Multipl skleroz hastalarında kognitif yorgunluğun mental imgeleme üzerine etkisinin araştırılması
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Farzinmoghaddam, F., Investıgatıon Of The Effect Of Cognıtıve Fatıgue On Mental Imagınatıon In Multıple Sclerosıs Patıents, Hacettepe University, Graduate school of Health Sciences, Neurology Physiotherapist Program, Master Thesis, Ankara, 2022. Cognitive fatigue is a psychobiological disorder that is seen in 46% of multiple sclerosis (MS) patients. There are many methods used to combat fatigue in patients. Mental imagery (MI) training is one of these applications and is defined as a dynamic situation in which a subject mentally simulates a certain action. During MI, different cortical connections are activated. Although studies have emphasized that there is a relationship between mental imagery and the severity of MS, The effect of cognitive fatigue on mental imagery ability and extremity motor function is not fully known. Thirty-six MS patients with EDSS scores ranging from 1 to 4 were included in the study. Patients were randomly divided into two groups as study and control groups. Both groups were evaluated in terms of mental imagery ability. Evaluations include the test of ability in movement imagery (TAMI), the kinesthetic and visual imagery questionnaire (KVIQ), the motion imagery questionnaire (MIQ), and mental chronometry. In the evaluation of motor functions, 9 hole peg test (9HPT), 10 m walking test (10MWT) and time dependent motor images were used. One week after the first evaluation, some tests that would increase cognitive fatigue were applied to the individuals in the study group, and then the mental imagery tests were repeated. Individuals in the control group were re-evaluated without any application. The mean age of MS patients in the study group was 35 ± 10, the control group was 40 ± 8 years, the EDSS score of all participants was 2.3 ± 0.94, and the disease durations were 9.6 ± 6.51 years. While the motor imagery score of the study group was 16.6 ± 4.5 in the first evaluation, it decreased to 10.8 ± 4.32 points in the second evaluation (p꓿0.04). When the groups were compared in terms of the differences between the first and second evaluations in terms of TAMI, the difference was found to be significant (p<0.05). However, it was observed that the change in the study group was higher in the other parts of the KVIQ and MIQ, except for the external visual imagery subsection (p<0.05). At the same time, it was observed that the 9HPT and 10MWT mental chronometry values were different between the groups, and the mental chronometry values were more affected in the study group (p<0.05). It was determined that the duration of 9HPT was prolonged after cognitive intervention in the study group (p<0.05). It was observed that the 10MWT and TDMI scores, which were used to determine the effect of cognitive fatigue on the lower extremities, did not change (p>0.05). When the effects of cognitive fatigue on motor functions in MS patients in the study and control groups were compared, it was determined that the groups were different in terms of the change in 9 HPT (p<0.05). In terms of 10 MWT results, it was observed that the groups were different in the first and last evaluation, and the individuals in the study group walked faster (p<0.05). At the end of our study, it was determined that cognitive fatigue has an effect on the controllability and vitality component of mental imagery and also affects upper extremity motor function. It has been shown that cognitive fatigue causes impairments in this ability, even in patients with low EDSS scores. It may be important to consider this interaction, especially in patients to whom mental imagery will be applied.