Stroke patients have substantial long term disability, particularly in walking. Motor and motivational imagery (""""""""Integrated mental practice"""""""") is a safe and inexpensive exercise routine for improving self efficacy and motor performance. The goals of the proposed study are to implement and test the outcomes of an integrated mental practice intervention to community dwelling individuals with stroke who are walking-impaired due to hemiparesis. The PIs hypothesize that the application of this integrated mental practice program to individuals post-stroke will (1) improve gait speed and community walking, and (2) enhance fall related self efficacy. The experimental intervention will be composed of motor imagery practice of ambulatory tasks using both visual and kinesthetic imagery;visual imagery tasks will be coupled with motivational imagery strategies. Following randomization, an experimental group receiving four weeks of imagery training will be compared with controls receiving upper extremity exercises. Subsequently, following a two week interval, the control patients will also receive the four-week experimental treatment. The main outcomes will be walking speed, community walking performance and fall efficacy, tested before the intervention, at midterm, post-intervention, and at two weeks follow-up. This proposal leverages the expertise of an Israeli researcher and her team using a unique and practical intervention with an experienced U.S. team. The goal is to transfer the program to the U.S. and eventually develop a larger scale U.S.-based randomized controlled RO1 study to examine outcomes as well as mechanisms of integrated imagery training for individuals post-stroke. Relevance to Public Health: Individuals post-stroke are often confined to their homes or have only limited mobility in the community. Decreased gait speed as well as low fall-related self efficacy are major causes of immobility and restricted life style in these individuals. There is also a shortage of rehabilitation options once individuals are in their communities. In this feasibility study the PIs propose the use of a home based self practice of motor and motivational imagery to enhance self confidence, prevent deterioration and facilitate the restoration of motor and functional abilities.
| Dickstein, Ruth; Deutsch, Judith E; Yoeli, Yonat et al. (2013) Effects of integrated motor imagery practice on gait of individuals with chronic stroke: a half-crossover randomized study. Arch Phys Med Rehabil 94:2119-25 |
