Comparison of embedded and added motor imagery training in patients after stroke: results of a randomised controlled pilot trial Mental Practice Combined with Physical Practice to Enhance Hand Recovery in Stroke Patients Motor imagery training improves precision of an upper limb movement in patients with hemiparesis. Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy Motor Imagery Training on Muscle Strength and Gait Performance in Ambulant Stroke Subjects-A Randomized Clinical Trial. Influence of motor imagery training on gait rehabilitation in sub-acute stroke: A randomized controlled trial. Mental Practice in Chronic Stroke: Results of a Randomized, Placebo-Controlled Trial Effect of imagery perspective on occupational performance after stroke: a randomized controlled trial. Effects of motor imagery training on balance and gait abilities in post-stroke patients: a randomized controlled trial Task-Oriented Circuit Class Training Program with Motor Imagery for Gait Rehabilitation in Poststroke Patients: A Randomized Controlled Trial
Background Motor imagery ( MI ) when combined with physiotherapy can offer functional benefits after stroke . Two MI integration strategies exist : added and embedded MI . Both approaches were compared when learning a complex motor task ( MT ) : ' Going down , laying on the floor , and getting up again ' . Methods Out patients after first stroke participated in a single-blinded , r and omised controlled trial with MI embedded into physiotherapy ( EG1 ) , MI added to physiotherapy ( EG2 ) , and a control group ( CG ) . All groups participated in six physiotherapy sessions . Primary study outcome was time ( sec ) to perform the motor task at pre and post-intervention . Secondary outcomes : level of help needed , stages of MT-completion , independence , balance , fear of falling ( FOF ) , MI ability . Data were collected four times : twice during one week baseline phase ( BL , T0 ) , following the two week intervention ( T1 ) , after a two week follow-up ( FU ) . Analysis of variance was performed . Results Thirty nine out patients were included ( 12 females , age : 63.4 ± 10 years ; time since stroke : 3.5 ± 2 years ; 29 with an ischemic event ) . All were able to complete the motor task using the st and ardised 7-step procedure and reduced FOF at T0 , T1 , and FU . Times to perform the MT at baseline were 44.2 ± 22s , 64.6 ± 50s , and 118.3 ± 93s for EG1 ( N = 13 ) , EG2 ( N = 12 ) , and CG ( N = 14 ) . All groups showed significant improvement in time to complete the MT ( p < 0.001 ) and degree of help needed to perform the task : minimal assistance to supervision ( CG ) and independent performance ( EG1 + 2 ) . No between group differences were found . Only EG1 demonstrated changes in MI ability over time with the visual indicator increasing from T0 to T1 and decreasing from T1 to FU . The kinaesthetic indicator increased from T1 to FU . Patients indicated to value the MI training and continued using MI for other difficult-to-perform tasks . Conclusions Embedded or added MI training combined with physiotherapy seem to be feasible and benefi-cial to learn the MT with emphasis on getting up independently . Based on their baseline level CG had the highest potential to improve outcomes . A patient study with 35 patients per group could give a conclusive answer of a superior MI integration strategy .Trial Registration Clinical Trials.gov : Objectives . To evaluate whether combining mental practice with physical practice training enhances h and function in patients with stroke . Methods . 10 for treatment and 10 for control were recruited for this pre/posttraining matched case control study . In the treatment group , subjects underwent combining mental practice with physical practice for four weeks . In the control group , subjects only participated in physical practice .  Change of h and function and the number of activated voxels of the contralateral somatosensory motor cortex ( SMC ) acquired by functional magnetic resonance imaging were measured . Results . After training , the Action Research Arm Test score increased by 12.65 for treatment and by 5.20 for control . There was a significant difference in the Action Research Arm Test score between the two groups ( P = 0.04 ) . The activated voxels number of the contralateral SMC increased in both groups , but the activated voxels number in the contralateral SMC and the improvement of h and function for treatment were greater than for control . In the treatment group , the number of activated voxels of the contralateral SMC was positively correlated with better h and function scores . Conclusions . Combining mental practice with physical practice may be a more effective treatment strategy than physical training alone for h and recovery in stroke patients BACKGROUND In healthy participants , beneficial effects of motor imagery training on movement execution have been shown for precision , strength , and speed . In the clinical context , it is still debated whether motor imagery provides an effective rehabilitation technique in patients with motor deficits . OBJECTIVE To compare the effectiveness of two different types of movement training : motor imagery vs. motor execution . METHODS Twenty-five patients with hemiparesis were assigned to one of two training groups : the imagery or the execution-training group . Both groups completed a baseline test before they received six training sessions , each of which was followed by a test session . Using a novel and precisely quantifiable test , we assessed how accurately patients performed an upper limb movement . RESULTS Both training groups improved performance over the six test sessions but the improvement was significantly larger in the imagery group . That is , the imagery group was able to perform more precise movements than the execution group after the sixth training session while there was no difference at the beginning of the training . CONCLUSIONS The results provide evidence for the benefit of motor imagery training in patients with hemiparesis and thus suggest the integration of cognitive training in conventional physiotherapy practice 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 INTRODUCTION The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living ( ADLs ) . Motor imagery ( MI ) is an active process during which a specific action is reproduced within working memory without any actual