Efficacy of Graded Motor Imagery in Improving Leg Rotation for Stroke Patients with Hemiplegia: A Randomized Controlled Trial

Article Sidebar

PDF HTML
Published: Sep 2, 2024
DOI: https://doi.org/10.29070/tqtjwb69
Keywords:
Graded Motor Imagery (GMI), Stroke rehabilitation, Hemiplegia, Leg rotation, Lower limb dysfunction, Motor coordination, Neuroplasticity, Randomized Controlled Trial (RCT), LEMOCOT (Lower Extremity Motor Coordination Test), KVIQ-10 (Kinesthetic and Visual Imagery Questionnaire), Chronic stroke, Mirror therapy, Motor imagery, Laterality discrimination, Pain reduction (VAS - Visual Analog Scale), Cortical reorganization, Functional recovery, Task-oriented training, Lesion location (cortical vs. subcortical), Clinical rehabilitation

Main Article Content

Authors

Mohan. N

PhD Scholar, CMJ University, Jorabat, Meghalaya, India

Dr. Ravishankar Ravi

Professor, Department of Physiotherapy, Capital University, Koderma, Jharkhand

Abstract

Background: Chronic stroke survivors often experience persistent lower limb dysfunction, particularly impaired leg rotation, which significantly affects mobility and gait. Graded Motor Imagery (GMI), a neuroscience-based intervention, has shown promise in upper limb rehabilitation but remains understudied for lower limb deficits.


Methods: A single-blind randomized controlled trial allocated 60 chronic stroke patients (>6 months post-stroke) with hemiplegia to GMI (n=30; 3-stage protocol targeting leg rotation) or conventional therapy (n=30; task-oriented lower limb training). Outcomes included the Lower Extremity Motor Coordination Test (LEMOCOT), Kinesthetic and Visual Imagery Questionnaire (KVIQ-10), and pain (VAS) at baseline, post-intervention, and 3-month follow-up.


Results: The GMI group demonstrated significantly greater improvement in LEMOCOT scores (Δ=12.3 points, p<0.001, Cohen’s d=0.89) and KVIQ-10 (Δ=7.8 points, p=0.002) compared to controls. Pain reduction was 38% in GMI versus 10% (p=0.01).


Conclusion: GMI significantly enhances leg rotation and motor imagery ability in chronic stroke patients, with sustained effects at 3 months.

Downloads

Download data is not yet available.

Article Details

Issue

Vol. 21 No. 2 (2024): Journal of Advances in Science and Technology (JAST)

