Motor Imagery: A Pilot Intervention for Improving Gait and Cognition in the Elderly

? DESCRIPTION (provided by applicant): Over a third of community-residing elders have clinically diagnosable gait abnormalities, and gait impairment has been linked to an increased risk for morbidity, hospitalization, mortality, cognitive decline, and dementia. Convincing new studies in Parkinson's disease and post stroke suggest that motor imagery - envisioning motor actions without actual execution - is an effective rehabilitative tool, but the efficacy of motor imagery for improving gait in relatively healthy elderly is currently unknown. The proposed research aims to establish the efficacy of an imagined gait protocol for improving both gait in healthy elderly. This imagined gait protocol involves imagined gait in single (imagined walking; iW) and dual-task (imagined walking while talking; iWWT) situations, demands executive functions (EF), and has been validated against an actual gait protocol that involves an ecologically- valid dual-task situation (walking while talking; WWT) that predicts falls, frailty, disability and mortality in the elderly. A pilot Randomized Clinical Trial of 48 cognitively-health elderly with pre-post measures of gait, EF, and fMRI during imagined gait is proposed. The overall working hypothesis is that imagined gait can be used as a rehabilitative tool for improving gait in the elderly because it engages and strengthens similar neural systems as actual gait. The first aim of this pilot is to establish the efficacy of our imagined gait protocolto improve gait and EF in the elderly. We predict that our imagined gait intervention will improve: 1) gait velocity during actual W and WWT conditions to a greater extent than the Active Control (AC; Visual imagery), and 2) improve cognitive performance during actual T and WWT conditions to a greater extent than the AC condition. The second aim of this pilot is to determine neuroplasticity changes in response to our imagined gait intervention. We predict that: 1) our imagined gait protocol engages neural systems linked to actual gait and EF, while the AC condition engages neural systems linked to visual processing and imagery in general, and 2) the neural systems engaged during our imagined gait protocol are strengthened following our imagined gait intervention. This pilot RCT has the potential to build the foundation for a future full-scale RCT to test the therapeutic potential of imagined gait in the elderly.