Comparison of embedded and added motor imagery training in patients after stroke: results of a randomised controlled pilot trial

Abstract

BackgroundMotor 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'.MethodsOutpatients after first stroke participated in a single-blinded, randomised 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.ResultsThirty nine outpatients 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 standardised 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.ConclusionsEmbedded 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 RegistrationClinicalTrials.gov: NCT00858910

Guidelines for Adult Stroke Rehabilitation and Recovery

“…The later studies have similar methodological challenges (8-40 subjects per group) and lead to similar, inconsistent conclusions about the superiority of any 1 specific treatment. [594][595][596][597][598][599][600][601][602][603][604] Likewise, a systematic review of fall prevention after stroke has shown that inconsistencies in outcome measures, intervention type, and implementation in previous research make it difficult to determine the effectiveness of fall prevention programs after stroke. 174 The Prevention of Falls section provides more discussion.…”

Motor Imagery and Action Observation as Effective Tools for Physical Therapy

“…Motor imagery studies were conducted on several diseases relating to the central nervous system and acute injuries involving orthopedics such as subacute stroke [15][16][17][18][19], chronic stroke [20][21][22], traumatic brain injury [23], multiple sclerosis [23], shoulder impingement syndrome [24], postsurgical anterior cruciate ligament [25], postsurgical flexor tendon repair [26], burn injury [27], phantom limb pain [28], complex regional pain syndrome [28,29], and motor coordination problems [30]. Table 1 lists motor imagery clinical studies found in PubMed.…”

“…The effects of motor imagery were observed in upper extremity function in subacute [16] and chronic [23] stroke patients, gait function in subacute [15,18] and chronic [20][21][22] stroke patients, and balance functions in chronic stroke patients [22]. Motor imagery used for motor recovery showed a lack of results in subacute stroke patients with limited upper extremity function [19], stroke patients struggling with goal attainment and Neurological Physical Therapy task performance [17], and those with traumatic brain injury and multiple sclerosis [23]. A possible reason for the different effects of motor imagery is the decline of cognitive function after a patient experiences a stroke.…”

The effects of mirror therapy on arm and hand function in subacute stroke in patients

“…Nowadays, MT is used mostly as an additional therapy for rehabilitation of paretic hand after stroke Sathian et al, 2000;Ramachandran, 2005;Thieme et al, 2010;Rothgangel et al, 2011;Schuster et al, 2012), even in severe hand paresis (Dohle et al, 2009), in hemiparesis in children (Gygax et al, 2011) but also as a kind of cognitive stimulation in nonused syndrome or neglect syndrome (Beis et al, 2001;Ramachandran et al, 1999) or in deterioration of cognitive functions (Tichelaar Vladimir et al, 2007). There are also studies on surgery intervention in sensory-motor re-education after nerve injuries Lundborg, 2005, 2008;Altschuler and Hu, 2008).…”