Motor imagery in neurological rehabilitation

Background Rehabilitation interventions have been shown to benefit individuals with neurological disorders. More intensive treatments, whilst being expensive on resources, have been observed to attain greater impact. Motor imagery is a promising intervention for use in rehabilitation as it can be used to safely increase treatment dose at low cost. However, motor imagery is a complex intervention and there is limited evidence on the optimal content and delivery of the motor imagery intervention and on the effectiveness of motor imagery in neurological rehabilitation. Methodology/Principal findings A literature review was performed to make an inventory of the content of motor imagery interventions used in neurological rehabilitation. This showed that the interventions were heterogeneous and often poorly described with evidence from other fields rarely implemented. To effectively embed motor imagery in clinical practice it should be client-tailored. The literature review and experiences from a pilot study resulted in a comprehensive client-tailored motor imagery strategy for increasing motor function. Goal attainment scaling is a client-centred outcome measure evaluating the attainment of goals. The attainment of goals can be scored by the clinician but in a randomised controlled trial scoring is preferably performed by an independent person. This thesis, whilst demonstrating low agreement (ICC(A,k)=.478; Limits of Agreement -1.52 ± 24.54) between the clinician and the independent assessor in scoring the goal attainment, found that change scores in goal attainment scaling scored by the Independent assessor were stronger correlated with change scores on the Barthel Index (r=O.36, P=.049) and the Rivermead Mobility Index (r=0.41, P=.025) than the change scores by the clinician. The developed client-tailored motor imagery strategy and goal attainment scaling were employed in a phase II randomised clinical trial which investigated the effectiveness and feasibility of service-delivered motor imagery in neurological rehabilitation. The experimental as well as the control group improved significantly over time (F(2, 27) = 45.159, P=.OOO).The group by time effect was not significant: F(2, 27) = 0.OS5, P=.919 and the main effect of Group was not significant: F(l, 2S) = 0.039, P=.S45. Conclusions/Significance In this thesis a comprehensive motor imagery strategy and a standardisation of the goal attainment scaling method were developed and tested. Although the intervention did not demonstrate statistically significant positive benefits, it also did not show a negative effect, whereas the patients in the motor imagery group employed less physical practice. It does show that the goal attainment scaling method can be used as a client-centred outcome measure in clinical practice and that the motor imagery strategy can be client-tailored and service-delivered

Biomechanical mechanisms of jumping performance in youth elite female soccer players

We aimed to determine key biomechanical parameters explaining age-related jumping performance differences in youth elite female soccer players. Multiple biomechanical parameters from countermovement (CMJ) squat (SJ) and drop (DJ) jump testing of elite female soccer players (n?=?60) within the same national training centre were analysed across ages 9-11y, 12-14y and 15-19y. Effects of age group and jump type on jump height were found, with the older jumping higher than the younger groups in all jumps (P

Switch hands!: Mapping proactive and reactive cognitive control across the life span

We investigated the effects of age on proactive and reactive cognitive control in a large population sample of 809 individuals, ranging in age between 5 and 97 years. For that purpose, we used an anticue paradigm, which required a consistent remapping of cue location and response hand: Left-sided cues required right-hand responses and vice versa. After a random preparation interval of 100-850 ms, these anticues were followed by a target stimulus, which prompted a response with the index or middle finger of 1 of 2 hands. A neutral control condition involved uninformative cues, indicating all 4 possible response locations. The primary outcome measure was the difference between neutral and anticue reaction time (RT). Negative values indicated RT costs of the anticue, relative to the neutral condition, reflecting reactive cognitive control. Positive values indicated RT benefits, reflecting proactive cognitive control. Results were twofold. First, the switch from RT costs to benefits took place at longer preparation intervals in the youngest and oldest age groups than in the intermediate age groups. Second, irrespective of preparation interval, anticue performance followed an inverted U-shaped trajectory as a function of age, with a relatively steep improvement during childhood and adolescence, relative stability between 26 and 60 years, and a slightly accelerating decline into old age. Both patterns of results suggest an age-related transition from a primarily reactive, to a primarily proactive mode of cognitive control in early life and back again from a primarily proactive, to a primarily reactive mode of control in later life. (PsycINFO Database Recor

Dynamic testing of learning potential in adults with cognitive impairments: A systematic review of methodology and predictive value

Dynamic testing includes procedures that examine the effects of brief training on test performance where pre- to post-training change reflects patients' learning potential. The objective of this systematic review was to provide clinicians and researchers insight into the concept and methodology of dynamic testing and to explore its predictive validity in adult patients with cognitive impairments. The following electronic databases were searched: PubMed, PsychINFO, and Embase/Medline. Of 1141 potentially relevant articles, 24 studies met the inclusion criteria. The mean methodological quality score was 4.6 of 8. Eleven different dynamic tests were used. The majority of studies used dynamic versions of the Wisconsin Card Sorting Test. The training mostly consisted of a combination of performance feedback, reinforcement, expanded instruction, or strategy training. Learning potential was quantified using numerical (post-test score, difference score, gain score, regression residuals) and categorical (groups) indices. In five of six longitudinal studies, learning potential significantly predicted rehabilitation outcome. Three of four studies supported the added value of dynamic testing over conventional testing in predicting rehabilitation outcome. This review provides preliminary support that dynamic tests can provide a valuable addition to conventional tests to assess patients' abilities. Although promising, there was a large variability in methods used for dynamic testing and, therefore, it remains unclear which dynamic testing methods are most appropriate for patients with cognitive impairments. More research is warranted to further evaluate and refine dynamic testing methodology and to further elucidate its predictive validity concerning rehabilitation outcomes relative to other cognitive and functional status indices

Dynamic testing of learning potential in adults with cognitive impairments:A systematic review of methodology and predictive value

Dynamic testing includes procedures that examine the effects of brief training on test performance where pre- to post-training change reflects patients' learning potential. The objective of this systematic review was to provide clinicians and researchers insight into the concept and methodology of dynamic testing and to explore its predictive validity in adult patients with cognitive impairments. The following electronic databases were searched: PubMed, PsychINFO, and Embase/Medline. Of 1141 potentially relevant articles, 24 studies met the inclusion criteria. The mean methodological quality score was 4.6 of 8. Eleven different dynamic tests were used. The majority of studies used dynamic versions of the Wisconsin Card Sorting Test. The training mostly consisted of a combination of performance feedback, reinforcement, expanded instruction, or strategy training. Learning potential was quantified using numerical (post-test score, difference score, gain score, regression residuals) and categorical (groups) indices. In five of six longitudinal studies, learning potential significantly predicted rehabilitation outcome. Three of four studies supported the added value of dynamic testing over conventional testing in predicting rehabilitation outcome. This review provides preliminary support that dynamic tests can provide a valuable addition to conventional tests to assess patients' abilities. Although promising, there was a large variability in methods used for dynamic testing and, therefore, it remains unclear which dynamic testing methods are most appropriate for patients with cognitive impairments. More research is warranted to further evaluate and refine dynamic testing methodology and to further elucidate its predictive validity concerning rehabilitation outcomes relative to other cognitive and functional status indices