Mental imagery

Mental imagery technique recently used as motor imagery. Theories of mental imagery developed by psychologists till date and use of this technique in the improvement of function has lot of evidences.

1. Mental Imagery Dr. Manasi Kulkarni MPT- Neurophysiotherapy Guide: Dr. Suvarna Ganvir D.V.V.P.F’s College of Physiotherapy, Ahmednagar

2. Content Introduction History Theories Recent Advances References

3. Introduction Mental imagery refers to the active process by which humans relive sensations with or without external stimuli..

4. History Mental Practice Cognitive rehearsal of task in absence of overt physical movement

5. It is important to distinguish this specific definition of mental practice from broader term Mental preparations. Mental practice Visual stimuli Audiovisual Audio stimuli

6. Movement imagery is a general term that describes the process of imaging the movement of an object or a person. Mental imagery – humans relive sensations with or without external stimuli. When the human body is involved, however, researchers have preferred to use the term motor imagery , which corresponds to an active process during which the representation of a specific action is internally reproduced within working memory without any motor output. This cognitive operation can be performed in different modalities such as visual, auditory, tactile, kinesthetic, olfactory, gustatory, or any combination of these senses

7. Mental Rotation- Refers to ability to Imagine the rotation of an object in space. Motion Imagery- Concerned with prediction of path and direction of movements of non-bodily objects moving in space According to research When participants were given 3D objects result showed that time required for the judgement increased as the angle of rotation.

8. Theories of Mental imagery Many theories have been proposed to explain the mechanisms by which mental practice acts to increase performance in motor learning. Sackett proposed the symbolic learning theory States mental practice facilitates motor performance by allowing subjects to rehearse the cognitive component of a task. Implies the movements are symbolically coded in the CNS, making them easier to execute. Limitation: Does not explain other findings such as increase in muscular strength reported after mental practice of isometric contractions

9. Psychoneuromuscular theory More compatible with results obtained form pure motor tasks. Proposes that micronerve impulses are propagated to target muscles when a subject engages in mental practice of a movement, hence facilitating future performance. Some researchers raised possibility that increase in muscular activity during mental practice is not specific to the muscle groups involved in the execution of the movement but EMG confirmed that increase was found in nonrelated muscle groups also.

10. A theory by Paivio Suggested that mental practice enhances performance by acting on both the motivational and cognitive components of an activity at either general (e.g. degree of physiologic arousal of an individual) or specific levels (e.g. actual practice of motor task using motor imagery) Van Leeuwen and Inglis modified above theory They correctly argue that large part of preoccupation in rahabilitation is given to physical components of training often neglecting motivational conditions Mental practice would help patients focus on specific goals and could contribute to reduction of depressive state frequently observed in neurologic disorders

11. Cortical areas involved Supplementary motor cortex Precentral and post central gyri Superior Parietal area

12. A study was done on Cortical changes after mental imagery training combined with EMG –triggered electrical stimulation in patients with stroke. 14 stroke patients divided in 2 groups EMG & FES Outcome measures- FMA, motor activity log, Barthel index F- Flurocodeoxyglucose brain positron emission tomography Significantly increased cerebral glucose metabolism after 4 week was seen in EMG group Mental imagery training combined with electromyogram-triggered electri stimulation improved motor function of the paretic extremity in patients with chronic stroke. The intervention increased metabolism in the contralesional motor–sensory cortex

13. Eligibility Criteria > 24 score on MMSE ≥ 25 on KVIQ-10 < 2 grade on MAS 15% strength on paretic side

14. Advantages Innovative in many conditions Effective Easy to use Cost effective Can be used as an adjunct or independently as a treatment modality.

15. Criticized points It is not possible to decide between imaginal and propositional representations strictly on the basis of behavioral data. There are a number of reactions to the possibility that we may not be able to identify the nature of information representation.

16. Past evidences A study by Letswaart M. et al done on Mental practice with motor imagery in stroke recovery: RCT (2011) 121 stroke patients were included-3 groups- control, Attention placebo and Mental imagery Outcome measures- ARAT, Grip Strength by dynamometer Timed manual dexterity performance 45 min session-3days/week for 4 weeks for each group

17. Conclusion: It remains unclear whether the benefit of this combination is associated with enhanced cognitive models of performed movements, motivational mechanisms, or an indirect effect of neuroplasticity where mental practice reactivates recently used motor representations allowing for an increased effect of the physical practice itself.

18. Potential role of mental practice using motor imagery in neurologic rehabilitation –a review by Jackson P. (2001) This article discusses the rationale for investigating mental practice as a means of promoting motor recovery in with a neurologic disorder. Brain mapping studies of healthy subjects executing anf imagining Upper limb movements were included in this study. Although the behavioral effects of mental practice on the learning of a motor skill have been investigated using different types of paradigms, only a few studies have examined physiologic correlates of the changes in performance

19. Conclusion: It will be useful to elaborate guidelines to determine the best timing to introduce mental practice in the rehabilitation process. Additional important clinical issues that await further support include the selection of patients most likely to benefit from mental practice, the effects of cognitive deficits after brain lesion on the ability to imagine movements, the choice of instruments able to detect small changes in performance, as well as the use of a technologic medium such as virtual reality in mental practice.

