|Year : 2022 | Volume
| Issue : 1 | Page : 30-35
Effectiveness of mental practice on balance in normal young adults
Manjiri Ajit Kulkarni, Vidhi T Rawal
Department of Physiotherapy in Neurological Conditions, Pioneer Physiotherapy College, Vadodara, Gujarat, India
|Date of Submission||29-Sep-2021|
|Date of Decision||27-May-2022|
|Date of Acceptance||27-Jun-2022|
|Date of Web Publication||30-Jul-2022|
Dr. Manjiri Ajit Kulkarni
Pioneer Physiotherapy College, Ajwa Nimeta Road, Vadodara, Gujarat
Source of Support: None, Conflict of Interest: None
Context: Mental practice (MP) is a method in which, mental imagery is used to train the performance of a task without performing any visible physical practice. The effects of the MP are dependent on factors such as the characteristics of the learner and the task, practice settings, the learning phase, and form of MP. Balance is defined as the condition of an object when the resultant load actions (forces or movement) acting upon it are zero. Good balance is important for many activities. Exercises that improve balance can help prevent falls. There are limited studies which focus on the effect of MP on balance using clinical tests for balance assessment. Hence, the aim of the study is to find the effectiveness of MP on balance using the clinical test on normal younger adults.
Aim: To compare the effects of MP and balance training on Unipedal Stand Test, 1 Repetition Maximum and modified Clinical test for sensory interaction on balance in younger adults.
Materials and Methods: 60 subjects who followed inclusion criteria were taken and divided into experimental and control groups (n = 30) respectively. The experimental group was given MP and balance training whereas the control group received only balance training for 4 weeks. Outcome measures were assessed before and after the intervention.
Statistical Analysis Used: Intergroup analysis was done by MannWhitney U-test and within group analysis were done by Wilcoxon rank test for all outcome measures with pre, post data. The results showed significant improvement in balance, ankle muscular strength, and sensory organization in the experimental group.
Conclusion: This study shows that MP in combination with the balance training leads to improvement in balance in normal younger adults.
Keywords: Balance training, Mental Practice, Muscle strength, Sensory organization
|How to cite this article:|
Kulkarni MA, Rawal VT. Effectiveness of mental practice on balance in normal young adults. Indian J Phys Ther Res 2022;4:30-5
|How to cite this URL:|
Kulkarni MA, Rawal VT. Effectiveness of mental practice on balance in normal young adults. Indian J Phys Ther Res [serial online] 2022 [cited 2022 Nov 27];4:30-5. Available from: https://www.ijptr.org/text.asp?2022/4/1/30/353018
| Introduction|| |
Mental practice (MP) is a method in which, mental imagery is used to train the performance of a task without performing any visible physical practice. The advantage to administer MP includes cost effectiveness, can be delivered in groups, no requirement of additional equipment's, and easy incorporation into home based programs.
It has been shown in past literatures that mentally practicing motor imagery is an effective tool for improving motor learning, performance, which helps healthy individuals. It also helps people to obtain new skills, change maladaptive habits, modify older skills, and overcome psychological or physical challanges., Multiple studies have supported the benefits of MP in sports preparations within diverse sporting activities.
Balance can be stated as the capacity to maintain one's Centre of Gravity within the balance plane with least possible shaking, whereas the ability to maintain equilibrium within the base of support according to one's Centre of Mass and maintaining postural control to cope with external swaying and various motion is postural balance. Postural control is a prerequisite to the maintenance of a myriad of postures and activities. To assess the balance clinical scales like Unipedal Step Test (UPST) have been found to be reliable in younger adults.
Ponce-González et al. conducted a study “A reliable Unipedal Stance Test for the assessment of balance using a force platform” The authors concluded that UPST is a reliable method for assessing static balance in young adults. Eriksrud et al. conducted a study titled “An Alternative test for Dynamic postural control and functional mobility.” They concluded that that Hand reach Star Excursion Balance Test can be used for the assessing the dynamic postural control and is specifically suitable for examination of full-body functional mobility in young adults.,
There have been studies that have reported improvement in balance following MP using quantitative measures. However this improvement can be measured using clinical tests still remains unexplored. Hence, the purpose of this study is to find the effectiveness of MP on balance using the clinical tests for assessing balance.
| Subjects and Methods|| |
Ethical approval was obtained from the Institutional Review Board (PPC/OW/1676/2020). The estimated total sample size was 80 which was computed by G-Power software version 18.104.22.168 (Informer Technologies, Inc.) was taken as the sample size (α = 0.10 and β = 0.2 to achieve 80% power and 90% confidence level).
