Many clinical studies have investigated the use of mental practice (MP) through motor imagery (MI) to enhance functional recovery of patients with diverse physical disabilities. Although beneficial ...effects have been generally reported for training motor functions in persons with chronic stroke (e.g., reaching, writing, walking), attempts to integrate MP within rehabilitation programs have been met with mitigated results. These findings have stirred further questioning about the value of MP in neurological rehabilitation. In fact, despite abundant systematic reviews, which customarily focused on the methodological merits of selected studies, several questions about factors underlying observed effects remain to be addressed. This review discusses these issues in an attempt to identify factors likely to hamper the integration of MP within rehabilitation programs. First, the rationale underlying the use of MP for training motor function is briefly reviewed. Second, three modes of MI delivery are proposed based on the analysis of the research protocols from 27 studies in persons with stroke and Parkinson's disease. Third, for each mode of MI delivery, a general description of MI training is provided. Fourth, the review discusses factors influencing MI training outcomes such as: the adherence to MI training, the amount of training and the interaction between physical and mental rehearsal; the use of relaxation, the selection of reliable, valid and sensitive outcome measures, the heterogeneity of the patient groups, the selection of patients and the mental rehearsal procedures. To conclude, the review proposes a framework for integrating MP in rehabilitation programs and suggests research targets for steering the implementation of MP in the early stages of the rehabilitation process. The challenge has now shifted towards the demonstration that MI training can enhance the effects of regular therapy in persons with subacute stroke during the period of spontaneous recovery.
Over the past 2 decades, much work has been carried out on the use of mental practice through motor imagery for optimizing the retraining of motor function in people with physical disabilities. ...Although much of the clinical work with mental practice has focused on the retraining of upper-extremity tasks, this article reviews the evidence supporting the potential of motor imagery for retraining gait and tasks involving coordinated lower-limb and body movements. First, motor imagery and mental practice are defined, and evidence from physiological and behavioral studies in healthy individuals supporting the capacity to imagine walking activities through motor imagery is examined. Then the effects of stroke, spinal cord injury, lower-limb amputation, and immobilization on motor imagery ability are discussed. Evidence of brain reorganization in healthy individuals following motor imagery training of dancing and of a foot movement sequence is reviewed, and the effects of mental practice on gait and other tasks involving coordinated lower-limb and body movements in people with stroke and in people with Parkinson disease are examined. Lastly, questions pertaining to clinical assessment of motor imagery ability and training strategies are discussed.
Over the last 25 years the definition and classification of cerebral palsy (CP) have evolved, as well as the approach to rehabilitation. CP is a disorder of the development of movement and posture, ...causing activity limitations attributed to nonprogressive disturbances of the fetal or infant brain that may also affect sensation, perception, cognition, communication, and behavior. Motor control during reaching, grasping, and walking are disturbed by spasticity, dyskinesia, hyperreflexia, excessive coactivation of antagonist muscles, retained developmental reactions, and secondary musculoskeletal malformations, together with paresis and defective programing. Weakness and hypoextensibility of the muscles are due not only to inadequate recruitment of motor units, but also to changes in mechanical stresses and hormonal factors. Two methods, the General Movements Assessment and the Test of Infant Motor Performance, now permit the early detection of CP, while the development of valid and reliable outcome measures, particularly the Gross Motor Function Measure (GMFM), have made it possible to evaluate change over time and the effects of clinical interventions. The GMFM has further led to the development of predictive curves of motor function while the Gross Motor Classification System and the Manual Ability Classification System provide standardized means to classify the severity of the movement disability. With the emergence of the task-oriented approach, the focus of therapy in rehabilitation has shifted from eliminating deficits to enhancing function across all performance domains by emphasizing fitness, function, participation, and quality of life. There is growing evidence supporting selected interventions and interest for the therapy and social integration of adults with CP.
