Visual and kinesthetic locomotor imagery training integrated with auditory step rhythm for walking performance of patients with chronic stroke Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy Locomotor imagery training improves gait performance in people with chronic hemiparetic stroke: a controlled clinical trial Retention of motor changes in chronic stroke survivors who were administered mental practice. The Combined Impact of Virtual Reality Neurorehabilitation and Its Interfaces on Upper Extremity Functional Recovery in Patients With Chronic Stroke Incidence and Case-Fatality of Stroke on the East Border of the European Union: The Grodno Stroke Study Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Modified Constraint-Induced Therapy Combined With Mental Practice: Thinking Through Better Motor Outcomes Mental Practice in Chronic Stroke: Results of a Randomized, Placebo-Controlled Trial Feasibility of a mental practice intervention in stroke patients in nursing homes; a process evaluation Added Value of Mental Practice Combined with a Small Amount of Physical Practice on the Relearning of Rising and Sitting Post-Stroke: A Pilot Study A multicenter randomized controlled trial to compare subacute 'treatment as usual' with and without mental practice among persons with stroke in Dutch nursing homes. Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial An integrated motor imagery program to improve functional task performance in neurorehabilitation: a single-blind randomized controlled trial. Effects of mental practice on affected limb use and function in chronic stroke. Mental practice improves hand function after hemiparetic stroke. Mental practice is effective in upper limb recovery after stroke: a randomized single-blind cross-over study. A randomized efficacy and feasibility study of imagery in acute stroke Home-based motor imagery training for gait rehabilitation of people with chronic poststroke hemiparesis. Task-Oriented Circuit Class Training Program with Motor Imagery for Gait Rehabilitation in Poststroke Patients: A Randomized Controlled Trial Motor Imagery Practice for Improving Sit to Stand and Reaching to Grasp in Individuals With Poststroke Hemiparesis
Objective : To compare the effect of visual and kinesthetic locomotor imagery training on walking performance and to determine the clinical feasibility of incorporating auditory step rhythm into the training . Design : R and omized crossover trial . Setting : Laboratory of a Department of Physical Therapy . Subjects : Fifteen subjects with post-stroke hemiparesis . Intervention : Four locomotor imagery trainings on walking performance : visual locomotor imagery training , kinesthetic locomotor imagery training , visual locomotor imagery training with auditory step rhythm and kinesthetic locomotor imagery training with auditory step rhythm . Main outcome measures : The timed up- and -go test and electromyographic and kinematic analyses of the affected lower limb during one gait cycle . Results : After the interventions , significant differences were found in the timed up- and -go test results between the visual locomotor imagery training ( 25.69 ± 16.16 to 23.97 ± 14.30 ) and the kinesthetic locomotor imagery training with auditory step rhythm ( 22.68 ± 12.35 to 15.77 ± 8.58 ) ( P<0.05 ) . During the swing and stance phases , the kinesthetic locomotor imagery training exhibited significantly increased activation in a greater number of muscles and increased angular displacement of the knee and ankle joints compared with the visual locomotor imagery training , and these effects were more prominent when auditory step rhythm was integrated into each form of locomotor imagery training . The activation of the hamstring during the swing phase and the gastrocnemius during the stance phase , as well as kinematic data of the knee joint , were significantly different for posttest values between the visual locomotor imagery training and the kinesthetic locomotor imagery training with auditory step rhythm ( P<0.05 ) . Conclusions : The therapeutic effect may be further enhanced in the kinesthetic locomotor imagery training than in the visual locomotor imagery training . The auditory step rhythm together with the locomotor imagery training produces a greater positive effect in improving the walking performance of patients with post-stroke hemiparesis This r and omized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness . There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements . Imagining h and movements could stimulate restitution and redistribution of brain activity , which accompanies recovery of h and function , thus result ing in a reduced motor deficit . Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to method ological limitations . This r and omized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke ( on average <3 months post-stroke ) . R and omization was performed using an automated statistical minimizing procedure . The primary outcome measure was a blinded rating on the Action Research Arm test . The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week , compared to 31 patients who performed equally intensive non-motor mental rehearsal , and 32 patients receiving normal care without additional training . No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test ( ANCOVA statistical P = 0.77 , and effect size partial η2 = 0.005 ) or any of the secondary outcome measures . Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke . In light of the evidence , it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right Objective : The purpose of this study was to evaluate whether locomotor imagery training leads to clinical improvements in gait after stroke . Design : Pretest — posttest matched control design . Participants : A total of 24 people with chronic hemiparetic stroke ( 13 for experimental and 11 for control ) were recruited in this study . Interventions : The subjects in the experimental group participated in videotape-based locomotor imagery training five days a week for four weeks . They also conducted regular physical therapy . Outcome measures : Kinematic gait parameters were collected using a three-dimensional motion analysis system . Functional gait performance was assessed using clinical measures : Activities-specific Balance Confidence Scale , Berg Balance Test , Dynamic Gait Index and modified Emory Functional Ambulation Profile . Results : After training , walking velocity increased 0.07 ± 0.06 m/s in the experimental group and 0.01 ± 0.07 m/s in the control group . In the experimental group , the affected and less affected limb stride lengths increased by 0.09 ± 0.12 m and 0.10 ± 0.07 m respectively , whereas in the control group they decreased by 0.00 ± 0.04 m and increased by 0.02 ± 0.06 m , respectively . Kinematic parameters in the lower extremity joints during walking were more improved after the training in the experimental group . Confidence in balance , postural control , dynamic balance and performance time for different environmental walking situations were also improved more in the experimental group . Conclusion : Locomotor imagery training can be considered as a useful option for restoration of ambulation for individuals with chronic hemiparetic stroke who are unable to participate in physical gait training OBJECTIVE To determine retention of motor changes 3 months after participation in a regimen consisting of mental practice ( MP ) combined with repetitive task-specific ( RTP ) practice . DESIGN Prospect i ve , blinded , cohort , pre-post study . SETTING Outpatient rehabilitation hospital . PARTICIPANTS Individuals ( N=21 ) in the chronic stage of stroke ( mean age ± SD , 66.1 ± 8.1y ; age range , 56 - 76y ; mean time since stroke at study enrollment , 58.7mo ; range , 13 - 129mo ) exhibiting mild to moderate impairments of h and function . INTERVENTIONS All individuals had been r and omly assigned to receive a 10-week regimen consisting of MP emphasizing paretic upper extremity ( UE ) use during valued activities . Directly after each of these sessions , subjects were administered audiotaped MP . We assessed this group 's paretic UE motor levels before , after , and 3 months after intervention . MAIN OUTCOME MEASURES The UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment ( FM ) , the Action Research Arm Test ( ARAT ) , the Arm Motor Ability Test ( AMAT ) , and the Box and Block Test ( BB ) . RESULTS None of the scores significantly changed from the period directly after intervention to the 3-month posttesting period ( FM : t=.817 ; ARAT : t=.923 ; AMAT : t=.898 , t=.818 , and t=.967 for the Functional Ability , Quality of Movement , and Time scales , respectively ; BB : t=.892 ) . CONCLUSIONS Changes in paretic UE movement realized through MP combined with RTP ( MP + RTP ) participation are retained 3 months after the intervention has concluded . This is the first study examining retention of motor changes after MP + RTP participation , and one of only a few studies examining long retention of motor changes after any intervention targeting stroke-induced hemiparesis Background and Purpose — Although there is strong evidence on the beneficial effects of virtual reality (VR)-based rehabilitation , it is not yet well understood how the different aspects of these systems affect recovery . Consequently , we do not exactly know what features of VR neurorehabilitation systems are decisive in conveying their beneficial effects . Methods — To specifically address this issue , we developed 3 different configurations of the same VR-based rehabilitation system , the Rehabilitation Gaming System , using 3 different interface technologies : vision-based tracking , haptics , and a passive exoskeleton .  