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Motor Imagery for Gait Rehabilitation After Stroke

2021; Lippincott Williams & Wilkins; Volume: 52; Issue: 6 Linguagem: Inglês

10.1161/strokeaha.120.033098

1524-4628

Stephano Tomaz da Silva, Lorenna Raquel Dantas de Macedo Borges, Lorenna Marques de Melo Santiago, Larissa Coutinho de Lucena, Ana Raquel Rodrigues Lindquist, Tatiana Souza Ribeiro,

Sport Psychology and Performance

HomeStrokeVol. 52, No. 6Motor Imagery for Gait Rehabilitation After Stroke Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyRedditDiggEmail Jump toFree AccessReview ArticlePDF/EPUBMotor Imagery for Gait Rehabilitation After Stroke Stephano Tomaz da Silva, MS, Lorenna Raquel Dantas de Macedo Borges, PhD, Lorenna Marques de Melo Santiago, PhD, Larissa Coutinho de Lucena, PhD, Ana Raquel Rodrigues Lindquist, PhD and Tatiana Souza Ribeiro, PhD Stephano Tomaz da SilvaStephano Tomaz da Silva Correspondence to: Stephano Tomaz da Silva, MS, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil. Email E-mail Address: [email protected] https://orcid.org/0000-0002-4537-516X Department of Physical Therapy (S.T.d.S., L.R.D.d.M.B., L.M.d.M.S., L.C.d.L.), Federal University of Rio Grande do Norte, Natal, Brazil. , Lorenna Raquel Dantas de Macedo BorgesLorenna Raquel Dantas de Macedo Borges Department of Physical Therapy (S.T.d.S., L.R.D.d.M.B., L.M.d.M.S., L.C.d.L.), Federal University of Rio Grande do Norte, Natal, Brazil. , Lorenna Marques de Melo SantiagoLorenna Marques de Melo Santiago Department of Physical Therapy (S.T.d.S., L.R.D.d.M.B., L.M.d.M.S., L.C.d.L.), Federal University of Rio Grande do Norte, Natal, Brazil. , Larissa Coutinho de LucenaLarissa Coutinho de Lucena https://orcid.org/0000-0002-1739-5737 Department of Physical Therapy (S.T.d.S., L.R.D.d.M.B., L.M.d.M.S., L.C.d.L.), Federal University of Rio Grande do Norte, Natal, Brazil. , Ana Raquel Rodrigues LindquistAna Raquel Rodrigues Lindquist https://orcid.org/0000-0001-9628-7891 PhD Program in Physical Therapy (A.R.R.D., T.S.R.), Federal University of Rio Grande do Norte, Natal, Brazil. and Tatiana Souza RibeiroTatiana Souza Ribeiro https://orcid.org/0000-0002-9611-1076 PhD Program in Physical Therapy (A.R.R.D., T.S.R.), Federal University of Rio Grande do Norte, Natal, Brazil. Originally published24 May 2021https://doi.org/10.1161/STROKEAHA.120.033098Stroke. 2021;52:e272–e273Stroke is the second highest cause of disability. Motor imagery (MI) was initially used to improve athletic performance and has subsequently been suggested to rehabilitate people with stroke to promote motor relearning.ObjectivesTo assess the treatment effects of MI for enhancing ability to walk among people following stroke.MethodsSearch MethodsWe searched the Cochrane Stroke Group registry, CENTRAL, MEDLINE, Embase, and 7 other databases. We also searched trial registries and reference lists. The last searches were conducted on February 24, 2020.Selection CriteriaRandomized controlled trials using MI alone or associated with action observation or physical practice to improve gait in individuals after stroke were included. The critical outcome was the ability to walk, assessed using either a continuous variable (walking speed) and a dichotomous variable (dependence on personal assistance). Important outcomes included walking endurance, motor function, functional mobility, and adverse events.Data Collection and AnalysisTwo review authors independently selected the trials according to predefined inclusion criteria, extracted the data, assessed the risk of bias, and applied the GRADE approach to evaluate the certainty of the evidence. The review authors contacted the study authors for clarification and missing data.Main ResultsWe included 21 studies with 762 participants. All studies compared MI training versus other therapies. Most of the included studies used MI associated with physical practice in the experimental groups.Critical OutcomeWe did not include the dichotomous variable dependence on personal assistance in the meta-analysis, because only 1 study provided information about the number of dependent or independent participants after interventions. Thus, the ability to walk was assessed only as a continuous variable (walking speed). There was very low-certainty evidence that MI was more beneficial for improving gait (walking speed) compared with other therapies at the end of the treatment (6 studies with 191 participants) (standardized mean difference, 0.44 [95% CI, 0.06–0.81]; P=0.02; see the Figure).Download figureDownload PowerPointFigure. Motor imagery therapy vs other therapies (control): effect on ability to walk (walking speed), immediately after intervention.Important OutcomesThere was very low-certainty evidence that MI was no more beneficial than other interventions for improving motor function (3 studies with 130 participants; mean difference 2.24 [95% CI, −1.20 to 5.69]; P=0.20) and functional mobility at the end of the treatment (4 studies with 116 participants; standardized mean difference, 0.55 [95% CI, −0.45 to 1.56]; P=0.09). No adverse events related to MI and other therapies were observed. We were unable to pool data about walking endurance and all other outcomes at follow-up.Authors' ConclusionsMI may provide short-term benefits on gait (ie, walking speed) compared with other therapies. About motor function and functional mobility, MI was not more beneficial than other therapies.We only found studies comparing the effects of MI to other therapies, so it was impossible to generalize our results to comparisons between MI and placebo or no treatment. Because of the lack of follow-up data, only data related to the immediate posttreatment effects of MI were analyzed. Therefore, it was impossible to reach any conclusion about the potential medium or longer-term (follow-up) effects of MI.There was heterogeneity in the application of MI in the studies, mainly in terms of the type of MI (visual or kinesthetic), treatment dose, and additional therapies. Most of the included studies used MI and physical practice in the experimental groups, in addition, it was also used action observation, physical activity, or functional gait training. Physical practice was the most often applied therapy in the comparison groups (controls), in addition, it was also used mirror therapy, muscle relaxation, neuromuscular electrical stimulation, drug treatment and physical practice, etc.Further randomized controlled trials are needed with greater methodological rigor to reduce the risk of bias, and larger samples are needed to increase the accuracy of the clinical findings.This article is based on a Cochrane Review published in The Cochrane Library 2020, Issue 9 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.1Sources of FundingThis work was supported in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES) (Financial code 001). The authors declare no competing financial interests or personal relationships influencing this article.Disclosures None.FootnotesFor Sources of Funding and Disclosures, see page e273.Correspondence to: Stephano Tomaz da Silva, MS, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil. Email stephano.[email protected]comReferences1. Silva S, Borges LRDM, Santiago L, Lucena L, Lindquist AR, Ribeiro T. Motor imagery for gait rehabilitation after stroke.Cochrane Database Syst Rev. 2020; 9:CD013019. doi: 10.1002/14651858.CD013019.pub2.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetails June 2021Vol 52, Issue 6Article InformationMetrics © 2021 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.120.033098 Originally publishedMay 24, 2021 Keywordsrehabilitationdata collectiongaitwalkingregistriesPDF download Advertisement SubjectsCerebrovascular Disease/Stroke