The effect of mental imagery and physical exercise on static balance in subjects with multiple sclerosis

Document Type : Original Articles


1 MSc, Department of Motor Behavior, Shahid Chamran University of Ahvaz, Ahvaz, Iran

2 Faculty Member, Department of Motor Behavior, Shahid Chamran University of Ahvaz, Ahvaz, Iran



Introduction: Mental imagery is a psychological factor effecting the improvement of motor skills. The present study was aimed to examine the effect of mental imagery and physical exercise on static balance in subjects with Multiple sclerosis (MS).Materials and methods: In this quasi experimental study, all male patients with MS (n = 300) in Ahvaz province (n = 300) were recruited. Kinesthetic and visual imagery questionnaire (KVIQ) was distributed among them to select a suitable sample size. In next step, thirty three individuals with the same imagery ability and expanded disability status scale (EDSS) were chosen and randomly and equally classified in three groups of mental imagery-physical exercise(combined) (n = 11), mental imagery (n = 11), and physical exercise (control) (n = 11). Participants carried out the selected training program three times a week (for 6 weeks). After 2-week, retention test was completed in last training session. The modified Romberg balance test (MRBT) was used to assess static balance in pre-test, post-test, and retention-test. Data, then were analyzed by SPSS, version 16.Results: The results showed that, after 18 sessions, there was a significant difference between post-test (P = 0.01) and retention test (P = 0.001) in different groups; and combined group had a better performance in both stages.Conclusion: According to the results, mental imagery could be used as a practical method for better static balance performance in individuals with multiple sclerosis.Key Words: Mental imagery, Physical exercise, Static balance, Multiple sclerosis

  1. Sharissa HA, Henrik G, Jens K, Ludwig K, John HJ. Allum, O. Balance control in multiple sclerosis: Correlations of trunk sway during stance and gait tests with disease severity. Gait Posture 2013; 37(1): 55–60.
  2. - McNalley TE, Haselkorn JK. Disorders of mobility in multiple sclerosis. In: Giesser BS, editor. Primer on multiple sclerosis. New York: Oxford University Press; 2011. pp. 189–96.
  3. - Finlayson ML, Peterson EW, Cho CC. Risk factors for falling among people aged 45 to 90 years with multiple sclerosis. Arch Phys Med Rehabil 2006; 87(9): 1274–9.
  4. - Nilsagard Y, Denison E, Gunnarsson LG, Bostrom K. Factors perceived as being related to accidental falls by persons with multiple sclerosis. Disabil Rehabil 2009; 31(16): 1301–10.
  5. - Peterson EW, Cho CC, von Koch L, Finlayson ML. Injurious falls among middle aged and older adults with multiple sclerosis. Arch Phys Med Rehabil 2008; 89(6): 1031–7.
  6. - Bronnum-Hansen H, Hansen T, Koch-Henriksen N, Stenager E. Fatal accidents among Danes with multiple sclerosis. Mult Scler 2006; 12(3): 329–32.
  7. - Heremans E, Nieuwboer A, Spildooren S, De Bondt S, D,hooge AM , Helsen W, et al. Cued motor imagery in patients with multiple sclerosis. Neuroscience 2012; 206: 115–21.
  8. - Pearson DG, Deeprose C, Wallace-Hadrill SM, Burnett Heyes S, Holmes EA. Assessing mental imagery in clinical psychology: A review of imagery measures and a guiding framework. Clin Psychol Rev 2013; 33(1): 1–23.
  9. - Hosseini SA , Fallahpour M, Sayadi M, Gharib M, Haghgoo H. The impact of mental practice on stroke patients' postural balance. J Neurological Sci 2012; 322(1-2): 263–7.
  10. - Tamir R. Dickstein R. Huberman M. Integration of motor imagery and physical practice in group treatment applied to subjects with Parkinson’s disease. Neurorehabil Neural Repair 2007; 21(1): 68-75.
  11. - Braun S , Beurskens A, Kleynen M, Schols J, Wade D. Rehabilitation with mental practice has similar effects on mobility as rehabilitation with relaxation in people with Parkinson’s disease: a multicentre randomised trial. J Physiother 2011; 57(1): 27-34.
  12. - Heremans E, Helsen WF, Feys P. The eyes as a mirror of our thoughts: quantification of motor imagery of goal directed movements through eye movement registration. Behav Brain Res 2008; 187(2): 351–60.
  13. - Butler AJ, Page SJ. Mental practice with motor imagery: evidence for motor recovery and cortical reorganization after stroke. Arch Phys Med Rehabil 2006; 87(Suppl 2): S2–S11.
  14. - Malouin F, Richards CL. Mental practice for relearning locomotor skills. Physical Ther 2010 90(2): 240–51.
  15. - Malouin F, Richards CL, Jackson PL, Lafleur MF, Durand A, Doyon J. The kinesthetic and visual imagery questionnaire (KVIQ) for assessing motor imagery in persons with physical disabilities: a reliability and construct validity study. J Neurol Phys Ther 2007; 31(1): 20–9.
  16. - Randhawa B , Harris S, Boyd LA. The Kinesthetic and Visual Imagery Questionnaire Is a Reliable Tool for Individuals With Parkinson Disease. J Neurol Phys Ther 2010; 34(3): 161-7.
  17. - Agrawal Y, Carey JP, Hoffman HJ, Sklare DA, Schubert MC. The Modified Romberg Balance Test: Normative Data in U.S. Adults. Otol Neurotol 2011; 32(8): 1309-11.
  18. - Dickstein R, Dunsky A, Marcovitz E. Motor imagery for gait rehabilitation in post-stroke hemiparesis. Phys Ther 2004; 84(12): 1167-77.
  19. - Stinear CM, Byblow WD. Modulation of corticospinal excitability and intracortical inhibition during motor imagery is task-dependent. Exp Brain Res 2004; 157(3): 351-8.
  20. - Hosieni SS, Rostamkhani H, Naghiloo Z, Lotfi N. The effects of balance, mental and concurrent training on balance in healthy older males.Res Rehabil Sci 2010; 6(2): 107-114.
  21. - Yagüez L, Nagel D, Hoffman H, Canavan AG, Wist E, and Hömberg V. A mental route to motor learning: Improving Trajectorial kinematics through imagery training. Behav Brain Res 1998; 90(1): 95-106.
  22. - Sadeghi H, Hadi H, Rostamkhani H, Bashiri J, Bashiri M; The Effect of Balance Mental Practice on Dynamic Postural Control in Non-Athletic Male Students; Human Mov Sci 2008; (2): 107-114.
  23. - Perry C, Morris T. Mental imagery in sport. In: Morris T, Summers J. Sport psychology: theory, applications and issues. Brisbane, Australia: John Wiley; 1995.
Volume 10, Issue 7 - Serial Number 7
February 2015
Pages 866-74
  • Receive Date: 28 April 2014
  • Revise Date: 19 April 2024
  • Accept Date: 22 May 2022