Forty-four patients with chronic stroke were r and omly allocated to one of the configurations and used the system for 35 minutes a day for 5 days a week during 4 weeks . Results — Our results revealed significant within-subject improvements at most of the st and ard clinical evaluation scales for all groups . Specifically we observe that the beneficial effects of VR-based training are modulated by the use/nonuse of compensatory movement strategies and the specific sensorimotor contingencies presented to the user , that is , visual feedback versus combined visual haptic feedback . Conclusions — Our findings suggest that the beneficial effects of VR-based neurorehabilitation systems such as the Rehabilitation Gaming System for the treatment of chronic stroke depend on the specific interface systems used . These results have strong implication s for the design of future VR rehabilitation strategies that aim at maximizing functional outcomes and their retention . Clinical Trial Registration — This trial was not registered because it is a small clinical study that evaluates the feasibility of prototype devices Background and Purpose — The epidemiology of stroke in Belarus is unclear . Therefore , a population -based register of stroke was set up in western Belarus to determine incidence and case-fatality in a defined urban population . Methods — The Grodno Stroke Study is a prospect i ve community-based research among 311 134 residents of the city of Grodno , Belarus . St and ard definitions and multiple overlapping sources of ascertainment were used to identify all cases of first-ever-in-a-lifetime strokes in all age groups occurring between January 1 , 2001 , and December 31 , 2003 . Results — During 3 years , 2069 cases of first-ever-in-a-lifetime strokes were registered . Mean age at stroke onset was 65.8±11.6 years ; rate of hospitalization was 89.7 % . The crude annual incidence rate of first-ever-in-a-lifetime strokes for the study period was 222 per 100 000 ( 95 % CI , 212 to 233 ) . Incidence adjusted to the European st and ard population and to the World Health Organization world st and ard population was 287 per 100 000 ( 95 % CI , 274 to 301 ) and 220 per 100 000 ( 95 % CI , 210 to 231 ) , respectively . The 28-day case-fatality rate was 26.1 % . The prevalence of hypertension among all first-ever-in-a-lifetime stroke patients was 87.5 % ; 529 ( 25.6 % ) were current smokers . A total 23.1 % of patients had atrial fibrillation , 19.1 % had past myocardial infa rct ion , 14.7 % had diabetes mellitus , and 22.1 % had hypercholesterolemia . Conclusions — High incidence and case-fatality rates determine the considerable burden of stroke in Belarus and might at least partly be related to the high prevalence of risk factors among the population OBJECTIVE To study the efficacy of mental imagery at promoting relearning for people after a stroke . DESIGN Prospect i ve , r and omized controlled trial . SETTING An inpatient rehabilitation stroke unit in Hong Kong . PARTICIPANTS Forty-six in patients , 60 years of age or older , after a cerebral infa rct ion . INTERVENTIONS Patients were r and omized to receive 15 sessions ( 1 h/d for 3 wk ) of either the mental imagery program or the conventional functional training intervention on the relearning of daily living tasks . MAIN OUTCOME MEASURES Performance of 15 trained and 5 untrained tasks , including household , cooking , and shopping tasks ; and the Fugl-Meyer Assessment and Color Trails Test ( CTT ) . RESULTS Patients engaged in mental imagery-based intervention showed better relearning of both trained and untrained tasks compared with the control group ( trained tasks : P<.005 ; untrained tasks : P<.001 ) . They also demonstrated a greater ability to retain the trained tasks after 1 month and transfer the skills relearned to other untrained tasks ( P<.001 ) . However , among the various ability measures , the mental imagery group showed a significant increase in the CTT scores only after the intervention ( P<.005 ) . CONCLUSIONS Mental imagery can be used as a training strategy to promote the relearning of daily tasks for people after an acute stroke . The imagery process is likely to improve the planning and execution of both the trained and the untrained ( novel ) tasks . The effect of its relearning appears to help patients to retain and generalize the skills and tasks learned in the rehabilitation program Background and Purpose — Modified constraint-induced therapy ( mCIT ) is an outpatient therapy encouraging repetitive , task-specific practice with the affected arm . mCIT has shown efficacy in all stages poststroke . Given its efficacy when combined with other therapy regimens , the current study examined the efficacy of mental practice when combined with mCIT versus mCIT only using r and omized , controlled methods . Method — Ten patients with