Seventy seven participants were screened selected on the basis of inclusion and exclusion criteria, there were 17 drop-outs. Inclusion criteria were young adults (age group 18–22 years), Unipedal score: <43 s with eyes open <10 s with eyes closed, and Mental Imagery Questionnaire score >23. Adults suffering from any pathological condition affecting the balance and who have had recent surgery were excluded. Prior information regarding the study was provided to the individual before the commencement of the study. After taking informed consent from individuals, participants were randomly divided into two groups using simple random method by chit method into Experimental group (Group A) and control group (Group B). An assessment was taken to record their demographic details and outcome measure. The participants in the experimental group and in the control group the carried out balance training in a sitting position on a gym ball for the duration of 20 min, five sessions per week, for 4 weeks. Whereas the participants in the experimental group completed a programme for MP for duration of 17 min before each balance training session.
MP sessions were conducted in a quiet and dark environment, where subjects were given a comfortable sitting position on a chair. The subjects were asked to listen to a recorded audio explaining the imaginary task of sitting balance on a vestibular ball while maintaining balance. Muscle relaxation technique of 5 min was given during the warm-up stage for, to ensure mental stability. In the audio file, view point of first person was used to describe the activity to be performed on vestibular ball. While performing MP exercises, each subject was informed to feel the weight shifts in sitting position, the therapist ensured that no physical activity was performed during the session; the MP session was performed for 10 min. The cool-down period of 2 min was given to guide the subject back to real environment.
The balance exercises that were given included maintenance of correct posture in a sitting position on a vestibular ball. For initial 2 weeks subjects performed weight shifting to anterior-posterior and lateral directions while stabilizing the ball. After 2 weeks subjects were progressed to weight shifting along with of upper limb and lower limb movements like alternate overhead flexion of upper limb alternated hip knee flexion while maintaining the stability of the ball.
After 4 weeks outcomes were assessed to measure each subject's balance activity. The primary outcome measures were assessment of balance which was assessed using unipedal stance test. Secondary outcomes were assessing muscle strength i.e.: 1 RM of ankle dorsiflexors, and invertors, and modified clinical test for interaction on balance.
| Results|| |
Data was analyzed was done using SPSS 16.0 (IBM SPSS Modeler) Before applying statistical-test data were screened for normal distribution using Shapiro-Wilk's test at a 10% level of significance.
As the data did not follow normal distribution for outcome measures, hence Wilcoxon rank Test and Mann-Whitney U-test were used for intragroup and intergroup comparisons respectively. Data was analyzed at a 10% level of significance with a confidence interval of 90%.
All the outcome measures were analyzed at baseline which showed no significant results. Hence the outcomes were found to be comparable.
| Discussion|| |
This study shows improvement in UPST, modified Clinical test for sensory interaction on balance (mCTSIB), ankle 1 RM in the experimental group (Group A) and control group (Group B). However, improvement was greater in experimental group which was statistically significant.
The results show significant improvement in balance in the experimental group (Group A) as seen in [Table 2]. This could be due to improvement in the memory of the movement to understand the process of the action. The repetition of imaginary acts, improves the actual performance of the movement. In this process, combining physical and MP, the person mentally and explicitly rehearses the sequence of movement required while doing the task which increases awareness of the task.,
|Table 2: Pre- and post-mean and standard deviation of intervention in unipedal step test|
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Neurocognitive mechanisms for the planning and carrying out a voluntary movement can be activated by MI in same manner as actually performed movement. These results are in accord with the findings in the study, which shows an improved motor function though MP in patients following total hip arthroplasty.
The results show significant improvement in mCTSIB in the experimental group (Group A) as per [Table 3]. This could be due to mental imagery used for applying the concept of “re-learning” enhances the somatosensory system. Disturbances of body schema which is the model that is used by the musculoskeletal system for control is a cause of difference between motor output and proprioceptive feedback. This is in accord with the study “Effects of tai-chi exercise combined with mental imagery theory in improving balance” which demonstrated an improvement in the sensory organization.,
|Table 3: Pre- and post-mean difference of intervention in modified clinical test for sensory interaction on balance|
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The results also show significant improvement in 1 RM in experimental group (Group A) as seen in [Table 4]. This is according to the symbolic-perceptual hypothesis. which states that Mental imagery helps the subject to get perceptual inputs of the intended movement. It is hypothesized subjects are able to learn the cognitive components of the task using MP, this leads in improvement of their performance. Studies have shown that, untrained individuals are unable to fully recruit their muscles under normal conditions. There is are some inhibition that exists which restricts full recruitment of the available motor units. The underlying practice which involves the isometric contraction leads to increase in motor unit recruitment and, eventually a resultant improvement in isometric force output.
