Original article
Home-Based Motor Imagery Training for Gait Rehabilitation of People With Chronic Poststroke Hemiparesis

https://doi.org/10.1016/j.apmr.2007.12.039Get rights and content

Abstract

Dunsky A, Dickstein R, Marcovitz E, Levy S, Deutsch J. Home-based motor imagery training for gait rehabilitation of people with chronic poststroke hemiparesis.

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

Nonrandomized 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.

Section snippets

Participants

Participants (N=17) with hemiparesis were recruited from a community support group of people who suffered a stroke. They volunteered to take part in the study and met the following inclusion criteria: (1) had a unilateral stroke that occurred at least 3 months before joining the study, (2) were able to walk a total of 6m with or without a cane, (3) were able to maintain proper communication skills as determined by free conversation with each volunteer and by reports of relatives, and (4) did

Results

Because none of the participants dropped out from the study, the results are based on all 17 admitted patients. No significant differences were found between the 2 baseline assessments for any of the measured variables. Therefore, the mean of the values from the first and second assessments was calculated for each variable to determine the baseline average. For overall ANOVA of the effect of time on the spatiotemporal parameter, see appendix 3.

Discussion

The main purpose of this study was to determine the feasibility and efficacy of using home-based motor imagery training to improve the walking performance of people with chronic poststroke hemiparesis. All participants completed training with excellent adherence to the program. Thus, there were no dropouts, and, for the entire program, only 2 sessions were cancelled and rescheduled. The kinematic and clinical test findings provide preliminary support for the efficacy of this treatment mode for

Conclusions

In future controlled studies, the effects of imagery training should be contrasted with no intervention as well as with the effects of other interventions; one intriguing question that should be resolved through a controlled study is the effect of verbal descriptions or performance instructions on the subsequent execution of a motor task in comparison to the effect of motor imagery on performance of that same task. The possibility that some of the improvements are because of participants

Acknowledgments

We thank Claudet Ariav, PT, and the Neeman Association for Stroke Survivors.

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    Supported by Kort (grant no. 1165-8711).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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