Hemiparesis, Stroke
Conditions
Keywords
mental practice, motor imagery, hemiparesis, stroke, gait, mobility
Brief summary
Stroke is a neurovascular event characterized by impaired blood supply to the brain due to rupture or obstruction of certain cerebral arteries, which often results in hemiparesis and can affect individuals of any age and sex, being prevalent in the elderly population. Among the main treatments available for stroke rehabilitation, most of them demands an appropriate structure and high-qualified personnel. Searching for more affordable treatment options, several studies suggest the use of mental practice with motor imagery as a potential therapeutic tool, since it can be performed at any place or any time the patient wishes, including their own homes. Motor imagery can be defined as the covert cognitive process of imagining a movement of your own body(-part) without actually moving that body(-part). Within this context, the objective of this study is to investigate the effects of mental practice for mobility, gait function and speed and muscle strength of the lower limb in subacute post-stroke hemiparesis.
Detailed description
Post-stroke patients will be invited to participate after hospital discharge, based on inclusion and exclusion criteria. Then, after acceptance, participants will be randomized (block strategy) into two groups: Control group (Physiotherapy and Cognitive mental exercise) and Intervention group (Physiotherapy and Mental Practice group). At baseline, 4 weeks (end of intervention) and 6 weeks, participants will be evaluated through the following tests: Timed-Up and Go test, 5-Meter Walk Test, TUG-ABS, WHOQOL-Bref, DASS-21 and muscle strength.
Interventions
OTHERMental practice
The sessions will be individualized and carried out in a peaceful setting.The aim of the mental practice protocol was to promote motor imagery of the following activities: get up from a chair and walk and sit, which enrolls the basic and instrumental activities of daily living. The sessions will consist of six steps: (1) Physical Practice (2) Familiarization (3) Memory (4) Relaxation (5) Repeat and (6) post-practice mental relaxation. After the mental practice session, participants will be submitted to individual and structured physiotherapy sessions (the same as the control groups).
OTHERCognitive training and Relaxation
Cognitive training and relaxation session (lasting 30 minutes, three times a week), totaling 12 sessions. The sessions will consist of calculations, memorization, imagination and body relaxation exercises. These sessions will not have any motor imagery. After the cognitive training and relaxation session, participants will be submitted to individual and structured physiotherapy sessions lasting 40 minutes with muscle strengthening and stretching exercises.
Sponsors
Federal University of Juiz de Fora
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 73 Years
Healthy volunteers
No
Inclusion criteria
* hemiparesis after ischemic stroke (15 to 180 days after the event); * only one cerebral hemisphere affected; * no chemical, alcohol or drug dependency; * Score average ≥ 2,5 point in the instrument Visual and Kinesthetic Imagery Questionnaire (KIVQ-10); * No cognitive impairment (18 points in the Mini-Mental State Examination - 0-4 years of educations and 24 points (\>4 years of education); * Not participating in any other type of physiotherapy or physical activity during the study period; * Complaining of difficulty in gait and mobility after stroke; * Able to stand up from a chair and walk some distance with or without auxiliary device;
Exclusion criteria
* Hemorrhagic or ischemic progressing to hemorrhagic stroke; * Score ≥ 4 on the Visual Analogue Pain Scale; * Score ≥ 2 on the modificator Ashworth scale; * Visual disabilities; * Severe Aphasia; * Cardiovascular instability and/or other neurological disorders that may impair the mobility and gait.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Timed Up and Go (TUG) | 1 week before intervention; 4 weeks after intervention; 6 weeks after intervention | This is a measure that examines the participant's basic mobility skills by measuring seconds to rise from sitting, walk 3 meters, return, and sitting down |
| 5-Meter Walk Test | 1 week before intervention; 4 weeks after intervention; 6 weeks after intervention | This is a measure that examines the participant's gait speed (cut off 6 seconds) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Muscle strength | 1 week before intervention; 4 weeks after intervention; 6 weeks after intervention | Hand-held dynamometer (HDD) for measuring lower-limb muscle strength |
| Change in Quality of life | 1 week before intervention; 4 weeks after intervention; 6 weeks after intervention | Using World Health Organization Quality of Life Instrument (WHOQOL-Bref) |
| Change in Mental health | 1 week before intervention; 4 weeks after intervention; 6 weeks after intervention | Using Depression, anxiety and stress scale (DASS-21) |
| Change in TUG-ABS | 1 week before intervention; 4 weeks after intervention; 6 weeks after intervention | The Timed Up and Go Assessment of Biomechanical Strategies (TUG-ABS) |
Countries
Brazil
Outcome results
None listed