This chapter reviews the evolution of stroke rehabilitation in the last 20 years. It begins by describing the different types of stroke that can occur in adults, their potential consequences on a ...person's capacity to function in daily life and statistics on the number of strokes and their burden on families and the economy. The assessment of stroke severity, recovery of function over time, and the impact of initial stroke severity and age on potential recovery are then addressed as well as the concept of rehabilitation to enhance recovery. Fueled by the synthesis of an ever-increasing research knowledge base and the creation of stroke rehabilitation recommendations for optimal delivery of rehabilitation services and of therapeutic interventions, stroke rehabilitation has changed dramatically. Examples of improvements in stroke rehabilitation in Canada are given with emphasis on the "best practices" inspired stroke rehabilitation continuum recently recommended for the Province of Quebec. The need for an improved community-based rehabilitation approach that includes regular follow-ups and community-based programs promoting reintegration is emphasized. The importance of knowledge translation strategies to promote the uptake of best-practice recommendations is illustrated by describing the activities of the Sensorimotor Rehabilitation Research Team. Over the past 3 years, the researchers of this team and clinicians in three rehabilitation centers, two in Montreal and one in Quebec City, have collaborated to adopt standardized assessment tools, create a common stroke registry, a best-practice recommended approach to interventions and the participation of clinicians in the research process.
To investigate the effects of normal aging on motor imagery vividness and working memory.
Descriptive study with 3 groups.
Laboratory of a university-affiliated research rehabilitation center.
A ...sample of healthy persons (N=80) divided into 3 age groups: young (26+/-5.0 y), intermediate (53.6+/-5.4 y), and elderly (67.6+/-4.6 y).
Not applicable.
The kinesthetic and visual imagery scores of the Kinesthetic and Visual Imagery Questionnaire and scores from 3 domains of working memory (visuospatial, kinesthetic, verbal).
Results revealed that visual motor imagery scores were higher than kinesthetic scores (imagery effect: P=.001); however, there was also a significant imagery x group interaction (P=.017). Post hoc analyses showed that only the young and intermediate groups had higher visual than kinesthetic motor imagery scores (P=.005 and .001, respectively), indicating a loss of visual motor imagery dominance in the elderly group. There was no group effect (P=.963) signifying that the level of motor imagery vividness was comparable between age groups. Significant decreases (17.3% and 22.5%, respectively) in visuospatial working memory scores were found in the intermediate (P=.011) and elderly (P=.001) groups, whereas a significant reduction (P=.01) in kinesthetic working memory scores was observed only in the elderly group (26.7%). There was also an age-related significant decline of visuospatial (r= -.50) and kinesthetic (r=-.34) working memory.
The level of motor imagery vividness does not diminish with age, but the quality changes. The dominance of visual motor imagery lessens with aging resulting in motor imagery modality-equivalence. These motor imagery alterations are associated with an age-related decline in visuospatial and kinesthetic working memory.
Objective:
To evaluate a minimal dose intervention of six 1-hour sessions of task-oriented circuit gait training including a caregiver over a 12-week period to persons post stroke in the South ...African public health sector.
Design:
Stratified, single blinded, randomized controlled trial with three intervention groups.
Participants:
Persons post stroke (n = 144, mean age 50 years, 72 women), mean 9.5 weeks post stroke.
Interventions:
Task group (n = 51)—accompanied by a caregiver; task-oriented circuit gait training (to improve strength, balance, and task performance while standing and walking). Strength group (n = 45); strength training of lower extremities while sitting and lying. Control group (n = 48); one 90-minute educational session on stroke management.
Measures:
The six-minute walk test (6MinWT) was the primary outcome; the secondary outcomes included comfortable and fast gait speeds, Berg Balance Scale (BBS), and Timed Up and Go (TUG). Particpants evaluated at baseline, post intervention (12 weeks), and at follow-up 12 weeks later. Change scores were compared using generalized repeated measures analysis of variance (ANOVA).
Results:
Task group change scores for all outcomes post intervention and at follow-up were improved compared to the other groups (P-values between 0.000005 and 0.04). The change scores (mean, 1SD) between baseline and follow-up for the Task, Strength, and Control groups, respectively, were as follows: 6MinWT:119.52 m (81.92), 81.05 m (79.53), and 60.99 m (68.38); comfortable speed 0.35 m/s (0.23), 0.24 m/s (0.22), and 0.19 m/s (0.21); BBS: 9.94 (7.72), 6.93 (6.01), and 5.19 (4.80); and TUG: –14.24 seconds (16.86), –6.49 seconds (9.88), and –5.65 seconds (8.10).
Conclusion:
Results support the efficacy of a minimal dose task-oriented circuit training program with caregiver help to enhance locomotor recovery and walking competency in these persons with stroke.
Somatic mutations in GNAQ, GNA11, SF3B1, EIF1AX, and BAP1 have been identified in uveal melanoma (UM). The aim of this study was to determine whether mutations in these genes in primary tumors were ...associated with metastases in individuals diagnosed with UM.
A total of 63 UM cases who developed a metastasis within 48 months of primary treatment and 53 UM controls who were metastasis-free over a similar time period were selected for the study. Primary UM cases were screened for mutations in GNAQ, GNA11, SF3B1, EIF1AX, and BAP1. The association of these mutations with tumor characteristics, chromosome 3 copy number, and metastatic status was analyzed by logistic regression to estimate the odds of developing metastasis within 48 months.
As expected, tumor diameter, thickness, cilio-choroidal location, and chromosome 3 monosomy were all significantly (P < 0.02) associated with the presence of metastasis. In univariate analysis, GNA11 (odds ratio OR 2.5, 95% confidence interval CI 1.1-5.5) and BAP1 (OR 6.3, 95% CI 2.7-14.4) mutations were positively associated and EIF1AX mutation (OR 0.13, 95% CI 0.034-0.47) was inversely associated with metastatic status at 48 months after UM treatment. After adjustment for covariates, a chromosome 3 monosomy/BAP1-mutation/EIF1AX-wild-type (WT) mutation profile was strongly associated (OR 37.5, 95% CI 4.3-414) with the presence of metastasis compared with a chromosome 3 disomy/BAP1-WT/EIF1AX mutation profile.
The results suggest that knowledge of mutations in BAP1 and EIF1AX can enhance prognostication of UM beyond that determined by chromosome 3 and tumor characteristics. Tumors with chromosome 3 disomy/BAP1-WT/EIF1AX-WT have a 10-fold increased risk of metastasis at 48 months compared with disomy-3/BAP1-WT/EIF1AX mutant tumors.
To examine the reproducibility of 2 chronometric tests: time-dependent motor imagery (TDMI) screening test and temporal congruence test.
Test-retest 10 to 14 days apart.
Laboratory of a ...university-affiliated center for research in rehabilitation.
Twenty persons post cerebrovascular accident (CVA) and 46 healthy persons (controls).
The reproducibility of the TDMI screening test, wherein the number of stepping movements (performed in sitting) imagined over 15, 25, and 45 seconds is recorded, and of the temporal congruence test wherein the duration of physically executed (E) and imagined (I) stepping movements is recorded, was evaluated.
The test-retest reliability of the number of imagined movements (TDMI screening test), movement duration and I/E time ratios (temporal congruence test), and intrasession reliability of the temporal congruence test were assessed by using intraclass correlation coefficients (ICCs).
For the TDMI screening test, the ICCs ranged from .88 to .93 (CVA, n=20) and from .87 to .92 (controls, n=9). For the temporal congruence test, when the total duration of 2 series of 5 stepping movements was averaged, ICCs ranged from .76 to .97 (CVA, n=20) and from .77 to .93 (controls, n=46), whereas for 1 series the ICCs ranged from .71 to .95 and from .63 to .95 in the CVA and control groups, respectively. The ICCs for intrasession reliability for the CVA (n=20) and control (n=46) groups, respectively, ranged from .90 to .98 and .95 to .97.
The present findings support the reproducibility of both tests in both groups. Mental chronometry can be used reliably for the screening of patients capable of motor imagery or for measuring temporal congruence between real and imagined movements poststroke.
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