Section

Articles

References

  1. Moseley, G. L. (2006). Graded motor imagery for pathologic pain: A randomized controlled trial. Neurology, 67(12), 2129–2134. https://doi.org/10.1212/01.wnl.0000249112.56935.32
  2. Kwakkel, G., Kollen, B., & Lindeman, E. (2003). Understanding the pattern of functional recovery after stroke: Facts and theories. Restorative Neurology and Neuroscience, 21(3-4), 281–299. https://doi.org/10.3233/RNN-2003-213-416
  3. World Health Organization. (2022). Global report on stroke burden and rehabilitation. https://www.who.int/publications
  4. Bowering, K. J., O'Connell, N. E., Tabor, A., Catley, M. J., Leake, H. B., Moseley, G. L., & Stanton, T. R. (2013). The effects of graded motor imagery and its components on chronic pain: A systematic review and meta-analysis. Journal of Pain, 14(1), 3–13. https://doi.org/10.1016/j.jpain.2012.09.007
  5. Thieme, H., Morkisch, N., Mehrholz, J., Pohl, M., Behrens, J., Borgetto, B., & Dohle, C. (2018). Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews, 7(7), CD008449. https://doi.org/10.1002/14651858.CD008449.pub3
  6. Braun, S. M., Beurskens, A. J., Borm, P. J., Schack, T., & Wade, D. T. (2013). The effects of mental practice in stroke rehabilitation: A systematic review. Archives of Physical Medicine and Rehabilitation, 87(6), 842–852. https://doi.org/10.1016/j.apmr.2006.02.034
  7. Pollock, A., Farmer, S. E., Brady, M. C., Langhorne, P., Mead, G. E., Mehrholz, J., & van Wijck, F. (2014). Interventions for improving upper limb function after stroke. Cochrane Database of Systematic Reviews, 11(11), CD010820. https://doi.org/10.1002/14651858.CD010820.pub2
  8. Tretriluxana, J., Runnarong, N., & Winstein, C. J. (2022). Motor recovery after stroke: Linking neuroplasticity and rehabilitation. Neurorehabilitation and Neural Repair, 36(1), 5–16. https://doi.org/10.1177/15459683211062890
  9. Feigin, V. L., Stark, B. A., Johnson, C. O., Roth, G. A., Bisignano, C., Abady, G. G., & Murray, C. J. L. (2022). Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology, 20(10), 795–820. https://doi.org/10.1016/S1474-4422(21)00252-0
  10. Malouin, F., Jackson, P. L., & Richards, C. L. (2013). Towards the integration of mental practice in rehabilitation programs: A critical review. Frontiers in Human Neuroscience, 7, 576. https://doi.org/10.3389/fnhum.2013.00576
  11. Moseley, G. L., & Butler, D. S. (2020). Explain pain supercharged: The clinician's handbook. Noigroup Publications.
  12. Patterson, K. K., Parafianowicz, I., Danells, C. J., Closson, V., Verrier, M. C., Staines, W. R., & McIlroy, W. E. (2021). Gait asymmetry in community-ambulating stroke survivors. Archives of Physical Medicine and Rehabilitation, 102(3), 429–437. https://doi.org/10.1016/j.apmr.2020.09.388
  13. Page, S. J., Levine, P., & Leonard, A. (2007). Mental practice in chronic stroke: Results of a randomized, placebo-controlled trial. Stroke, 38(4), 1293–1297. https://doi.org/10.1161/01.STR.0000260205.67348.2b
  14. Sharma, N., Pomeroy, V. M., & Baron, J. C. (2006). Motor imagery: A backdoor to the motor system after stroke? Stroke, 37(7), 1941–1952. https://doi.org/10.1161/01.STR.0000226902.43357.fc
  15. Dickstein, R., & Deutsch, J. E. (2007). Motor imagery in physical therapist practice. Physical Therapy, 87(7), 942–953. https://doi.org/10.2522/ptj.20060331
  16. Hétu, S., Grégoire, M., Saimpont, A., Coll, M. P., Eugène, F., Michon, P. E., & Jackson, P. L. (2013). The neural network of motor imagery: An ALE meta-analysis. Neuroscience & Biobehavioral Reviews, 37(5), 930–949. https://doi.org/10.1016/j.neubiorev.2013.03.017
  17. Ietswaart, M., Johnston, M., Dijkerman, H. C., Joice, S., Scott, C. L., MacWalter, R. S., & Hamilton, S. J. (2011). Mental practice with motor imagery in stroke recovery: Randomized controlled trial of efficacy. Brain, 134(5), 1373–1386. https://doi.org/10.1093/brain/awr077
  18. Butler, A. J., & Page, S. J. (2006). Mental practice with motor imagery: Evidence for motor recovery and cortical reorganization after stroke. Archives of Physical Medicine and Rehabilitation, 87(12), 2–11. https://doi.org/10.1016/j.apmr.2006.08.326
  19. Zimmermann-Schlatter, A., Schuster, C., Puhan, M. A., Siekierka, E., & Steurer, J. (2008). Efficacy of motor imagery in post-stroke rehabilitation: A systematic review. Journal of NeuroEngineering and Rehabilitation, 5(1), 8. https://doi.org/10.1186/1743-0003-5-8
  20. Barclay-Goddard, R., Stevenson, T., Poluha, W., Moffatt, M. E., & Taback, S. P. (2004). Force platform feedback for standing balance training after stroke. Cochrane Database of Systematic Reviews, 4, CD004129. https://doi.org/10.1002/14651858.CD004129.pub2
  21. Mehrholz, J., Thomas, S., Werner, C., Kugler, J., Pohl, M., & Elsner, B. (2017). Electromechanical-assisted training for walking after stroke. Cochrane Database of Systematic Reviews, 5, CD006185. https://doi.org/10.1002/14651858.CD006185.pub4
  22. Langhorne, P., Bernhardt, J., & Kwakkel, G. (2011). Stroke rehabilitation. The Lancet, 377(9778), 1693–1702. https://doi.org/10.1016/S0140-6736(11)60325-5
  23. Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., & Zorowitz, R. D. (2016). Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47(6), e98–e169. https://doi.org/10.1161/STR.0000000000000098
  24. Dimyan, M. A., & Cohen, L. G. (2011). Neuroplasticity in the context of motor rehabilitation after stroke. Nature Reviews Neurology, 7(2), 76–85. https://doi.org/10.1038/nrneurol.2010.200
  25. Nilsen, D. M., Gillen, G., & Gordon, A. M. (2010). Use of mental practice to improve upper-limb recovery after stroke: A systematic review. American Journal of Occupational Therapy, 64(5), 695–708. https://doi.org/10.5014/ajot.2010.09034
  26. Harris, J. E., & Eng, J. J. (2010). Strength training improves upper-limb function in individuals with stroke: A meta-analysis. Stroke, 41(1), 136–140. https://doi.org/10.1161/STROKEAHA.109.567438
  27. Veerbeek, J. M., van Wegen, E., van Peppen, R., van der Wees, P. J., Hendriks, E., Rietberg, M., & Kwakkel, G. (2014). What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS ONE, 9(2), e87987. https://doi.org/10.1371/journal.pone.0087987
  28. French, B., Thomas, L. H., Coupe, J., McMahon, N. E., Connell, L., Harrison, J., & Watkins, C. L. (2016). Repetitive task training for improving functional ability after stroke. Cochrane Database of Systematic Reviews, 11, CD006073. https://doi.org/10.1002/14651858.CD006073.pub3
  29. Bernhardt, J., Hayward, K. S., Kwakkel, G., Ward, N. S., Wolf, S. L., Borschmann, K., & Cramer, S. C. (2017). Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce. International Journal of Stroke, 12(5), 444–450. https://doi.org/10.1177/1747493017711816
  30. Cramer, S. C., Sur, M., Dobkin, B. H., O'Brien, C., Sanger, T. D., Trojanowski, J. Q., & Vinogradov, S. (2011). Harnessing neuroplasticity for clinical applications. Brain, 134(6), 1591–1609. https://doi.org/10.1093/brain/awr039