Home-based motor imagery training for gait rehabilitation of people with chronic poststroke hemiparesis.
Arch Phys Med Rehabil. 2008 Aug;89(8):1580-8
Authors: Dunsky A, Dickstein R, Marcovitz E, Levy S, Deutsch J
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.