Effect of Telerehabilitation‐Based Music Therapy and Motor Imagery on Pain, Autonomic Function, and Psychosocial Outcomes in People With Multiple Sclerosis: A Randomized Controlled Trial Protocol

The Effects of M2M and Adapted Yoga on Physical and Psychosocial Outcomes in People With Multiple Sclerosis

Background: Poincare plot analysis of heart rate variability (HRV) is a complex nonlinear method for assessing cardiac autonomic nerve function (CANF) in generalized anxiety disorder (GAD).
 Objective: This study aimed to observe the effect of music therapy on HRV by poincaré plot analysis in GAD patients.
 Methods: This prospective Interventional study was done in 2019 on 60 newly diagnosed GAD patients aged 20- 40 years, both male and female. Among them, 30 patients were under music therapy with Raga Bhairabi based Rabindra Sangeet for 3 months and 30 patients were without music therapy and both patient groups were studied over three months. Healthy controls, who were enrolled in this study, were Age, sex and BMI matched. Poincaré plot (non linear measure) of HRV of all GAD patients and control were recorded at baseline and after three months of follow up. HRV were recorded by Power Lab 8/ 35. For statistical analysis Bonferroni’s Post Hoc test and paired sample ‘t’ test were done.
 Results:Standard deviation of the points perpendicular to the axis of line of identity(SD1), standard deviation of the points along the axis of line of identity (SD2) SD and SD1/SD2 were significantly lower in all GAD patients compared to healthy control at baseline. After 3 months of music therapy, significant increment of these parameters occurred in GAD patients, whereas no changes of these except SD1 were noted in patients without music therapy after 3 months. Moreover, these parameters were not significantly different in patients under music therapy compared to control at the end of three months.
 Conclusion: This study concluded that music therapy can improve cardiac autonomic dysfunction in GAD patients.
 J Bangladesh Soc Physiol. 2020, June; 15(1): 39-45

Motor imagery (MI) practice has shown substantial benefits on force, but this was mostly demonstrated on force produced by isometric contractions in laboratory settings. Here, we tested a new type of MI intervention to improve force and power in expert athletes. CrossFit® athletes (n = 100) of national level were randomly assigned to experimental groups who completed a 5-week back squat training program (3 resistance training sessions/week, ~1 h per week). A first group (n = 35) received instructions to perform kinesthetic MI of the concentric phase of the back squat concomitant to its physical execution (MICONCENTRIC). A second group (n = 35) performed kinesthetic MI of the eccentric phase concomitant to its physical execution (MECCENTRIC). A control group (n = 30) completed the same amount of physical training without engaging in MI (Control). Performance was indexed from the 5 repetition maximum (5 RM) squat workload before and after the intervention. Weekly, we assessed squat power using an accelerometer. MICONCENTRIC and MIECCENTRIC groups outperformed Control regarding pretest vs. posttest improvements in both 5 RM force and power (RP2 = 0.60, both p < 0.001). The MIECCENTRIC group also outperformed the MICONCENTRIC group for the 5 RM workload (RP2 = 0.27, p < 0.001). However, subjective evaluations revealed that athletes in the MIECCENTRIC group experienced higher effort perception and difficulty to complete the experimental task. MI practice concomitant to physical training was efficient to improve force on a dynamic multi-joint exercise in expert athletes.

Breathing with the mind: Effects of motor imagery on breath-hold performance

Characterisation of cardiac autonomic function in multiple sclerosis based on spontaneous changes of heart rate and blood pressure

