The effect of rhythmic cued motor imagery on walking, fatigue and qual

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Background and study aims Multiple sclerosis (MS) is a long-term and disabling illness of the brain and spinal cord. Patients with MS often have problems with walking and an overwhelming tiredness. Therefore, activities of daily life are challenging and quality of life is poor. Physiotherapy has been found to be useful to improve walking, fatigue and quality of life in patients with MS. This is even more true for physiotherapy settings that are tailored to the individual patient's needs. In recent years, new physiotherapy strategies have been developed. Two of them are motor imagery and rhythmic auditory stimulation. Motor imagery means that somebody thinks about moving her or his body in a certain way. Motor imagery of walking has been shown in studies to improve walking. Motor imagery can be practised with verbal guiding and/or audible information. It has been found in studies that it is easier to concentrate on the motor imagery with this additional information. Further, motor imagery works best when patients 'feel' the movement they imagine. Rhythmic auditory stimulation means that while moving a person hears the rhythm made by music or a metronome, and that this person´s movement is influenced by the rhythm. Rhythmic auditory stimulation also has been shown to improve walking in patients with neurologic diseases. Only two studies were found to test the effects of rhythmic auditory stimulation in people with MS. These were only small studies showing that balance and fatigue got better. Several researchers compared the effect of music and metronome signals on walking. This was mostly done in patients with stroke and Parkinson´s disease. The studies' results showed a walking improvement, and motor imagery was more lively and precise with any audible signals. Therefore, it will be interesting if either music or metronome signals can support motor imagery in patients with MS. In this study, a combination of motor imagery and music or metronome signals will be used. This study seeks to find out the effect of rhythmic-cued motor imagery on walking (speed and distance), tiredness and quality of life in people with multiple sclerosis. Who can participate? Adult, German-speaking, MS patients at the participating clinic can take part. What does the study involve? You will be randomly allocated to one of three groups: A, B or C. Group A receives motor imagery with music and verbal guiding, plus weekly phone calls for support; group B receives motor imagery with metronome signals and verbal guiding, plus weekly phone calls for support; and group C receives usual treatment plus weekly phone calls asking about well-being. If you are in the treatment groups you will be informed beforehand. The treatment will take place at your home and it will last 4 weeks. You will be asked to sit down, close your eyes and imagine that you are walking at various speeds, according to the CD. You are asked to do this six times a week for 17 minutes. The Audio Mix on the CDs will be changed every week. Walking will be assessed using two walking tests. You will be asked to fill in five questionnaires about walking, fatigue and quality of life. Assessments will be taken at the start and after 4 weeks. Refreshments will be provided during testing. What are the possible benefits and risks of participating? You will not be at risk of falling or exhaustion during the home-based motor imagery, therefore the treatment is considered to be safe. The walking tests will be done in a hallway close to the wall and you will be safeguarded by the researcher. You will be allowed to rest during the assessments if you wish to. You might benefit from the intervention if you are in the treatment group with better walking and feeling less fatigued; however, this cannot be guaranteed. No side effects are expected as result of this treatment. Where is the study run from? MS Clinics, Innsbruck Medical University, Department of Neurology, Austria. When is the study starting and how long is it expected to run for? The study starts in March 2014. Participants will be enrolled on the study for a period of two and a half years (September 2016); however, the study will extend beyond this if necessary, up to 42 months (September 2017). Who is funding the study? Multiple Sclerosis Society of Austria (Austria) Who is the main contact? Mrs Barbara Seebacher b.seebacher@aon.at