20. Amasiatu A N. conducted study on Mental Imagery rehearsal as a psychological technique to enhance sports performance-Review article Mental imagery rehearsal has become one of the vital tools that can make the difference on cutting edge to enhancing sports excellence if properly utilized. No matter how good or how limited your imagery skills are now, you can improve them through daily practice.

21. Recent Advances A study by Guerra Z. et al on Effect of mental practice based on motor imagery for mobility recovery after subacute stroke (2018) 14 acute stroke patients (<3 months) 2 groups- Mental imagery & control Outcome measures- TUG 5 mWT 4 week intervention for both the groups- Strengthening and stretching exercises for both groups Control group- Cognitive therapy 30 min ( Memorizing, calculations, logical reasoning, relaxation and non motor imagery)

22. Week Sessions Duties Mental practice 1 st 1 2,3 Getting up from a chair Getting up and standing 10 reps of KC 10 reps of partially learned task 2 nd 4,5,6 Gait 10 reps of each KC 10 reps of partially learned task 3 rd 7,8,9, Gait 10 reps of each KC 10 reps of total task 4 th 10,11,12 Standing up, gait 10 reps of getting up, 10 reps of gait and 10 reps of marching Mental imagery group The possible beneficial effects of the association between mental practice and physical exercises as compared to a control group in the subacute phase of recovery after stroke are greatly relevant in clinical practice and justify the scientific interest

23. Mental imagery training for treatment of central neuropathic pain: a narrative review by Kaur J. et al (2019) Neuropathic pain is of 2 types- peripheral and central Peripheral neuropathic pain results from damage to peripheral nerves while central neuropathic pain is associated with CNS PNP CNP Diabetic polyneuropathy Vascular- Ischemic or hemorrhagic Post herpetic neuralgia Infections- Encephalitis, myelitis HIV-associated NP Demyelinating or traumatic (SCI) Cancer pain Neoplastic disorders

24. The presence of pain is associated with negative images .The use of a mirror based on the concept of mirror neurons by Ramachandran et al. to train patients with phantom limb pain supports the role of MI in chronic pain. Several techniques like graded imagery, Guided imagery can be used. Imagery is not just a visualization but it involves all the senses. This is the first review to focus on MI techniques for CNP in neurological conditions. It helps to bring about the similarity and differences in the nature and treatment of MI techniques for treating CNP. They are innovative, effective and easy to use.

25. Weigelt M & Memmert conducted a study on The mental rotation ability of Expert Basketball players: identifying On court plays (2020) Purpose of study- (1) To test a new version of a mental rotation task (MRT), which assesses mental rotation abilities of men and women for sport-specific items, and (2) To investigate potential differences in MRT performance, which are based on athletic expertise. Participants: 88 basketball players- 42 females & 46 males 123 novices without specific BB-64 females & 57 males The Mental Rotation Task—Basketball (MRT-BB) was constructed as a paper-and-pencil test that was similar to the original MRT. six different basketball plays were used as basic stimuli to create the MRT-B

26. The psychometric parameters of the MRT-BB are comparable to the standard MRT resembling the sex differences the effects of time limit, and the effects of practices, which have been consistently obtained in mental rotation research.

27. Reference De varies S., Mulder T. Motor imagery and stroke rehabilitation: a critical discussion. J Rehabil Med 2007; 39: 5-13. Jackson P., Lafleur M., Malouin F., Richards C., Doyon D. Potential role of mental practice using motor imagery in neurologic rehabilitation. Arch Phys Med Rehabil 2001;82 : 1133-1141 Kawasaki Tsubasa . Clinical Applicarion of Motor Imagery Training. Neurological Physical Therapy.Chpt 4 : 51-69. Letswaart M., Johnston M., Dijkerman HC., Joice S., Scott C., Macwalter R., Hamilton S. Mental Practice with motor imagery in stroke recovery: randomized controlled trial of efficacy. Brain 2011;134: 1373-1386.

28. Hong I.K., Choi J B., Lee J H. Cortical changes after mental imagery training combined with electromyography- triggered electrical stimulation in patients with chronic stroke. Driskell J., Moran A. Does mental practice enhance performance? Journal of applied psychology 1994; 79(4): 481-492. Kaur J., Ghosh S., Sahani A., Sinha J. Mental imagery for treatment of central neuropathic pain: a narrative review. Acta Neurologica Belgica 2019 Weigelt M., Memmert D. The mental rotation ability of expert Basketball players: identifying on court plays. Research Quarterly for Exercise and Sports 2020 Lopez N., Pereira E., Jodra E., Page C.M. Motor Imagery as a complementary technique for functional recovery after stroke: a systematic review. Topics on Stroke rehabilitation 2019: 1945-1952. Guerra Z., Bellose L., Faria C., Lucchetti G. The effect of mental practice based on motor imagery for mobility recovery after subacute stroke: protocol for a randomized controlled trial. Complementary Therapies in Clinical Practice 2018

29. Anderson John. Arguments concenrning representations for mental Imagery: Psychological review.1978 ;85(4)

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