Motor Imagery and Action Observation for Gait Function in MS

Not Applicable

Not yet recruiting

• Conditions: Multiple Sclerosis

• Registration Number: NCT07137624
• Lead Sponsor: Hacettepe University

Brief Summary

This study will investigate whether mentally simulating walking movements while watching others walk can improve walking performance in individuals with Multiple Sclerosis (MS). Participants will be divided into two groups: one group will watch walking videos and imagine themselves walking, while the other group will watch nature scenes. The study will measure muscle activity and walking patterns to assess the effects. The results may help support the use of mental practice techniques to improve mobility in people with MS.

Detailed Description

This study aims to explore the impact of mental simulation of walking movements on walking performance in individuals with Multiple Sclerosis (MS). The participants will be randomly assigned to two groups: the experimental group will watch walking-related videos and engage in mental imagery exercises, imagining themselves walking, while the control group will watch nature scenes without any walking-related content.

Objectives:

To determine whether mental imagery can enhance walking ability and gait parameters in individuals with MS.

To measure the effect of mental simulation on muscle activity and walking patterns, including stride length, walking speed, and balance.

Study Procedure:

The study will consist of multiple sessions, where participants will first undergo baseline assessments of walking ability. Following this, they will engage in either the walking video and imagery task (experimental group) or the nature video viewing task (control group) for a predetermined period of time. Measurements of muscle activity using electromyography (EMG) and walking patterns will be recorded before and after the intervention.

Potential Impact:

The results from this study may provide insights into the use of mental practice techniques as a non-invasive intervention to improve mobility in individuals with MS, a population often affected by walking difficulties. Mental imagery could serve as an adjunct therapy to traditional physical rehabilitation methods.

Study Timeline

• Status Verified: 2025-08
• Study Start: 2025-08-01
• Study First Submitted: 2025-08-06
• Study First Submitted QC: 2025-08-21
• Last Update Submitted: 2025-08-21
• Study First Posted: 2025-08-22
• Last Update Posted: 2025-08-22
• Primary Completion: 2025-10
• Study Completion: 2025-10-01

Recruitment & Eligibility

• Status: NOT_YET_RECRUITING
• Sex: All
• Target Recruitment: 20

Inclusion Criteria

• A confirmed diagnosis of multiple sclerosis (MS) by a neurologist
• No history of relapse within the past 3 months and not currently experiencing a relapse
• A score of 24 or higher on the standardized Mini Mental State Examination

Exclusion Criteria

• Presence of serious health conditions affecting the muscles, heart, lungs, or metabolism that could interfere with participation
• History of other neurological disorders, head injury, or chronic psychiatric conditions
• Chronic pain lasting longer than six months
• Significant muscle stiffness in the legs that may affect EMG recordings
• Hearing difficulties
• Vision problems as determined by the Snellen visual acuity test

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Primary Outcome Measures

Name	Time	Method
Change in Tibialis Anterior and Gastrocnemius Medialis Muscle Activity Amplitude	Before and immediately after the intervention	Change in muscle activity amplitude (microvolts, µV) of tibialis anterior and gastrocnemius medialis during gait initiation measured by surface EMG.
Change in Tibialis Anterior and Gastrocnemius Medialis Muscle Activity Onset Latency	Before and immediately after the intervention.	Change in onset latency (milliseconds, ms) of tibialis anterior and gastrocnemius medialis muscle activation during gait initiation measured by surface EMG.
Change in Step Length	Before and immediately after the intervention	Change in step length (centimeters, cm) during gait initiation measured by the GAITRite system.
Change in Step Time	Before and immediately after the intervention	Change in step time (seconds, s) during gait initiation measured by the GAITRite system.
Change in Step Width	Before and immediately after the intervention	Change in step width (centimeters, cm) during gait initiation measured by the GAITRite system.
Change in Double Support Period	Before and immediately after the intervention	Change in double support period (percentage of gait cycle, %) during gait initiation measured by the GAITRite system.
Change in Gait Velocity	Before and immediately after the intervention	Change in gait velocity (centimeters per second, cm/s) during gait initiation measured by the GAITRite system.
Change in Cadence	Before and immediately after the intervention	Change in cadence (steps per minute, steps/min) during gait initiation measured by the GAITRite system.

Secondary Outcome Measures

Name	Time	Method
Motor Imagery Vividness	Baseline only	Kinesthetic and visual imagery vividness will be assessed using the Kinesthetic and Visual Imagery Questionnaire-20 (KVIQ-20), which includes 10 visual and 10 kinesthetic items (20 total). Each item is rated on a 5-point Likert scale (1 = no image/sensation, 5 = vivid image/sensation). Higher scores indicate better imagery ability.
Mental Chronometry Ratio	Baseline only	The ratio between imagined and actual Timed Up and Go (TUG) performance time (both measured in seconds, s) will be calculated. During imagined trials, participants will press a button to mark the start and end of the imagined movement sequence. A ratio closer to 1 indicates better temporal congruence between imagined (iTUG) and executed TUG performance.
Limb Laterality Recognition Performance	Baseline only	Right-left discrimination ability will be evaluated using the Recognise Foot App™ developed by the NOI Group™. Both accuracy (percentage of correct responses, %) and response time (milliseconds, ms) will be recorded.
Cognitive Status	Baseline only	General cognitive functioning will be screened using the Standardized Mini-Mental State Examination (SMMSE). The test is scored on a 30-point scale (0-30). Scores ≥24 indicate normal cognitive functioning.
Anxiety and Depression	Baseline only	Emotional state will be assessed using the Hospital Anxiety and Depression Scale (HADS). The scale consists of 14 items divided into two subscales: anxiety (7 items) and depression (7 items). Each item is scored from 0 to 3, yielding subscale scores ranging from 0 to 21. Higher scores indicate greater levels of anxiety or depression.
Fatigue Level	Baseline only	Fatigue severity specific to MS will be measured with the Fatigue Severity Scale (FSS). The FSS consists of 9 items rated on a 7-point Likert scale (1 = strongly disagree; 7 = strongly agree). The final score is calculated as the mean of all items (range: 1-7), with higher scores indicating greater fatigue severity.
Visual Acuity	Baseline only	Participants' visual acuity will be assessed using the Snellen chart under standard conditions. The test will be conducted with or without corrective lenses depending on the participant's usual visual aid usage. Visual acuity will be recorded as a Snellen fraction (e.g., 20/20, 20/40), where larger denominators indicate poorer visual performance.
Disability Level	Baseline only	Expanded Disability Status Scale (EDSS) scoring will be performed using the standardized Neurostatus-EDSS format. This scale evaluates functional systems such as motor ability, balance, vision, and sensory function to quantify disability level in individuals with multiple sclerosis. Scores range from 0 to 10 in 0.5-point increments, where 0 indicates normal neurological status and 10 represents death due to MS. Higher scores reflect greater disability.

Trial Locations

Locations (1)

Hacettepe University, Faculty of Physical Therapy and Rehabilitation; 🇹🇷 Ankara, Turkey