Mahsa Mohammadzadeh - Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Hojjat Allah Haghgoo - Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Akbar Biglarian - Department of Biostatistic, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

Objectives: Mental practice, as a neuropsychological factor effective in motor recovery, is a cognitive rehearsal of a physical skill without muscular activity. Considering the high level of fatigue in patients with Multiple Sclerosis (MS), we hypothesized that using mental practice as a low-level energy-consuming method added to physical practice could be a useful therapeutic strategy. Therefore, the current study aimed to investigate the effects of combined mental and physical practices on walking and daily living activities in patients with MS. Methods: A randomized double-blind controlled trial was applied in the present research. In total, ۲۲ subjects with MS were randomly allocated into the occupational therapy and mental practice groups; all study subjects received equal occupational therapy interventions ۳ days a week for ۶ weeks. However, in addition to occupational therapy services, the study group received mental exercises. Such practices included the visual and kinesthetic imagery of walking activity in the presence of external cues. Walking ability and daily living activities were assessed at pre-treatment, post-treatment, and ۲ weeks after the treatment (follow-up). Gait parameters (distance and speed) were measured by the functional scales of the ۶-Minute Walk Test and the Timed ۲۵-Foot Walk Test. The Barthel Index was used to test individuals’ performance in daily living activities. Results: The presented combined mental and physical practice significantly improved walking distance and walking speed in post-treatment (P=۰.۰۴۷, P<۰.۰۰۱) and follow-up (P=۰.۰۴۴, P=۰.۰۰۱) assessments, respectively. The Barthel Index scores significantly changed per group; however, no significant differences were found between the control and test groups in this regard (P=۰.۳۸۶). Discussion: The present study data revealed that performing mental practice along with occupational therapy interventions are more effective than regular interventions alone in the gait rehabilitation of patients with MS. These significant differences in walking performance in the intervention group remained obvious till the follow-up stage.

Multiple sclerosis, Walking, Daily living activities, Occupational therapy, Rehabilitation, Mental practice