Introduction: Transcranial Direct Current Stimulation (tCDS) is a non-invasive neuromodulation technique that alters neuronal activity through weak electrical currents. While tDCS has been widely studied for its effects on cognition, mood, and pain, emerging research suggests that it may also infl uence the autonomic nervous system function, particularly Heart Rate Variability (HRV). HRV is an important indicator of autonomic regulation, refl ecting the balance between sympathetic and parasympathetic activity. Aim: This systematic review aims to evaluate the effects of tDCS on HRV and autonomic function by synthesising existing literature. It seeks to identify optimal stimulation parameters and assess the potential clinical applications of tDCS in autonomic regulation. Additionally, it aims to address inconsistencies in prior fi ndings and provide recommendations for future research. Materials and Methods: The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted in NCBI, PubMed, and Google Scholar using the terms “Heart rate variability,” “Autonomic function,” and “Non-invasive stimulation” in combination with “Transcranial direct current stimulation.” Only peer-reviewed studies published in English between 2015 and 2025 were included. Studies involving animals or using transcranial alternating current stimulation or repetitive transcranial magnetic stimulation as interventions were excluded. Results: This systematic review analysed 13 studies involving 245 participants, including healthy individuals, patients suffering from Hemiplegia due to stroke, fi bromyalgia, cerebral palsy, spinal cord injury, and refractory epilepsy. The fi ndings indicate that tDCS signifi cantly modulates HRV and autonomic function in most cases, with the left Dorsolateral Prefrontal Cortex (DLPFC) being the most effective stimulation site. Nine studies reported positive effects {positive outcomes included increases in Standard Deviation of Normal-toNormal Intervals (SDNN), Root Mean Square of Successive Differences (RMSSD) and High Frequency (HF) power suggesting enhanced parasympathetic activity. Some studies also reported improvements in Low Frequency to High Frequency (LF/HF) and stress reduction}, while 4 studies reported no signifi cant effects (minimal changes in SD2-RR intervals), particularly when stimulation was applied to M1 or T3/Fp2 regions. Additionally, dose-dependent responses were observed, with higher intensities (3 mA) yielding superior autonomic benefi ts compared to lower intensities (1-1.5 mA). Conclusion: The tDCS is a promising non-invasive intervention for enhancing autonomic regulation by modulating HRV, particularly when applied to the left DLPFC at 2-3 mA. The fi ndings suggest that tDCS can be a valuable non-invasive approach for modulating autonomic function and enhancing HRV. Future research should focus on standardising protocols, assessing long-term effi cacy, and exploring its broader applications in clinical and rehabilitation settings.

Motor imagery (MI) is known to improve motor function through enhancement of motor cortex activity. Spinal reciprocal inhibition (RI) is modulated by motor cortex activity, and, therefore, MI may change RI. The aim of this study was to examine the changes in RI during MI involving the lower extremity. Spinal RI was measured from the tibialis anterior (TA) to the soleus (SOL). Eleven healthy adults participated in experiment 1. All participants performed the following three conditions, and RI was assessed during each condition: (1) resting condition; (2) MI of ankle dorsiflexion condition (MI-DF); and (3) MI of ankle plantarflexion condition (MI-PF). Twelve healthy adults participated in experiment 2. All participants performed the following two conditions, and RI was assessed before and after MI practice for 10min: (1) resting condition and (2) MI-DF. The interval between the conditioning and test stimulus (inter-stimulus interval; ISI) was set at 0, 1, 2, or 3ms and 20ms. In experiment 1, RI during MI-PF was significantly decreased compared with that during resting with both stimulus intervals. RI during MI-DF showed no significant change compared with that during resting with both ISIs. In experiment 2, the difference between the rest condition and the MI-DF condition after the MI task with ISI of 20ms was significantly higher than before the MI task. Our findings suggest that real-time changes in RI during MI involving the lower extremity may vary depending on the direction of motion and MI practice.

The aim of this study was to investigate the perceptions of music therapy among those living with chronic pain, and the possible facilitators and barriers to music therapy if offered as part of treatment. Following ethical approval, a convenience sample of 105 adult participants, who attended multisite pain clinics were included. Quantitative data were collected through an eighteen-item questionnaire using a Likert scale. Eighty-nine per cent of participants believe that music can improve mood, and 86% perceive health benefits from music. 81% agree that music can be a valuable self-help tool. However, 45% reported that they had not heard of music therapy. The majority (60%) would like to attend music therapy if it was offered as part of their pain management. For some, use of technology (9%), internet connection (15%), and private space (16%) were identified as barriers to accessing music therapy online. Music therapy has the potential to be a part of a person-centered care plan for those with chronic pain. Currently, music therapy is not an accessible treatment option. Healthcare providers should consider music therapy as a part of a chronic pain treatment plan, and future studies should be directed to evaluating its efficacy in chronic pain.

Dorsal column stimulation (DCS) was used in the treatment of chronic intractable pain in 51 patients. Twenty-five of the patients had back and leg pain secondary to the treatment of intervertebral disc disease; 11 had postoperative pain after general or thoracic surgical procedures. The remainder suffered pain related to multiple sclerosis, spinal cord injury, carcinoma, and peripheral vascular disease. Pain had been present for a mean of 24 months. Thirty-seven patients underwent DCS electrode placement by open laminectomy, and 11 had percutaneous epidural DCS electrode placement. Three patients first underwent epidural DCS electrode implantation and subsequently had DCS electrode implantation by laminectomy. No major complications were noted, although multiple lesser complications required 33 additional operative procedures for correction. Follow-up periods ranged from 12 to 67 months, with a mean of 38 months. Immediately after implantation. 47% of the patients reported that they had essentially complete pain relief, but 3 years later this had decreased to 8%. No patient followed for 4 years or longer reported complete pain relief. Thirty-three per cent of the patients discontinued the regular use of narcotics for pain relief after DCS electrode implantation. Unfortunately, only 16% were able to return to gainful employment or full physical activity after DCS. Based on these data and a review of the literature, the following conclusions are made: (a) assessment of success in the treatment of chronic pain is strongly dependent on the criteria used for patient evaluation: (b) with the criteria of this report, DCS is a relatively ineffective treatment for chronic pain; (c) epidural percutaneous DCS systems are no more effective than are those placed by laminectomy, and, because of technical problems with epidural systems (mainly lead breakage and migration), the latter may actually be less effective; and (d) at present DCS seems to play a minor role in the treatment of chronic intractable pain.