chronic stroke ( 7 males ; mean age , 61.4±3.02 years ; age range , 48 to 79 years ; mean time since stroke , 28.5 months ; range , 13 to 42 months ) exhibiting stable , affected arm motor deficits were administered mCIT , consisting of : ( 1 ) structured therapy emphasizing affected arm use in functional activities 3 days/week for 10 weeks ; and ( 2 ) less affected arm restraint 5 days/week for 5 hours . Both of these components were administered during a 10-week period . Subjects r and omly assigned to the mCIT+mental practice experimental condition also received 30-minute mental practice sessions provided directly after therapy sessions . These mental practice sessions required daily cognitive rehearsal of the activities of daily living practice d during mCIT clinical sessions . Results — No pre-existing differences were found between groups on any demographic variable or movement scale . All subjects exhibited marked reductions in affected arm impairment and functional limitation . However , subjects in the mCIT+mental practice group exhibited significantly larger changes on both movement measures after intervention : Action Research Arm Test , + 15.4-point change versus + 8.4-point change for mCIT only subjects ( P<0.001 ) ; Fugl-Meyer , + 7.8-point change versus + 4.1-point change for the mCIT only subjects ( P=0.01 ) . These changes were sustained 3 months after intervention . Conclusions — mCIT remains a promising motor intervention . However , its efficacy appears to be enhanced by use of mental practice provided directly after mCIT clinical sessions Background and Purpose — Mental practice ( MP ) of a particular motor skill has repeatedly been shown to activate the same musculature and neural areas as physical practice of the skill . Pilot study results suggest that a rehabilitation program incorporating MP of valued motor skills in chronic stroke patients provides sufficient repetitive practice to increase affected arm use and function . This Phase 2 study compared efficacy of a rehabilitation program incorporating MP of specific arm movements to a placebo condition using r and omized controlled methods and an appropriate sample size . Method — Thirty-two chronic stroke patients ( mean=3.6 years ) with moderate motor deficits received 30-minute therapy sessions occurring 2 days/week for 6 weeks , and emphasizing activities of daily living . Subjects r and omly assigned to the experimental condition also received 30-minute MP sessions provided directly after therapy requiring daily MP of the activities of daily living ; subjects assigned to the control group received the same amount of therapist interaction as the experimental group , and a sham intervention directly after therapy , consisting of relaxation . Outcomes were evaluated by a blinded rater using the Action Research Arm test and the upper extremity section of the Fugl-Meyer Assessment . Results — No pre-existing group differences were found on any demographic variable or movement scale . Subjects receiving MP showed significant reductions in affected arm impairment and significant increases in daily arm function ( both at the P<0.0001 level ) . Only patients in the group receiving MP exhibited new ability to perform valued activities . Conclusions — The results support the efficacy of programs incorporating mental practice for rehabilitating affected arm motor function in patients with chronic stroke . These changes are clinical ly significant Background Within a multi-centre r and omised controlled trial in three nursing homes , a process evaluation of a mental practice intervention was conducted . The main aims were to determine if the intervention was performed according to the framework and to describe the therapists ' and participants ' experiences with and opinions on the intervention . Methods The six week mental practice intervention was given by physiotherapists and occupational therapists in the rehabilitation teams and consisted of four phases : explanation of imagery , teaching patients how to use imagery , using imagery as part of therapy , and facilitating the patient in using it alone and for new tasks . It had a m and atory and an optional part . Data were collected by means of registration forms , pre structured patient files , patient logs and self-administered question naires . Results A total of 14 therapists and 18 patients with stroke in the sub acute phase of recovery were involved .  