Motor Imagery and Turning Practice to Improve Mobility: pilot Trial

This randomized pilot clinical trial will evaluate the feasibility and preliminaryefficacy of combining in‐person locomotor turning practice with home‐based Motor ImageryTherapy (MIT) in older adults with self‐reported balance or turning‐related mobilityconcerns. Turning is a common component of daily mobility and a frequent contributor tofalls in older adults, yet it is often underemphasized in traditional rehabilitationprograms. MIT is a non‐invasive behavioral approach that combines mental rehearsal ofmovement with action observation to engage brain networks involved in movement planningand motor learning.Thirty community‐dwelling older adults aged 65 years and older will be randomized toeither a locomotor turning intervention combined with MIT (Loco+MIT) or a locomotorturning intervention combined with stress management education (Loco+SME). Both groupswill complete six weeks of in‐person turning practice focused on dynamic turning, weightshifting, and head‐trunk coordination. Home‐based sessions will be completed onalternating days and will consist of either guided motor imagery and action observationexercises or stress management and wellness education without motor practice components.The study will evaluate feasibility outcomes including intervention attendance,participant retention, and compliance with remote activity monitoring. Preliminaryefficacy outcomes will include turning performance, free‐living physical activity,walking intensity, sedentary behavior, and neurophysiological measures related tocortical inhibitory function assessed using transcranial magnetic stimulation (TMS). Thestudy will also explore whether baseline measures of cortical inhibition predictresponsiveness to the intervention and whether changes in inhibitory activity areassociated with mobility improvements following training.This study is intended to provide preliminary data regarding the feasibility, safety, andpotential benefits of combining motor imagery with locomotor turning practice to supportfuture larger‐scale rehabilitation trials targeting mobility and fall risk in olderadults.