Investigation of the Effects of Motor Imagery on Gait and Balance Functions in Children with Duchenne Muscular Dystrophy

The study aims to examine the effects of the MI (motor imagery) program applied in addition to the PTR (physiotherapy and rehabilitation) program on gait and balance functions in children with DMD (Duchenne Muscular Dystrophy). The 38 boys with DMD were included in the study and randomized into two groups: Group-A and Group-B. In Group-A, the PTR program was applied 2 days/week for 8 weeks, and in Group-B, the MI program was applied 5 days/week in addition to the PTR program 2 days/week for 8 weeks. Groups were assessed by the Brooke Lower Extremity Functional Classification Scale, Modified Pediatric Mini Mental Scale, Kinovea® Software Program, Timed Up & Go Test (TUG), Timed Function Tests (TFT), Pediatric Balance Scale, Movement Imagery Questionnaire (MIQ-c), Mental Chronometry, Two-Minute Walk Test (2MWT), Motor Function Measure (MFM-32), Gillette Functional Assessment Questionnaire, North Star Ambulatory Assessment (NSAA), Five-Times-Sit-to-Stand Test (FTSS), Pediatric Fear of Falling Questionnaire for neuromuscular diseases (Ped-FOF), lower extremity muscle strength, PedsQL Multidimensional Fatigue Scale, and Pediatric Quality of Life Inventory (PedsQL) Neuromuscular Module. The mean age of the groups was determined as 7.96±1.94 years (Group-A) and 9.03±1.71 years (Group-B). As a result of the study, in Group-A, TFT-Stairs descending (p=0.049), average values of muscle strength of right hip flexors, right hip extensors, left hip abductors, right knee extensors and left knee extensors (respectively; p=0.042; p=0.002; p=0.024; p=0.014; p=0.050), and Ped-FOF (p=0.047) were improved. In Group B, MIQ-c, Mental Chronometry (respectively; p≤0.001; p≤0.001), Kinovea® Software Program-Walking Speed (p=0.003), 2MWT (p=0.037), TFT-Stairs descending and 10m walking (respectively; p=0.001; p=0.039), MFM-32-D1 (p=0.036), average values of muscle strength of right hip flexors and right hip extensors respectively; p=0.036; p=0.001), Ped-FOF (p=0.004), and PedsQL Multidimensional Fatigue Scale-Cognitive (p=0.022) were improved. In the comparison of the groups, only the MIQ-c and Mental Chronometry results (respectively; p≤0.001; p≤0.001) were improved in favor of Group-B. Our results showed that the MI program applied in addition to the PTR program is a feasible program for children with DMD in favor of the maintenance and advance of gait and balance functions due to its contributions to children's walking speed, walking distance, functional performance and lower extremity muscle strength.