Effect of Integrated Mental Practice on Post-stroke Gait and Self Efficacy

描述(申请人提供)：中风患者有大量的长期残疾，特别是在行走方面。运动和动机表象(“综合心理练习”)是一种安全和廉价的锻炼程序，可以提高自我效能感和运动表现。这项拟议研究的目标是对因偏瘫导致行走障碍的社区居住的中风患者实施并测试综合心理实践干预的结果。PI假设，将这种综合心理练习计划应用于中风后个人将(1)提高步速和社区行走，(2)提高与跌倒相关的自我效能感。实验干预包括使用视觉表象和动觉表象的行走任务的运动表象练习；视觉表象任务将与动机表象策略相结合。随机化后，接受四周表象训练的试验组将与接受上肢锻炼的对照组进行比较。随后，在间隔两周后，对照组患者也将接受为期四周的实验性治疗。主要结果将是步行速度、社区步行能力和跌倒效果，在干预前、中期、干预后和两周随访时进行测试。这项建议利用了一名以色列研究人员和她的团队的专业知识，通过与经验丰富的美国团队进行独特而实际的干预。其目标是将该项目转移到美国，并最终开发一项以美国为基础的更大规模的随机对照RO1研究，以检查中风后个体的综合表象训练的结果和机制。 与公共卫生的相关性：中风后的个人通常被限制在自己的家中，或者在社区中活动有限。步态速度减慢以及与摔倒相关的自我效能感低是这些人行动不便和生活方式受限的主要原因。一旦个人进入他们的社区，也缺乏康复选择。在这项可行性研究中，私人投资者建议使用以家庭为基础的自我练习运动和动机意象，以增强自信，防止恶化，并促进运动和功能能力的恢复。

DESCRIPTION (provided by applicant): Stroke patients have substantial long term disability, particularly in walking. Motor and motivational imagery ("Integrated mental practice") is a safe and inexpensive exercise routine for improving self efficacy and motor performance. The goals of the proposed study are to implement and test the outcomes of an integrated mental practice intervention to community dwelling individuals with stroke who are walking-impaired due to hemiparesis. The PIs hypothesize that the application of this integrated mental practice program to individuals post-stroke will (1) improve gait speed and community walking, and (2) enhance fall related self efficacy. The experimental intervention will be composed of motor imagery practice of ambulatory tasks using both visual and kinesthetic imagery; visual imagery tasks will be coupled with motivational imagery strategies. Following randomization, an experimental group receiving four weeks of imagery training will be compared with controls receiving upper extremity exercises. Subsequently, following a two week interval, the control patients will also receive the four-week experimental treatment. The main outcomes will be walking speed, community walking performance and fall efficacy, tested before the intervention, at midterm, post-intervention, and at two weeks follow-up. This proposal leverages the expertise of an Israeli researcher and her team using a unique and practical intervention with an experienced U.S. team. The goal is to transfer the program to the U.S. and eventually develop a larger scale U.S.-based randomized controlled RO1 study to examine outcomes as well as mechanisms of integrated imagery training for individuals post-stroke. Relevance to Public Health: Individuals post-stroke are often confined to their homes or have only limited mobility in the community. Decreased gait speed as well as low fall-related self efficacy are major causes of immobility and restricted life style in these individuals. There is also a shortage of rehabilitation options once individuals are in their communities. In this feasibility study the PIs propose the use of a home based self practice of motor and motivational imagery to enhance self confidence, prevent deterioration and facilitate the restoration of motor and functional abilities.