This study shows significant improvement in UPST, mCTSIB, and ankle 1 RM, in the control group i.e.: Group B [Table 5],[Table 6],[Table 7].
|Table 5: Pre- and post-mean difference of intervention in unipedal step test|
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|Table 6: Pre- and post-mean difference of intervention in modified clinical test for sensory interaction on balance|
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The results also show significant improvement in balance in the control group (Group B). A balance training exercise may improve stability during walking and other functional activities. vestibular ball exercises have been considered to have many exercises that activate the core muscles. The results showed a significant improvement in balance. This is in accord with the study “The effect of ball exercise on the balance ability” which showed the significant improvement in static and dynamic balance.
The results also show significant improvement in mCTSIB in the control group (Group B). This could be due to activation of various sensory stimuli by means of balance training, which leads to enhance central integration following sensory training. This leads to improvement in postural stability during alteration of somatosensory or visual or vestibular systems or all of this by use of sensory integration following balance training. This is in accord with the study “Effect of sensory-specific balance-training in elderly” which showed that balance training focusing on various sensory systems can bring about a significant improvement in balance.
The results also show significant improvement in 1 Repetition Maximum in the control group (Group B). This could be due to the exercises given resulted in activation of core muscles which leads to an increase in activation of lower limb muscles because of improved proximal stability. This is in accord with the study “Swiss ball exercises improve muscle strength and walking performance in ankylosing spondylitis” which showed a significant improvement in muscle strength.,,
On analyzing the effectiveness of the therapy post-intervention, the result shows the significant improvement in UPST, mCTSIB, ankle 1 RM in Group A than Group B, which was statistically significant [Table 8],[Table 9],[Table 10].
|Table 8: Post mean difference in intervention in unipedal step test between two groups|
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|Table 9: Post mean difference in intervention in modified clinical test for sensory interaction on balance between two groups|
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|Table 10: Post mean difference in intervention in 1 RM between two groups|
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This could be based on several asumptions that describe the process of MP include Paivio's theory, also known a the psycho neuromuscular theory, and the cognitive-symbolio learning theory. Paivio's theory proposes that visual imagining of carrying out of movements leads to stimulation of cognitive function and motivation. However, the psycho neuromuscular theory proposes that reinforcement of the neural pathways needed to conduct the intended movements is achieved by rehearsing the task which is to be performed prior by means of mental imagery which, enhances ability to carry out the movements. However, according to the cognitive-symbolio learning, movements provide the opportunities to rehearse their order that enables prior planning, thus enhancing quality of actual movements when they are carried out.
Cognitive or symbolic theory, as proposed by Sackett (1934), states that MP simplifies the skills in which involve a symbolic control of the movements. This is further aided by demonstration of overall pattern in MP which is more effective for cognitive tasks compared with physical tasks.
The improvement in balance scores can also attributed to transfer of training theory as there is a difference in training conditions and the in assessment. Transfer of training is the capacity of an individual to transfer the trained task to new conditions and task variants. The neural structures which are thought to be responsible for this effect are the activity in the right cingulate gyrus, left superior parietal lobule, right inferior parietal lobule, left middle occipital gyrus, and bilaterally in the cerebellum. The cerebellar activation of the posterior superior fissure, is thought to be the site of storage associated with sensorimotor adaptation learning. Transfer comprises of retrieval of a motor memory formed previously, which allows the learner to proceed faster through the early stage of learning.
Hence, this study concludes that there is a significantly improved in balance and balance parameters in the experimental group (Group A) in comparison to the control group (Group B).
| Conclusion|| |
The present study shows that MP is an effective intervention in combination with the balance training on balance in normal younger adults clinically. Hence, this treatment can be further recommended to improve balance in patients with impaired balance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Karajgi A, Shah I. Comparison of mental imagery ability b/w community-dwelling & institutionalized older adults. Int J Health Sci Res 2018;8:118-23.
Glenna B, Rebecca SPT, Chris SPT, Jennifer SPT. Effect of Mental Practice Combined with Physical Practice on Balance in the Community-Dwelling Elderly. Activities. Adaptation & Aging. 2006:1-18. 10.1300/J016v31n02_01.
Glenna B. Motor Imagery for Stroke Rehabilitation: Current Research as a Guide to Clinical Practice. Alternative and Complementary Therapies 2004:10;84-9. 10.1089/107628004773933325.
Page SJ, Levine P, Sisto SA, Johnston MV. Mental practice combined with physical practice for upper-limb motor deficit in subacute stroke. Phys Ther 2001;81:1455-62.
Cocks M, Moulton CA, Luu S, Cil T. What surgeons can learn from athletes: Mental practice in sports & surgery. J Surg Educ 2014;71:262-9.
Cha HG, Kim MK. Effect of mental practice on normal adult balance ability. J Phys Ther Sci 2016;28:2041-3.
Pollock AS, Durward BR, Rowe PJ. What is balance? Clin Rehabil 2000;14:402-6.