movements . MI training enhances motor learning , neural reorganization and cortical activation in stroke . The efficacy of MI training involving lower extremity mobility tasks need to be assessed . AIM To evaluate the effects of combining motor imagery with physical practice in paretic Lower Extremity Muscles Strength and Gait Performance in Ambulant Stroke subjects . MATERIAL S AND METHODS A R and omized Clinical Trial was conducted in Department of Physical Therapy , Tertiary Care Hospitals , Mangalore , India which includes 40 hemi paretic subjects ( > 3 months post-stroke ) who were ambulant with good imagery ability in both KVIQ-20 ≥ 60 and Time dependent MI screening test were recruited and r and omly allocated into task-oriented training group ( n=20 ) and task-oriented training group plus MI group ( n=20 ) . Subjects in both groups underwent task orientated training for lower extremity 45 - 60 minutes , 4 days per week for 3 weeks . In addition , the experimental group received 30 minutes of audio-based lower extremity mobility tasks for MI practice  . Isometric muscle strength of Hip , Knee and Ankle using a h and -held dynamometer and self-selected 10 m gait speed were assessed before and after 3 weeks of intervention . RESULTS Both the groups had found a significant change for all the outcome measures following 3 weeks of interventions with p < .05 . The experimental group had shown a significant improvement in paretic hip muscles ( both flexors and extensors ) , knee extensors and ankle dorsiflexors and gait speed compare to control group with p < .05 between group analyses . CONCLUSION Additional task specific MI training improves paretic muscle strength and gait performance in ambulant stroke patients OBJECTIVE To evaluate the effect of mental practice on motor imagery ability and assess the influence of motor imagery on gait rehabilitation in sub-acute stroke . DESIGN R and omized controlled trial . SUBJECTS A total of 44 patients with gait dysfunction after first-ever stroke were r and omly allocated to a motor imagery training group and a muscle relaxation group . METHODS The motor imagery group received 6 weeks of daily mental practice . The relaxation group received a muscle relaxation programme of equal duration .  Motor imagery ability and lower limb function were assessed at baseline and after 6 weeks of treatment . Motor imagery ability was tested using a question naire and mental chronometry test . Gait outcome was evaluated using a 10-m walk test ( near transfer ) and the Fugl-Meyer assessment ( far transfer ) . RESULTS Significant between-group differences were found , with the vividness of kinesthetic imagery and the walking test results improving more in the motor imagery group than in the muscle relaxation group . There was no group interaction effect for the far transfer outcome score . CONCLUSION Motor imagery training may have a beneficial task-specific effect on gait function in sub-acute stroke ; however , longer term confirmation is required 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 OBJECTIVE This preliminary study sought to determine whether the imagery perspective used during mental practice ( MP ) differentially influenced performance outcomes after stroke . METHOD Nineteen participants with unilateral subacute stroke ( 9 men and 10 women , ages 28 - 77 ) were r and omly allocated to one of three groups . All groups received 30-min occupational therapy sessions 2 × /wk for 6 wk . Experimental groups received MP training in functional tasks using either an internal or an external perspective ; the control group received relaxation imagery training . Participants were pre- and posttested using the Fugl-Meyer Motor Assessment ( FMA ) , the Jebsen-Taylor Test of H and Function ( JTTHF ) , and the Canadian Occupational Performance Measure ( COPM ) . RESULTS At posttest , the internal and external experimental groups showed statistically similar improvements on the FMA and JTTHF ( p < .05 ) . All groups improved on the COPM ( p < .05 ) . CONCLUSION MP combined with occupational therapy improves upper-extremity recovery after stroke . MP does not appear to enhance self-perception of performance . This preliminary study suggests that imagery perspective may not be an important variable in MP interventions Objectives : To investigate the effects of motor imagery training on the balance and gait abilities of post-stroke patients . Design : R and omized controlled trial . Setting : Outpatient rehabilitation centre . Subjects : Twenty-eight individuals with chronic stroke . Interventions : The experimental group ( n = 15 ) performed motor imagery training involving imagining normal gait movement for 15 minutes embedded in gait training for 30 minutes ( 45 minutes/day , 3 times/week ) ; the control group ( n = 13 ) performed gait training only ( 30 minutes/day , 3 times/week ) . Main measures : Balance and gait abilities were measured by the Functional Reach Test , Timed Up- and -Go Test , 10-m Walk Test and Fugl-Meyer assessment before and after interventions . Results : All measurements improved significantly compared with baseline values in the experimental group . In the control group , there were significant improvements in all parameters except the Fugl-Meyer assessment . All parameters of the experimental group increased significantly compared to those of the control group as follows : Functional Reach Test ( control vs. experimental : 28.1 ± 3.1 vs. 37.51 ± 3.0 ) , Timed Up- and -Go Test ( 20.7 ± 4.0 vs. 13.2 ± 2.2 ) , 10-m Walk Test ( 17.4 ± 4.6 vs. 16.0 ± 2.7 ) and Fugl-Meyer assessment ( 12.0 ± 2.9 vs. 17.6 ± 1.3 ) . Conclusions : Gait training with motor imagery training improves the balance and gait abilities of chronic stroke patients significantly better than gait training alone 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 : Stroke is the leading cause of disability in adults , producing a major personal and economic impact on those affected .
The scientific evidence regarding the use of Motor Imagery ( MI ) as a preparatory process for motor control reinforces the need to explore this method as a complement to physical therapy .
Objectives : The objectives of this systematic review were to determine the effectiveness of MI for functional recovery after stroke and to identify a possible intervention protocol , according to the level of existing scientific evidence .