Response rates differed per assessment ( range 57 - 93 % ) . Two patients dropped out of the study ( total n = 16 ) . The m and atory part of the intervention was given to 11 of 16 patients : 13 received the prescribed amount of mental practice and 12 practice d unguided outside of therapy . The facilitating techniques of the optional part of the framework were partly used . Therapists were moderately positive about the use of imagery in this specific sample . Although it was more difficult for some patients to generate images than others , all patients were positive about the intervention and reported perceived short term benefits from mental practice . Conclusions The intervention was less feasible than we hoped . Implementing a complex therapy delivered by existing multi-professional teams to a vulnerable population with a complex pathology poses many challenges Background and Purpose : The additional effects of combining mental practice with a small amount of physical practice on the relearning of a motor task post-stroke are unknown . This study investigated the added value of mental practice on the relearning of rising up from a chair and sitting down when combined with a small amount of physical practice . Methods : Twelve individuals with chronic stroke were r and omly assigned to one of three groups : a group that combined mental practice with physical practice ( MP ) , a group that combined physical practice with cognitive training ( Cog ) and a group without training ( NOT . ) . Training was provided three times per week for four weeks , and participants were assessed at baseline , after training , and three weeks later . The vertical forces were recorded under each foot , and the vertical impulse was calculated for five trials and converted in percent of body weight . Results : The MP and Cog groups received the same amount of physical training . Significant gains ( P < 0.04 ) in limb loading found only in the MP group were retained . Larger ( P < 0.03 ) change scores in limb loading for rising up from a chair and sitting down were found in the MP group ( median = rising up : 18.4 % ; sitting down : 12.2 % ) compared with Cog group ( median = rising up : −6.8 % ; sitting down : 5.4 % ) and a group without training ( median = rising up : 6.2 % ; sitting down : 5.4 % ) . Conclusion : Combining series of mental repetitions ( ∼1100 repetitions ) with minimal physical repetitions ( ∼120 repetitions ) yielded significant gains and retention of those gains . These preliminary results provide some support to the added value of combining mental repetitions with a small number of physical repetitions to promote the relearning of motor strategies post-stroke and warrant further investigation in clinical trials OBJECTIVE Systematic review s suggest that mental practice as an additional therapy for people with stroke might be effective and suggest that more trials with better defined interventions are needed . This study investigated whether imagining the skilled movement systematic ally can contribute to a quicker and /or better recovery of stroke patients in long term care . DESIGN A multicenter r and omized controlled trial . SETTING Dutch nursing homes . PARTICIPANTS Stroke patients in the subacute phase of recovery . INTERVENTIONS Study participants were r and omly assigned to the control or experimental group . Over a 6-week intervention period , both groups received multi professional therapy as usual . Additionally , patients in the experimental group had instruction on mental practice with a 4-step framework embedded in regular therapy time . MAIN OUTCOME Outcomes were assessed at 6 weeks and 6 months with the patient-perceived effect on performance of daily activities ( 10-point Numeric Rating Scale ) . Six secondary outcomes on impairment and activity level were also assessed . Primary analyses were performed according to the intention-to-treat principle . Generalized estimating equations ( GEE ) were used to analyze effects . RESULTS Thirty-six adult stroke patients ( average age 77.8 , ± 7.2 years ) participated in the trial . No effect in favor of the mental practice intervention on any outcome measure could be detected at either measuring points . CONCLUSIONS This study could not show differences between embedded mental practice and current st and ard of care . However , stroke pathways in Dutch nursing homes select specific and frail patients , which might have reduced the effects of training Objective : To evaluate and compare efficacy of 20- , 40- , and 60-minute mental practice sessions on affected upper extremity impairment and functional limitation . Design : R and omized controlled study with multiple baseline design . Subjects : Twenty-nine subjects with chronic stroke and exhibiting stable , mild hemiparesis . Interventions : Subjects were given 30-minute rehabilitative sessions 3 days/week for 10 weeks , emphasizing affected upper extremity use during valued activities . Directly after these sessions , r and omly selected subjects were given audiotaped mental practice for 20 , 40 , or 60 minutes . Subjects assigned to a control group received the same therapy as the mental practice groups , and an audiotaped sham intervention directly after therapy sessions . Main outcome measures : Fugl-Meyer ( FM ) motor assessment