Integrated Mental Practice Training Improves Functional Mobility in Chronic Stroke: A Pilot Study

Background and Purpose of the Study: 50%-65% of stroke survivors have residual motor deficits;principal among them is hemi paretic gait that limits mobility, increases the risk of falls and promoting sedentary life style. Motor imagery (MI) an active process during which a specific action is reproduced within working memory without any real movements. There are evidences for MI training in enhancing motor learning, neural reorganization and cortical activation in stroke patients. However efficacy of Mental practice training involving lower extremity mobility tasks are limited in literature. Aim: To investigate the effects of combining mental practice with physical practice on functional mobility in Chronic stroke subjects. Methodology: Quasi Experimental Study design of 12 chronic hemi paretic subjects who can able to ambulate 10 m and good imagery ability in KVIQ20 e” 60 and Time dependent motor imagery screening test were recruited for the study. All Subjects underwent task orientated training for lower extremity 45 min per day and mental practice program for15 minutes for 3 weeks. Results: All the 12 subjects improved in Functional Gait Assessment from median score of 20 to 26 and in Timed Up and Go test from mean score of 56.5 to 45 seconds with the pvalue <.05. Discussion: This improvement can be explained by the principles of motor learning which is divided into 3 stages: cognitive, associative and autonomous stages. The cognitive stage is primarily declarative knowledge and must be interpreted through problem-solving. Participants used comparative information for feedback while comparing their task with that of a normal young adult through a five-stage protocol which includes progressive relaxation, external imagery (analysis of task sequences), problem identification, internal imagery and mental rehearsal. Another theoretical hypothesis is that role of mirror neuron system in humans which facilitates the motor learning. Conclusion: Motor imagery with mental practice provides additional benefits to regular physiotherapy to improve functional mobility in chronic stroke.