Upper Extremity Motor Imagery Functional Skills and Quality of Life in Patients With Multiple Sclerosis

Multiple sclerosis (MS) is a chronic inflammatory and autoimmune disease of the central nervous system (CNS) characterised by axonal loss and demyelination. MS is characterized by myelin, oligodendrocyte and axon damage. MS progresses in a wide spectrum, with motor, sensory, autonomic and cognitive disorders depending on the area affected.

Upper extremity dysfunction is common in patients with MS (pwMS), too. 75% of pwMS have impaired ability to perform activities of daily living (ADL) and quality of life (QoL).

Motor imagery (MI) refers to the mental simulation of an action without physical intervention.

MS is also characterised by motor and cognitive symptoms. Cognitive impairment, seen in approximately 40-70% of patients, is mainly related to problems in attention, information processing speed, memory, cognitive and visual structure. MI refers to the mental simulation of an action without physical intervention, which can be classified as explicit or implicit. MI skill is linked to motor planning and execution skills. MI is related to the subconscious activation of motor systems that play a role not only in producing movement, but also in imagining actions, learning through observation, recognising tools, and also understanding other people's behaviour.The speed and quality of upper extremity functional skills in pwMS may be related to MI ability.

Health-related quality of life (HRQoL) is an individual's assessment of how a health problem and its treatment affect their ability to perform daily activities and roles. Research studies have shown that pwMS report lower QoL scores than healthy controls. Losses in upper extremity functional skills may affect the activities of daily living and work life in pwMS, leading to a decrease in their QoL. When evaluating MI ability in these patients, the patient's functional skills and cognitive status should also be taken into consideration.

It is thought that upper extremity MI skills may be negatively affected by impairments with the cognitive syptoms in pwMS. The aim of this study is to investigate the relationship between upper extremity MI ability, upper extremity functional skills and QoL in pwMS.

Multiple Sclerosis (MS), a chronic inflammatory disease of the central nervous system (CNS), is characterized by myelin, oligodendrocyte and axon damage.MS is a chronic disease with unpredictable clinical presentations, ranging from mild, infrequent relapses causing mild functional impairment to severe disability, including loss of independent walking or severe cognitive impairment.Upper limb dysfunction is common in patients with MS (pwMS). 75% of pwMS report difficulties performing bimanual tasks that affect their independence and ability to perform daily activities and quality of life (QoL). Such dysfunction is typically a combination of sensory, motor, and central deficits that occur proximally, distally, or throughout both upper limbs and may occur unilaterally or bilaterally.Upper extremity disability in pwMS can be found in the proximal or distal parts of the upper extremity. Distal upper extremity dysfunction is often referred to as impaired manual dexterity or hand dysfunction. Impaired sensory function, fatigue, loss of manual skills, and mobility are the most commonly reported symptoms in the first year of the disease in pwMS. It has also been reported that 75% of the population with MS at the level 6.5 according to the Expanded Disability Status Scale (EDSS) has impaired bimanual skills.

Motor imagery (MI) refers to the mental simulation of an action without physical intervention, which can be classified as explicit or implicit. Expilicit MI is defined as consciously imagining an action. This ability is assessed with Mental Chronometer (MK) and MI questionnaires. In implicit MI some tests such as mental rotation (MR) are applied to ensure that individuals can use their ability unconsciously. MI skills are related to motor planning and execution skills.MI supports motor learning and motor performance and is a useful strategy for neurorehabilitation. The mechanism of this imagery involves activating the same sensorimotor regions in the brain that are active during the physical completion of the movement, thus potentially strengthening and increasing synaptic connectivity for the regions involved in the movement. Areas involved in this activation include the primary motor cortex, basal ganglia, cerebellum, premotor cortex, supplementary motor area, parietal cortex, and prefrontal cortex. The corticospinal tract is activated during MI, an important indication that the imagery stimulates surrounding motor neurons and affects the cortex. These neural networks are activated during MI, strengthening connections and improving performance during the physical completion of given tasks.Because training in MI is relatively easy and effective in improving motor performance, it has recently been used to improve motor deficits in stroke and Parkinson's disease. Due to the severe motor impairments in pwMS and the negative effects of these impairments on QoL, it has recently been recommended for therapeutic use in MS. A study found that patients with MS had significant differences in the mean accuracy and temporal organization of MI ability compared to age-matched healthy controls.

MI skills are associated with motor planning and regulation.Studies have shown that cognitive performance measured by processing speed and executive function is significantly related to patients' motor function. In one study, the MI ability of pwMS differed significantly in the mean accuracy and temporal organization of MI compared to the MI ability of age-matched healthy controls.

Health-related QoL is an individual's assessment of how a health problem and its treatment affect the ability to perform daily life activities and roles. Studies have shown that pwMS report lower QoL than healthy controls or those with other chronic diseases such as rheumatoid arthritis and inflammatory bowel disease.

There is no study evaluating upper extremity MI skills in pwMS and examining its effects on upper extremity functional skills and QoL. In this direction, the aim of this study is to investigate the relationship between upper extremity MI ability and upper extremity functional skills and QoL in MS patients.

Eligibility Criteria:
Inclusion Criteria:

* Being 18 years old or older
* Mini Mental Test score of 24 or higher
* No neuro-musculoskeletal disease

Exclusion Criteria:

* Being pregnant
* Having a neuromusculoskeletal disease other than Multiple Sclerosis
* Having any contractures in the upper extremity