and Action Research Arm Test ( ARAT ) . Results : No pre-existing differences were found between groups on any demographic variable or movement scale . On the FM , mental practice duration significantly predicted pretesting to post change ( P = 0.05 ) , with increasing duration related to larger FM score increases ( 5.4 point score increase for the 60-minute duration group ) . On the ARAT , a non-significant trend was seen ( P = 0.78 ) , favoring the 20-minute dosing condition ( 4.5 point increase ) . Importantly , regardless of dosing condition , subjects administered mental practice exhibited markedly larger score changes on both the FM and ARAT than subjects not receiving mental practice . Conclusions : Sixty minutes of mental practice appears to most significantly reduce affected arm impairment . However , no clear change pattern was seen in affected arm functional limitation according to mental practice duration . Results suggest that a stroke rehabilitative regimen augmented by mental practice renders a greater functional impact than therapy only OBJECTIVE To investigate the feasibility of a motor imagery program integrated into physiotherapy and occupational therapy . DESIGN A parallel-group , phase II , assessor-blind r and omized controlled trial comparing motor imagery embedded in usual therapy with usual therapy only . SETTING A neurologic rehabilitation center ( Oxford , United Kingdom ) . PARTICIPANTS In patients and out patients diagnosed with stroke , brain injury , or multiple sclerosis , participating in a rehabilitation program with sufficient language skills to undertake the intervention were recruited ( N=30 ) and assessed at baseline , after 6 weeks ( postintervention ) , and after 12 weeks ( follow-up ) . INTERVENTIONS A motor imagery strategy was developed that could be integrated into usual therapy , tailored to individual goals , and used for any activity . The control group received st and ard care . MAIN OUTCOME MEASURES Goal attainment scaling was used as the primary outcome measure . Other measures included the Barthel activities of daily living index and the Rivermead Mobility Index . RESULTS Compliance with advised treatment was poor in 85 % of the therapists and in 72 % of the patients . Goal attainment scaling scores significantly improved at postintervention and follow-up ( F(2,27)=45.159 ; P<.001 ) , but no significant difference was observed between the groups over time ( F(1,28)=.039 ; P=.845 ) . CONCLUSIONS Therapist and patient compliance with performing the intervention was low , restricting the conclusions regarding the effectiveness of the integrated motor imagery program . Future studies will need to explore barriers and facilitators to uptake of this intervention in clinical practice . Trial recruitment and retention were good . The study demonstrated that imagery could be successfully integrated into usual therapy and tailored for a wide range of functional activities OBJECTIVE To determine the efficacy of a mental practice ( MP ) protocol in increasing the function and use of the more affected limb in stroke patients . DESIGN R and omized , controlled , multiple baseline , pre-post , case series . SETTING Outpatient rehabilitation hospital . PARTICIPANTS Eleven patients who had a stroke more than 1 year before study entry ( 9 men ; mean age , 62.3+/-5.1 y ; range , 53 - 71 y ; mean time since stroke , 23.8 mo ; range , 15 - 48 mo ; 10 strokes exhibiting upper-limb hemiparesis on the dominant side ) and who exhibited affected arm hemiparesis and nonuse . INTERVENTION All patients received 30-minute therapy sessions 2 days a week for 6 weeks . The sessions emphasized activities of daily living ( ADLs ) : 6 subjects r and omly assigned to the MP condition concurrently received sessions requiring daily MP of the ADLs ; 5 subjects ( control group ) received an intervention consisting of relaxation techniques . MAIN OUTCOME MEASURES The Motor Activity Log and Action Research Arm ( ARA ) test . RESULTS Affected limb use as rated by MP patients and their caregivers increased ( 1.55 , 1.66 , respectively ) , as did patient and caregiver ratings of quality of movement ( 2.33 , 2.15 , respectively ) and ARA scores ( 10.7 ) . In contrast , the controls showed nominal increases in the amount they used their affected limb and in limb function . A Wilcoxon test on the ARA scores revealed significantly ( P = .004 ) greater changes in the MP group 's scores . CONCLUSIONS Participation in an MP protocol may increase a stroke patient 's use of his/her more affected limb . Data further support that the protocol result ed in correlative , MP-induced , motor function improvements . The mechanisms whereby MP increases affected arm use are unknown . Perhaps using the more affected limb becomes more salient through MP , or perhaps motor schema are altered during MP to integrate limb use