title: Effects of integrated motor imagery practice on gait of individuals with chronic stroke: a half-crossover randomized study.
abstract: OBJECTIVE
  To test the effects of a new motor imagery practice approach, in which motor and motivational contents were integrated in order to improve gait in subjects with chronic poststroke hemiparesis.
  
  
  METHODS
  A half-crossover study composed of 2 phases. In phase 1, subjects were randomly assigned to receive either the experimental or the control treatment. In phase 2, the subjects who had initially received the control treatment "crossed over" to receive the experimental intervention.
  
  
  METHODS
  The experimental and the control intervention were delivered in the subjects' homes; assessments were performed in a hospital laboratory.
  
  
  METHODS
  Community-dwelling individuals (N=23) with chronic poststroke hemiparesis whose gait was impaired.
  
  
  METHODS
  The experimental intervention, called integrated motor imagery practice, consisted of imagery scripts aimed at improving home and community walking as well as fall-related self-efficacy. The control treatment consisted of executed exercises to improve the function of the involved upper extremity.
  
  
  METHODS
  In-home walking, indoor and outdoor community ambulation, and fall-related self-efficacy. These were assessed before and after the intervention as well as at a 2-week follow-up.
  
  
  RESULTS
  In-home walking was significantly improved after application of the experimental intervention (P≤.003), but not after the control treatment (P≤.68). Community ambulation did not improve. Fall-related self-efficacy was slightly improved by the integrated motor imagery intervention; however, the findings were not unequivocal.
  
  
  CONCLUSIONS
  Home delivery of integrated motor imagery practice was feasible and exerted a positive effect on walking in the home. However, it was ineffective for improving gait in public domains. We speculate that the addition of physical practice to imagery practice may be essential for achieving that end.
authors.affiliation: Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel. Electronic address: ruthd@research.haifa.ac.il.
authors.forename: Ruth
authors.initials: R
authors.lastname: Dickstein
authors.forename: Judith E
authors.initials: JE
authors.lastname: Deutsch
authors.forename: Yonat
authors.initials: Y
authors.lastname: Yoeli
authors.forename: Michal
authors.initials: M
authors.lastname: Kafri
authors.forename: Faten
authors.initials: F
authors.lastname: Falash
authors.forename: Ayelet
authors.initials: A
authors.lastname: Dunsky
authors.forename: Adi
authors.initials: A
authors.lastname: Eshet
authors.forename: Neil
authors.initials: N
authors.lastname: Alexander
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D018592:Cross-Over Studies; D005240:Feasibility Studies; D005260:Female; D005684:Gait; D006801:Humans; D019018:Imagery, Psychotherapy; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009048:Motor Skills; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome
keywords: ANCOVA; ANOVA; C; CI; ES; FESS; FU; Falls-Efficacy Scale, Swedish version; Gait; I; RM; Rehabilitation; SAM; Self efficacy; Stroke; analysis of covariance; analysis of variance; confidence interval; control; effect size; follow-up; integrated imagery intervention; repeated measures; step activity monitor