Effects and mechanisms of a home-based action observation and motor imagery intervention on cognitive function and depression in spinal cord injury: a pilot randomized controlled trial protocol

Background: Cognitive impairment and depression frequently occur after spinal cord injury (SCI) and adversely affect functional independence and quality of life. There is a lack of research in addressing this important area in SCI rehabilitation/care. The home-based Action Observation and Motor Imagery (AOMI), a form of neurorehabilitation, was developed grounded in theoretical foundations and practical evidence, rendering it especially suitable for adults with SCI. This study aims to evaluate the feasibility, acceptability, and preliminary effects of this innovative intervention on SCI adults' cognitive function and depression, while also exploring the underlying neural mechanisms through multimodal magnetic resonance imaging (MRI). Methods: This is an assessor-blinded, two-arm pilot randomized controlled trial with repeated measures (pre-, post-intervention, and 1-month follow-up). In total, 46 participants will be randomly assigned to either the intervention group, which will receive an 8-week AOMI intervention combined with basic wheelchair exercises, or the control group, which will watch landscape videos and perform basic wheelchair exercises. The feasibility of study procedures will be assessed by examining the recruitment, dropout, and retention rates. The acceptability of interventions will be evaluated by the adverse events record, satisfaction, and adherence rate. The primary outcomes of intervention effectiveness include global cognitive function and depression; secondary outcomes include neurocognitive domains, multimodal MRI findings, chronic pain, self-efficacy for exercise, and motor imagery ability. Conclusion: The study findings will preliminarily determine the effects of AOMI in SCI rehabilitation. Multimodal MRI data will elucidate the neuroplastic changes and functional reorganization occurring in the brains of the SCI population following the intervention. Clinical trial registration: ClinicalTrials.gov, identifier NCT06708026.