PURPOSE In a multiple baseline design , we tested the hypothesis that imagery of finger movements is a specific strategy to improve h and function . METHODS The effect of mental training of sequential finger movements ( n=6 ) on h and function was compared to the repetitive execution of the same movements ( n=6 ) and conventional physical therapy ( n=5 ) in 17 patients after their first hemiparetic stroke . The behavioral outcome measures consisted of peak force of the pinch grip using a force transducer and manipulation functions of the upper extremity ( Jebsen-test ) . In addition , activities of daily living ( Barthel Index ) were acquired to describe the population . RESULTS Mental training result ed in an increase in the peak force of the pinch grip and generalized in a better functionality of the upper extremity ( Jebsen-test ) . This effect was similar to the repetitive execution of the movements and superior to conventional physiotherapy . CONCLUSIONS Our results suggest that the control of finger movements benefits from mental training of sequential finger movements and , thus , may be employed as a strategy in post-stroke rehabilitation AIM The aim of this study was to investigate the role of mental practice ( MP ) in functional recovery of upper limbs in stroke patients . METHODS Thirty-six hemiparetic stroke patients ( 15 females and 21 males ) were enrolled in a r and omized single blind cross-over study . Patients were r and omly divided into two groups , ( A and B ) each comprising 18 patients . Patients in group A underwent the conventional neuro-rehabilitation protocol ( therapeutic exercise and occupational therapy ) for three weeks ( 3 hours a day , 5 days a week ) and in the following 3 weeks , they received an additional 60 minutes of MP training . Patients in group B , instead , underwent , in the first 3 weeks , the rehabilitation program plus MP training and in the following 3 weeks , only the conventional neurorehabilitation program . All patients were evaluated at baseline ( T0 ) , at 3 weeks ( T1 ) and at 6 weeks ( T2 ) with the Motricity Index ( MI ) and the Arm Functional Test ( AFT ) . RESULTS At baseline ( T0 ) there were no significant differences at MI and AFT between the two groups . At T1 the differences between the two groups became significant . At T2 the difference was once again minimal . CONCLUSION These results suggest that MP could be used to complement to the conventional neurorehabilitative treatments usually prescribed for post-stroke neuromotor recovery . However , there is still much to be tested and discussed regarding the role that MP might play in the treatment of neurological patients Objective : To compare the feasibility and efficacy of a programme combining imagery and occupational therapy with a programme of therapy only . Design : R and omized , controlled case series . Setting : Subacute outpatient clinic . Subjects : Thirteen consecutively admitted patients between four weeks and one year post stroke exhibiting stable motor deficits in their affected upper limbs . Intervention : All patients received an hour of therapy three times a week for six weeks administered by the same physical and occupational therapists . During the same period , eight patients participated in 10-minute guided imagery sessions after each therapy session , as well as practising imagery at home twice each week . Five patients participated in a control intervention consisting of exposure to stroke information . Main outcome measures : The Fugl-Meyer Assessment of Motor Recovery ( Fugl-Meyer ) and Action Research Arm Test ( ARA ) . Results : After intervention , Fugl-Meyer and ARA scores of patients in the therapy only group remained virtually the same ; therapy plus imagery group scores improved by 13.8 and 16.4 points , respectively , on the Fugl-Meyer and ARA . Conclusions : Imagery is a clinical ly feasible , cost-effective complement to therapy that may improve outcomes more than participation in therapy only OBJECTIVE To test the feasibility and efficacy of a home-based motor imagery gait training program to improve walking performance of individuals with chronic poststroke hemiparesis . DESIGN Nonr and omized controlled trial . SETTING Local facility . PARTICIPANTS Participants ( N=17 ) were community-dwelling volunteers with hemiparesis caused by a unilateral stroke that occurred at least 3 months before the study . INTERVENTION Participants received 15 minutes of supervised imagery gait training in their homes 3 days a week for 6 weeks . The intervention addressed gait impairments of the affected lower limb and task-specific gait training . Walking ability was evaluated by kinematics and functional scales twice before the intervention , 3 and 6 weeks after the intervention began , and at the 3-week follow-up . MAIN OUTCOME MEASURES Spatiotemporal , kinematic , and functional