Motor imagery group practice for gait rehabilitation in individuals with post-stroke hemiparesis: a pilot study.

BACKGROUND: Stroke is the leading cause of adult disability, with walking impairment being a devastating indicator of chronic post-stroke hemiparesis. Limited resources exist for individual treatments; therefore, the delivery of safe group exercise therapy is highly desired. OBJECTIVE: To examine whether the application of group-based motor imagery practice to community-dwelling individuals with chronic hemiparesis improves gait. METHODS: Sixteen individuals with chronic hemiparesis from two community centers participated in the study, with eight from each center. