title: Comparison of embedded and added motor imagery training in patients after stroke: results of a randomised controlled pilot trial.
abstract: BACKGROUND
  Motor 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'.
  
  
  METHODS
  Outpatients 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.
  
  
  RESULTS
  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.
  
  
  RESULTS
  Thirty 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.
  
  
  CONCLUSIONS
  Embedded 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.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT00858910.
authors.affiliation: Reha Rheinfelden, Salinenstrasse 98, 4310 Rheinfelden, Switzerland. c.schuster@reha-rhf.ch
authors.forename: Corina
authors.initials: C
authors.lastname: Schuster
authors.forename: Jenny
authors.initials: J
authors.lastname: Butler
authors.forename: Brian
authors.initials: B
authors.lastname: Andrews
authors.forename: Udo
authors.initials: U
authors.lastname: Kischka
authors.forename: Thierry
authors.initials: T
authors.lastname: Ettlin
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D000704:Analysis of Variance; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D007858:Learning; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009483:Neuropsychological Tests; D015588:Observer Variation; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D004856:Postural Balance; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D016037:Single-Blind Method; D020521:Stroke / Q000503:physiopathology / Q000523:psychology; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome; D014741:Video Recording