Music therapy (MT) has been used in geriatric nursing hospitals, but there has been no extensive research into whether it actually has beneficial effects on elderly patients with cerebrovascular disease (CVD) and dementia. We investigated the effects of MT on the autonomic nervous system and plasma cytokine and catecholamine levels in elderly patients with CVD and dementia, since these are related to aging and chronic geriatric disease. We also investigated the effects of MT on congestive heart failure (CHF) events.Eighty-seven patients with pre-existing CVD were enrolled in the study. We assigned patients into an MT group (n = 55) and non-MT group (n = 32). The MT group received MT at least once per week for 45 minutes over 10 times. Cardiac autonomic activity was assessed by heart rate variability (HRV). We measured plasma cytokine and catecholamine levels in both the MT group and non-MT group. We compared the incidence of CHF events between these two groups. In the MT group, rMSSD, pNN50, and HF were significantly increased by MT, whereas LF/HF was slightly decreased. In the non-MT group, there were no significant changes in any HRV parameters. Among cytokines, plasma interleukin-6 (IL-6) in the MT group was significantly lower than those in the non-MT group. Plasma adrenaline and noradrenaline levels were significantly lower in the MT group than in the non-MT group. CHF events were less frequent in the MT group than in the non-MT group (P < 0.05). These findings suggest that MT enhanced parasympathetic activities and decreased CHF by reducing plasma cytokine and catecholamine levels.

Management of Adolescent Chronic Pelvic Pain from Endometriosis: A Pain Center Perspective

The aim of this study was to examine how imagery ability could affect service improvement, following pre-performance motor imagery (MI) intervention, in young novice tennis players. Participants were divided into 3 groups with regard to their MI ability scores (Poor imager, Good imager and Control groups) obtained on the Movement Imagery Questionnaire for Children. During a pre-test, participants performed 10 services. The pre-performance MI practice was included during physical practice for 24 sessions. Each session consisted of 20 services, which were first imagined and then physically performed. Participants of the Poor and Good imager groups were required to use external visual MI, while those of the control group were given a countdown task. Participants performed an intermediate-test, after a first block of 12 practice sessions, and a post-test one-week after the last block of practice session, which were identical to the pre-test. The results of this study showed that MI improved service performance (i.e., percentage of success, speed and efficiency), and that this improvement was faster in the Good imager than in the Poor imager group. More specifically, The Poor imager group required more MI interventions to achieve equivalent performance to Good imager group. The impact of MI practice on service performance, for novice tennis players, is discussed.

Heart rate variability (HRV) is a non-invasive indicator of autonomic nervous system function. HRV recordings show artefacts due to technical and/or biological issues. The Kubios software is one of the most used software to process HRV recordings, offering different levels of threshold-based artefact correction (i.e., Kubios filters). The aim of the study was to analyze the impact of different Kubios filters on the quantification of HRV derived parameters from short-term recordings in three independent human cohorts. A total of 312 participants were included: 107 children with overweight/obesity (10.0 ± 1.1 years, 58% men), 132 young adults (22.2 ± 2.2 years, 33% men) and 73 middle-aged adults (53.6 ± 5.2 years, 48% men). HRV was assessed using a heart rate monitor during 10–15 min, and the Kubios software was used for HRV data processing using all the Kubios filters available (i.e., 6). Repeated-measures analysis of variance indicated significant differences in HRV derived parameters in the time-domain (all p < 0.001) across the Kubios filters in all cohorts, moreover similar results were observed in the frequency-domain. When comparing two extreme Kubios filters, these statistical differences could be clinically relevant, e.g. more than 10 ms in the standard deviation of all normal R-R intervals (SDNN). In conclusion, the results of the present study suggest that the application of different Kubios filters had a significant impact on HRV derived parameters obtained from short-term recordings in both time and frequency-domains.

Chronic pain and narcotics: a dilemma for primary care.

Declarative interference affects off-line processing of motor imagery learning during both sleep and wakefulness