Motor Imagery Intervention for Improving Gait and Cognition in the Elderly

Study Overview
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Brief Summary
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The investigators propose a single-blind randomized clinical trial to determine if seniors show improved mobility (walking speed) and cognition following motor imagery (imagined walking) training. They hypothesize that imagined walking can be used as a rehabilitative tool for improving walking speed and cognition in the elderly, because it engages and strengthens similar neural systems as actual walking and cognition.

Detailed Description
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The proposed research aims to establish the efficacy of an imagined gait protocol for improving gait and cognition in the elderly. This imagined gait protocol involves imagined gait in single (imagined walking; iW) and dual-task (imagined walking while talking; iWWT) situations. A single-blind randomized clinical trial of 58 cognitively-healthy elderly with pre-post measures of gait, cognition, and functional Magnetic Resonance Imaging (fMRI) during imagined gait is proposed. The overall hypothesis is that imagined gait can be used as a rehabilitative tool for improving gait and cognition in the elderly because it engages and strengthens similar neural systems as actual gait and cognition. The first aim of this study is to establish the efficacy of our imagined gait protocol to improve gait and cognition in the elderly. We predict that our imagined gait intervention will improve gait velocity during actual walking and walking-while-talking conditions to a greater extent than the active control (visual imagery) intervention. We also predict that our imagined gait intervention will cognitive performance during dual-task walking conditions. The second aim of this study is to determine neuroplasticity changes in response to our imagined gait protocol. We predict that the neural systems engaged during imagined gait will change following our imagined gait intervention.

Official Title
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Motor Imagery Intervention for Improving Gait and Cognition in the Elderly

Conditions
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Motor Activity

Intervention / Treatment
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* Behavioral: Imagined Gait Intervention
* Behavioral: Visual Imagery Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults between 65 and 85 years and older, residing in the community. Able to speak English at a level sufficient to undergo study procedures. Plan to be in the area for the next 3 months. Exclusion Criteria: Presence of dementia (telephone-based memory impairment screen < 5 or Ascertain Dementia 8-item Informant Questionnaire score > 1) Presence of gait disorder diagnosed by clinician (e.g. neuropathy). Any medical condition or chronic medication use (e.g. neuroleptics) that will compromise safety or affect cognitive functioning. Terminal illness with life expectancy <12 months. Progressive, degenerative neurologic disease (e.g. Parkinson's disease, ALS). Major psychiatric disorders such as Schizophrenia. Pacemaker or any permanent metal implants like hip prosthesis (other than tooth fillings) and claustrophobia.

Ages Eligible for Study
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Minimum Age: 65 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Imagined Gait Intervention<br>During the phone-based imagined gait intervention, participants will be called by the experimenter three times a week and be asked to imagine walking, imagine talking and imagine walking-while-talking. They will also be asked to rate their visual and kinesthetic qualities of their images on a 1-5 scale following each trial. | Behavioral: Imagined Gait Intervention<br>* Phone-based imagined gait intervention: participants will be called by the experimenter three times a week and be asked to imagine walking, imagine talking and imagine walking-while-talking. They will also be asked to rate their visual and kinesthetic qualities of their images on a 1-5 scale following each trial.<br>|
| Active Comparator: Visual Imagery Intervention<br>During the phone-based visual imagery intervention, participants will be called three times a week by the experimenter and be asked to imagine concrete objects (e.g. octopus, teapot, and shovel). They will also be asked to rate their visual qualities of their images on a 1-5 scale following each trial. | Behavioral: Visual Imagery Intervention<br>* Phone-based visual imagery intervention: participants will be called three times a week by the experimenter and be asked to imagine concrete objects (e.g. octopus, teapot, and shovel). They will also be asked to rate their visual qualities of their images on a 1-5 scale following each trial.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement in walking speed during single and/or dual-task walking conditions | Improvement in gait speed (centimeters per second) measured during normal pace walking and walking while talking conditions using an instrumented pathway | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Improvement in cognitive performance during talking walking while talking | Increased number of correct letters generated during walking while talking | 3 months | 
| Change in blood-oxygen-level-dependent signal during single and/or dual-task imagined walking conditions | Change in blood-oxygen-level-dependent signal during single and/or dual-task imagined walking conditions measured with functional magnetic resonance imaging | 3 months | 
| Improvement on Trail Making Test form A | Improvement on Trail Making Test form A, a timed measure of attention and processing speed. Scoring is based on the time required to complete the task and on accuracy | 3 Months | 
| Improvement on Trail Making Test form B | Improvements on Trail Making Test form B, a timed measure of attention, processing speed and set-shifting. Scoring is based on the time required to complete the task and on accuracy | 3 months | 
| Improvement on Trail Making Test form B minus A | Improvements on Trail Making Test form B minus A, a timed measure of set-shifting. Scoring is based on the change in time and accuracy between completing form B compared to form A. | 3 months | 
| Improvement on the Letter Number Sequencing Task | Improvement on the letter number sequencing task, a measure of item manipulation. Scoring is based on the number of correctly completed sequences | 3 months | 
| Improvement in Stroop Interference: Color-Word minus Color score | Improvement on Stroop Interference: Color-Word (incongruent trials) minus Color (congruent trials) score. Scoring is based on the time and accuracy to complete incongruent relative to congruent trials. A measure of response competition and interference. | 3 months | 
| Improvement on the Flanker Interference Task | Improvement on the Flanker Interference: Incongruent minus Congruent trials. Scoring is based on the time and accuracy of responses during incongruent relative to congruent trials. A measure of response competition and interference | 3 months | 
| Stride Length | Change in stride length collected during normal pace walking and walking while talking conditions on an instrumented walkway | 3 months | 
| Gait Variability | Change in gait variability measured in standard deviation units, collected during normal pace walking and walking while talking on an instrumented walkway. | 3 months | 
| Gait Domains | Change in gait domains (summary measures reported in standard deviation units) derived from factor analysis of quantitative gait variables collected on an instrumented walkway during normal pace walking and walking while talking | 3 Months |