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Aug 07, 2008

Home-based motor imagery training for gait rehabilitation of people with chronic poststroke hemiparesis

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.

Aug 04, 2008

Virtual Rehabilitation in an Activity Centre for Community-Dwelling Persons with Stroke

Virtual Rehabilitation in an Activity Centre for Community-Dwelling Persons with Stroke. The Possibilities of 3-Dimensional Computer Games.

Cerebrovasc Dis. 2008 Jul 31;26(3):289-296

Authors: Broeren J, Claesson L, Goude D, Rydmark M, Sunnerhagen KS

Background: The main purpose of this study was to place a virtual reality (VR) system, designed to assess and to promote motor performance in the affected upper extremity in subjects after stroke, in a nonhospital environment. We also wanted to investigate if playing computer games resulted in improved motor function in persons with prior stroke. Methods: The intervention involved 11 patients after stroke who received extra rehabilitation by training on a computer 3 times a week during a 4-week period. The control group involved 11 patients after stroke who continued their previous rehabilitation (no extra computer training) during this period. The mean age of all was 68 years (range = 47-85) and the average time after stroke 66 months (range = 15-140). The VR training consisted of challenging games, which provided a range of difficulty levels that allow practice to be fun and motivating. An additional group of 11 right-handed aged matched individuals without history of neurological or psychiatric illnesses served as reference subjects. Results: All the participants reported that they were novel computer game players. After an initial introduction they learned to use the VR system quickly. The treatment group demonstrated improvements in motor outcome for the trained upper extremity, but this was not detected in real-life activities. Conclusions: The results of this research suggest the usefulness of computer games in training motor performance. VR can be used beneficially not only by younger participants but also by older persons to enhance their motor performance after stroke.