walking measurements . RESULTS Walking speed increased significantly by 40 % after training , and the gains were largely maintained at the 3-week follow-up . The effect size of the intervention on walking speed was moderate ( .64 ) . There were significant increases in stride length , cadence , and single-support time of the affected lower limb , whereas double-support time was decreased . Improvements were also noted on the gait scale of the Tinetti Performance-Oriented Mobility Assessment as well as in functional gait . Sixty-five percent of the participants advanced 1 walking category in the Modified Functional Walking Categories Index . CONCLUSIONS Although further study is recommended , the findings support the feasibility and justify the incorporation of home-based motor imagery exercises to improve walking skills for poststroke hemiparesis Abstract Background and Objective : The ability to walk is impaired in more than 80 % of poststroke patients . The objective of the present study was to evaluate the effectiveness of the task-oriented circuit class training ( TOCCT ) with motor imagery ( MI ) on the gait during the subacute phase after a stroke . Method : This was a r and omized , controlled , assessor-blinded trial in a neurology department of a university hospital . A convenience sample of 30 people , 4 to 12 weeks ( mean , 6.3 weeks ) after the stroke was r and omized into 2 groups ( the TOCCT with MI and st and ard training group ) of 15 people each . Twenty-nine participants completed the 6-week follow-up . Participants were assigned to receive either the TOCCT with MI or dose-matched st and ard training program based on the Bobath ’s neurodevelopmental technique , 7 days a week for 2 weeks , as out patients or in patients . Outcome measures were the Functional Ambulation Classification ( FAC ) , the Rivermead Visual Gait Assessment ( RVGA ) , step length asymmetry , walking speed , and 6-minute walk test ( 6MWT ) . Results : The TOCCT with MI group showed a positive improvement in the mean/median scores on most of the outcome measures at post and follow-up assessment s in comparison to the control group . However , statistically significant differences were observed in changes between the groups at post and follow-up assessment for FAC , RVGA , walking speed , and 6MWT ( ANOVA , P = .001 to .049 ; Mann-Whitney U test , P = .001 ) . Conclusion : Among the patients who had a stroke within the previous 4 to 12 weeks , the TOCCT with MI produced statistically significant and clinical ly relevant improvements in the gait and the gait-related activities Abstract Background : Motor imagery practice refers to the mental rehearsal of motor acts in the absence of actual movement production . Purpose : To evaluate the effect of motor imagery practice on the performance of  sit to st and ( STS )  and reaching to grasp in subjects with post stroke chronic hemiparesis . Method : The study was design ed as a crossover intervention . Participants were 13 individuals ( mean age , 68.9 [ ±4.9 ] years ) with chronic hemiparesis enrolled in a day center at the Bet-Rivka Rehabilitation Hospital in Petach Tikvah , Israel . Following 1 week of baseline measurements of the performance of STS and reaching to grasp , these functions were mentally practice d for 15 minutes 3 times a week for 4 weeks . Half of the subjects mentally practice d STS , while the other half practice d the reaching imagery protocol . Subsequently , the participants in each group crossed over to practice the second function for the next 4 weeks . All practice sessions were performed according to a pre-established protocol under supervision . Measurements of real performance took place twice before and twice immediately following each practice session . For STS , the Tetrax Balance System was used to measure the speed of performance and weight distribution between the legs . Reaching to grasp was appraised via a “ kinematic ” glove and included speed variables of the h and . Results : A significant decrease was found in the values of STS duration . Weight distribution between the legs was not affected by the intervention . For reaching to grasp , a significant improvement was found in the mean and the maximum reaching velocity . Conclusions : In individuals with chronic hemiparesis  , the imagery practice of meaningful motor tasks can positively affect real performance
INTRODUCTION In recent decades , many stroke rehabilitation methods have been developed .
Mental practice ( MP ) is a dynamic state in which the subject evokes an imaginary representation of a motor action or skill in order to learn or perfect that action .
Although functional imaging has shown that MP produces similar cortical activation patterns to those of movement , the clinical effectiveness of such methods in rehabilitation and functional recovery has yet to be demonstrated .