Mental Imagery in Parkinson’s Disease

Amit AbrahamPosting for Dr. Hackney this month is Amit Abraham (B.P.T, MAPhty, PhD candidate), a musculoskeletal physical therapist and a post-doctoral fellow at Emory University, the School of Medicine. His research focuses on the effect of mental imagery on dance performance and the effect of Gaga movement language and mental imagery on motor and non-motor aspects among individuals with Parkinson’s disease. Amit is in the process of becoming a certified Franklin Method© teacher.

Imagery, or mental imagery, is a general term used for describing a variety of mental approaches and techniques which use mental invention or recreation of images (or metaphors) that resemble the actual perception of an object, action or event without its actual presence (Neck et al 1992). These images are formed within the individuMadeleine E. Hackney, PhD The Exercise Files blogal’s brain, are personal and are usually based on previous experience of the individual (for example, the feeling of walking bare-feet on the beach) or on images the individual is familiar with (for example, a balloon flying up in the air). Imagery techniques can be practiced “exclusively” (i.e., with no actual physical component. For example, picturing one’s body as loose and watery) or simultaneously with the actual performance of the movement or function (for example, climbing stairs while picturing one’s knees being lifted by a big helium balloon).

Using imagery techniques require the ability to focus and concentrate in order to create the images and use them correctly. Imagery is a trainable skill which improves with practice. Saying that, being a trainable skill, imagery should be taught in a well-constructed way by experienced practitioners in the field of imagery and be practiced on a regular basis to fully experience its benefits. Imagery is a great tool for enhancing movement and holds substantial advantages: in addition to becoming more aware and focused on what one is doing and how he/she is doing it (attention which, by itself, can improve the movement), imagery has the potential to activate conscious movement-related mechanisms thus allowing one to use the body better and in accordance with the body’s anatomical and biomechanical design. Moreover, practicing imagery may encourage changes and corrections needed for improving one’s movement, posture, and even breathing. An example is the following: if one is more aware of pelvic mobility while walking, one is more likely to notice existing limitations within the pelvic region as well as being able to use the pelvic girdle more properly while walking. The present example requires acquiring some knowledge about anatomy and the bio-mechanics of the human body, which is an integral part of learning the practice of imagery properly. Another main advantage of imagery is that it can be used at all times and in all conditions with no need for special equipment or associated costs.

ImageryThe neuro-scientific background of imagery derives from research showing that brain areas responsible for physically executing specific functions are being activated during imagery of these functions, thus producing a ‘training effect’ to the brain without actual performance.(Lotze et al 2006) This training effect may result in improvement in physical performance, coordination, agility, range-of-motion, effort, etc. In recent years, the popularity of imagery techniques (or other mental techniques, such as meditation) has been growing rapidly. This increasing popularity is due to growing awareness and interest in body-mind topics as well as research and anecdotal evidence showing imagery’s beneficial effects in achieving goals, such as improving posture, enhancing muscular strength, improving efficacy, increasing motivation and self-awareness, and even preventing injuries.

Many approaches and methods use imagery to some extent as part of the training. The Franklin Method© (http://franklinmethod.com/) is one of these approaches, serving as a comprehensive approach for teaching the usage of imagery and dynamic imagery (that is, the different types of imagery being taught in combination with knowledge of the human body anatomy and biomechanics) in daily life with the aim of improving well-being, including posture and movement. Classes are offered to people at all ages and functional levels during which imagery is taught and practiced with additional elements of mental practice (such as breathing, self-awareness and cueing.) Online free videos and classes are also available to watch on the net and practice at home.

Imagery has also been used effectively in the management for people with various medical conditions, including stroke (Malouin et al 2004), multiple sclerosis (Heremans et al 2012) and Parkinson’s disease (PD) (Tamir et al 2007). For individuals with these comorbid conditions, imagery can be used in combination with another type of imagery, named motor imagery practice. During motor imagery practice, the person mentally rehearses the movement without actually executing it. The individual is also trained to focus on either kinesthetic elements associated with the movement (for example, the feeling of the muscles around the shoulder contracting while lifting the arm) or on visual ones (for example, watching oneself lifting the arm).

While some research showed people with PD exhibit different imagery characteristics (i.e., being slower) in comparison to controls, a finding which can be explained by the progressive nature of the disease and changes characterizing PD, other researchers claim that people with PD who have difficulties executing a task, may not exhibit these difficulties while mentally picturing themselves performing the task, a fact which suggests the beneficial potential of imagery to improve function among people with PD (Annett et al).

Because imagery is a key principle in the rehabilitation of people with neurological conditions, its applicability and efficacy for people with PD should be further investigated, with the aim of developing new treatment approaches for preventing further deterioration in disease’s severity and symptoms. This goal will be achieved only through more research being conducted in this field. Until we get there, don’t stay indifferent, start imagining…

References: CLICK HERE to view complete references to published research cited above.

Dr. Madeleine E. Hackney, Ph.D, is a Research Health Scientist at the Atlanta VA Center for Visual and Neurocognitive Rehabilitation and an Assistant professor of Medicine in the division of General Medicine and Geriatrics at the Emory School of Medicine. She holds a Ph.D. in Movement Science from Washington University and a BFA in Dance from NYU, Tisch School of the Arts and has also been an American Council on Exercise certified personal trainer since 2000. Dr. Hackney’s extensive research interests include inquiry into challenging exercise programs–traditional exercise, Tai Chi and partnered tango classes–designed to improve physical function and quality of life in people with PD, older adults and those with serious mental illness. In 2014, she co-founded MDT Education Solutions, which has trained dozens of fitness and allied health professionals how to develop and lead safe, evidence-based exercise programs for people with PD at all stages of the disease, including almost all instructors in the PD Gladiators Metro Atlanta Fitness Network (including the YMCA of Metro Atlanta).

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