of gross motor movement(Fansler, Nakano). Positive results have been reported for more than two decades on the use of MI to improve several aspects of motor performance in athletes (Driediger, MacIntyre, Taktek) and non-athlete adults to improve motor performance (Dickstein, Nakano). Few studies have focused on the use of MI in the following conditions: independent of physical practice, in the treatment of gait or balance dysfunctions in older adults without a primary neuromuscular condition (such as stroke or PD) (Deutsch), or in the treatment of gait and balance dysfunctions concurrently.

 Motor Imagery:

Learning or improving motor skills relies upon neuroplasticity(Warner). Motor imagery techniques involve imagining oneself correctly performing a particular motor skill while simultaneously focusing on the physical demands of the skill’s performance. This imagined movement recruits a subcortical network similar to that recruited for movement execution (Hardwick). Such recruitment manifests action potentials and minute muscular contractions, which facilitates movement (Debarnot, Ehrsson, Warner). MI allows patients to mentally rehearse movements, begin the healing process, and potentially reduce total recovery time (Warner). Vividly imagined motor ability is theorized to affect a person’s perceptions of actual ability, including belief in their ability to perform the activity, in a way similar to that of actually having demonstrated the performance(Debarnot, Ehrsson). Researchers suggest that much motor success is predicated upon perceptions, attitudes, and expectations, all of which can bealtered with the proper mental imagery and guidance (Benz, Berdik, Evans, Warner). Neuroimaging studies have found white matter to increase and the following motor areas of the brain to be active during motor imagery interventions: the SMA, left primary motor cortex, the left prefrontal cortex, the right thalamus and the cerebellum, all of which are highly correlated with successful gait performance (Debarnot, Nakano).

METHODS

Participants:
Men and women aged 65 years or older with self-reported difficulties with gait and balance were recruited from the independent and assisted-living residents of a local retirement center in North Carolina. Participants were excluded if they had cognitive or vestibular impairments(such as advanced dementia or vertigo), if they had had physical therapy (PT) for balance or gait within 3 months prior to the study, or if they were completely unable to stand or walk.The use of an assistive gait device did not exclude participants from this study.Eleven participants were accepted into the study. One participant dropped out of the study due to scheduling difficulties, and one after developing pneumonia; leaving 9 participants ranging in age from 73 to 95 years old.
Study Design:
Participants were randomly assigned to one of two groups: MI or PT. The MI group comprised 4 females and 1 male, with an average age of 85 years old. The PT group consisted of 3 females and 1 male, with an average age of 90 years old.Participants were asked to take part in 3 treatment sessions over a one-week period and return 1 week later for retention testing.
 Treatment Interventions:
The PT group was treated by a licensed physical therapist and APTA certified Geriatric Clinical Specialist who employed active gait and balance therapeutic activities within a 20-minute treatment session, 3 days during 1 week. The interventions were chosen to represent conventional gait and balance interventions: single leg stance, standing on a foam pad with eyes open and eyes closed, lower extremity strengthening, braiding, and gait with obstacles. Although activities were similar across participants, the level of difficulty was individualized to create a challenging intervention for each participant.Participants in the MI group were treated by listening to an MI script that guided participants through the mental practice of functional balance and gait. Participants were instructed to sit upright in a chair with feet flat on the floor and to keep their eyes closed during the script reading. They were informed that no physical movement was required during the intervention. The script was read by one of the experimenters to the participants on 3 days during 1 week.Each treatment for the MI group lasted about 15 minutes.No home regimen was prescribed for either group.
Assessments:
The subjects were each assessed with performance outcome measures preintervention for baseline, postintervention to determine effectiveness,and 1 week following intervention completion to assess retention.These assessments were chosen specifically for gait and balance to determine the subjects’ fall risk and assess confidence in independently performing such tasks(Middleton, Wallace). The assessments used were the Activities Specific Balance Confidence (ABC) Scale for self reported confidence and fear of falling, the Timed Up and Go (TUG) test as a widely accepted outcome measure for fall-risk and mobility, and the Short-Form Berg Balance as one of the most commonly used outcome measures for functional balance. The data were analyzed using one-way ANOVA, MCDs, and visual assessment for trends between groups.