Springer BA, Marin R, Cyhan T, Roberts H, Gill NW. Normative values for the unipedal stance test with eyes open and closed. J Geriatr Phys Ther 2007;30:8-15.
Ponce-González JG, Sanchis-Moysi J, González-Henriquez JJ, Arteaga-Ortiz R, Calbet JA, Dorado C. A reliable unipedal stance test for the assessment of balance using a force platform. J Sports Med Phys Fitness 2014;54:108-17.
Eriksrud O, Federolf P, Anderson P, Cabri J. Hand reach star excursion balance test: An alternative test for dynamic postural control and functional mobility. PLoS One 2018;13:e0196813.
Eriksrud O, Federolf P, Sæland F, Litsos S, Cabri J. Reliability and validity of the hand reach star excursion balance test. J Funct Morphol Kinesiol 2017;2:28.
Mahoney MJ, Avener M. Psychology of the elite athlete: An exploratory study. Cognit Ther Res 1977;1:135-41.
Epley B. Poundage chart. In: Boyd Epley Workout. Lincoln, NE: Body Enterprises; 1985. p. 86.
Pereira Marta Inez Rodrigues, Gomes Paulo Sergio Chagas. Muscular strength and endurance tests: reliability and prediction of one repetition maximum - Review and new evidences. Rev Bras Med Esporte [Internet]. 2003;9:325-35.
Boughen I, Dunn K, Nitz J, Johnston V, Khan A. A new method of interpreting the center of gravity location using the modified Clinical Test of sensory Interaction on Balance: A reliability study. Hong Kong Physiother J 2013;31:64-8.
Alsubiheen A, Petrofsky J, Daher N, Lohman E, Balbas E. Effect of tai chi exercise combined with mental imagery theory in improving balance in a diabetic and elderly population. Med Sci Monit 2015;21:3054-61.
Decety J. The neurophysiological basis of motor imagery. Behav Brain Res 1996;77:45-52.
Wright DJ, Williams J, Holmes PS. Combined action observation and imagery facilitates corticospinal excitability. Front Hum Neurosci 2014;8:951.
Villafañe JH, Pirali C, Isgrò M, Vanti C, Buraschi R, Negrini S. Effects of action observation therapy in patients recovering from total hip arthroplasty arthroplasty: A prospective clinical trial. J Chiropr Med 2016;15:229-34.
Cuenca-Martínez F, La Touche R, León-Hernández JV, Suso-Martí L. Mental practice in isolation improves cervical joint position sense in patients with chronic neck pain: A randomized single-blind placebo trial. PeerJ 2019;7:e7681.
McCormick K, Zalucki N, Hudson M, Moseley GL. Faulty proprioceptive information disrupts motor imagery: An experimental study. Aust J Physiother 2007;53:41-5.
Johnson PO. The functional equivalence of imagery and movement. Q J Exp Psychol 1982;34:270-6.
Heuer H. How does mental practice operate? Psychol Rundsch 1985;36:191-200.
Montani T, De Vries HA. Neural factors v/s hypertrophy in time course muscle strength gain. Am J Phys Med Rehabil 1979;58:115-30.
Cornwall MW, Bruscato MP, Barry S. Effect of mental practice on isometric muscular strength. J Orthop Sports Phys Ther 1991;13:231-4.
Thiamwong L, Suwanno J. Effects of simple balance training on balance performance and fear of falling in rural older adults. Int J Gerontol 2014;8:143-6.
Puranik M, Iyer S, Gore A, Prabha L, Khachane P, Mehta A. Effect of sensory-specific balance-training in elderly. Indian J Physiother Occup Ther 2012;6:162-6.
Souza MC, Jennings F, Morimoto H, Natour J. Swiss ball exercises improve muscle strength and walking performance in ankylosing spondylitis: A randomized controlled trial. Rev Bras Reumatol Engl Ed 2017;57:45-55.
Sundstrup E, Jakobsen MD, Andersen CH, Jay K, Andersen LL. Swiss ball abdominal crunch with added elastic resistance is an effective alternative to training machines. Int J Sports Phys Ther 2012;7:372-80.
Escamilla RF, Lewis C, Bell D, Bramblet G, Daffron J, Lambert S, et al.
Core muscle activation during Swiss ball and traditional abdominal exercises. J Orthop Sports Phys Ther 2010;40:265-76.
Taylor AG, Goehler LE, Galper DI, Innes KE, Bourguignon C. Top-down and bottom-up mechanisms in mind-body medicine: Development of an integrative framework for psychophysiological research. Explore (NY) 2010;6:29-41.
Seidler RD. Neural correlates of motor learning, transfer of learning, and learning to learn. Exerc Sport Sci Rev 2010;38:3-9.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]