Motor imagery in neurorehabilitation (FS-23)

Focused symposium
Monday 13 May 2019, 13:45-15:15
Room B

Schuster-Amft C1,2,3Sharma N4,5Mateo S6,7Lucchetti G8,9 
1Reha Rheinfelden, Research Department, Rheinfelden, Switzerland, 2Bern University of Applied Sciences, Institute for Rehabilitation and Performance Technology, Burgdorf, Switzerland, 3University of Basel, Department of Sport, Exercise and Health, Basel, Switzerland, 4National Hospital for Neurology and Neurosurgery, London, United Kingdom, 5University College London, Medical Research Council Unit for Lifelong Health and Ageing, London, United Kingdom, 6Université de Lyon, Université Lyon 1, INSERM U1028, CNRS UMR5292; Lyon Neuroscience Research Center, ImpAct Team, Lyon, France, 7Hospices Civils de Lyon, Hôpital Henry Gabrielle, Plate-forme Mouvement et Handicap, Lyon, France, 8Federal University of Juiz de Fora, Department of Medical Education, School of Medicine, Juiz de Fora, Brazil, 9Federal University of Juiz de Fora, Division of Geriatrics, School of Medicine, Juiz de Fora, Brazil

Learning objective 1: Provide an overview on current state of the art of the technique of motor imagery used in rehabilitation by: (1) learning about the physiological foundations of motor imagery,
Learning objective 2: (2) learning about the efficacy of motor imagery evaluated in clinical trials and how to evaluate and individual's motor imagery ability, and
Learning objective 3: (3) learning about the different elements of a successful motor imagery training intervention including an outlook to use of motor imagery as a brain-computer-interface to direct neuro-prostheses.
Description: Motor imagery gained wide interest in the field of rehabilitation in particular in stroke rehabilitation. Motor imagery has its origin in the field of sports psychology where it was developed for athletes to reach peak performance. Motor imagery is a mental process facilitating brain plasticity, where individuals rehearse a given motor action to maintain or improve their movement memory even if the movement can currently not be physically performed, e.g. due to an injury or paresis. Once learned, motor imagery can be used at any time and any place independent from therapists or expensive equipment. 
The symposium aims to answer the following questions: (1) Why does motor imagery work and what are measurements to evaluate patients motor imagery performance and ability? (2) What is the effect of motor imagery on different clinical outcomes, e.g. functional recovery of the upper and lower limb, balance, and gait? (3) What are important motor imagery intervention parameters? (4) What are the current developments for the use of motor imagery and how the application of motor imagery might help in the future, e.g. in the field of technology to act as brain-computer-interface to direct neuro-prostheses. 
Nikhil Sharma will present the evidence from functional imaging investigations in patients with a lesion in the central nervous system. He will describe the involvement of different brain regions during motor imagery that are involved in movement planning, execution, and modulation. Further he will discuss the controversial aspect of involvement of M1 to inhibit motor execution or activate subliminal muscle activity in the involved muscle of the movement to be imagined.
Christian Collet will present the evidence of integrating motor imagery in the rehabilitation programs of motor functions. He will address the issue of application to different motor pathologies and illustrate this point with examples from rehabilitation protocols designed for patients with paraplegia and quadriplegia. Finally, he will ask the question of the assessment of mental work through the use of a set of behavioral and physiological indices derived from the activity of the autonomic nervous system.
Giancarlo Lucchetti will present results from his latest research on the efficacy of motor imagery training interventions applied in stroke rehabilitation. He will present results of a systematic literature review and meta-analysis of randomised controlled trials on different outcomes, e.g. motor recovery of the upper limb, lower limb, balance, and gait. Furthermore, he will highlight gaps and methodological challenges in the literature of motor imagery efficacy that should be addressed in future research.
Corina Schuster-Amft will present a terminology that might help to describe motor imagery training interventions with an emphasis on different motor imagery modes and perspectives. Moreover, she will describe results from a recent longitudinal study with four measurement sessions investigating the preferred motor imagery perspective in patients with a lesion of the central nervous system. Based on two ongoing systematic reviews she will (1) provide an overview on frequently used measures to evaluate the individuals' motor imagery ability in clinical routine, and (2) present an outlook on the use of motor imagery as a brain-computer-interface to direct neuro-prostheses.
Implications / Conclusions: The symposium will highlight the foundations and beneficial effects of motor imagery when used in rehabilitation. Further, the symposium will stimulate the use of motor imagery in current clinical practice as a low-cost, easy to learn and to use technique. 
Key-words: 1. neurophysiological foundations 2. efficacy of motor imagery 3. neurorehabilitation
Funding acknowledgements: None declared.
Relevance to physical therapy globally: Motor imagery is a powerful mental training technique in motor learning and motor control by activating almost the same motor areas as during the actual execution of the corresponding movements. Individuals rehearse a given motor action to maintain or improve their movement memory even if the movement can currently not be physically performed, e.g. due injury or paresis. Motor imagery can be used at any time and any place independent from therapists or equipment.
Target audience: Therapists and other health professionals, who are interested in motor learning, re-learning, and improvement of movements in patients during neurorehabilitation.