title: Influence of functional task-oriented mental practice on the gait of transtibial amputees: a randomized, clinical trial.
abstract: Mental practice (MP) through motor imagery is a cognitive training strategy used to improve locomotor skills during rehabilitation programs. Recent works have used MP tasks to investigate the neurophysiology of human gait; however, its effect on functional performance has not been evaluated. In the present study, the influence of gait-oriented MP tasks on the rehabilitation process of gait in transtibial amputees was investigated by assessing the vertical (V), anterior-posterior (AP), and medio-lateral (ML) ground reaction forces (GRFs) and the time duration of the support phase of the prosthetic limb.
  
  
  
  Unilateral transtibial amputees, who were capable of performing motor imagination tasks (MIQ-RS score ≥4), were randomly divided into two groups: Group A (n = 10), who performed functional gait-oriented MP combined with gait training, and Group B (n = 5), who performed non-motor task MP. The MP intervention was performed in the first-person perspective for 40 min, 3 times/week, for 4 weeks. The GRF outcome measures were recorded by a force platform to evaluate gait performance during 4 distinct stages: at baseline (BL), 1 month before the MP session; Pre-MP, 1-3 days before the MP session; Post-MP, 1-3 days after the MP session; and follow-up (FU), 1 month after MP session. The gait variables were compared inter- and intra-group by applying the Mann-Whitney and Friedman tests (alpha = 0.05).
  
  
  
  All volunteers exhibited a homogenous gait pattern prior to MP intervention, with no gait improvement during the BL and Pre-MP stages. Only Group A showed significant improvements in gait performance after the intervention, with enhanced impact absorption, as indicated by decreased first V and AP peaks; propulsion capacity, indicated by increasing second V and AP peaks; and balance control of the prosthetic limb, indicated by decreasing ML peaks and increasing duration of support. This gait pattern persisted until the FU stage.
  
  
  
  MP combined with gait training allowed transtibial amputees to reestablish independent locomotion. Since the effects of MP were preserved after 1 month, the improvement is considered related to the specificity of the MP tasks. Therefore, MP may improve the clinical aspect of gait rehabilitation when included in a training program.
authors.affiliation: Graduate Program in Neuroscience-Federal University of Minas Gerais, Avenue Presidente Antônio Carlos, 6627, Belo Horizonte, Brazil.|Engineering School, Center for Research and Education in Biomedical Engineering-Pampulha, Belo Horizonte, MG, 31270-901, Brazil.
authors.forename: Rodrigo Gontijo
authors.initials: RG
authors.lastname: Cunha
authors.affiliation: Alberto Luiz Coimbra Institute for Graduate Studies and Research in Engineering, Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Paulo José Guimarães
authors.initials: PJ
authors.lastname: Da-Silva
authors.affiliation: Faculty of Ceilândia, University of Brasília, Brasília, Brazil.
authors.forename: Clarissa Cardoso
authors.initials: CC
authors.lastname: Dos Santos Couto Paz
authors.affiliation: Biomechanics Laboratory of Federal University of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Ana Carolina
authors.initials: AC
authors.lastname: da Silva Ferreira
authors.affiliation: Engineering School, Center for Research and Education in Biomedical Engineering-Pampulha, Belo Horizonte, MG, 31270-901, Brazil. carjulio@peb.ufrj.br.|Alberto Luiz Coimbra Institute for Graduate Studies and Research in Engineering, Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. carjulio@peb.ufrj.br.
authors.forename: Carlos Julio
authors.initials: CJ
authors.lastname: Tierra-Criollo
mesh_terms: D000328:Adult; D000674:Amputees / Q000534:rehabilitation*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D008124:Locomotion / Q000502:physiology; D008297:Male; D008875:Middle Aged; D055815:Young Adult
keywords: Gait; Lower limb amputees; Mental practice; Motor imagery; Rehabilitation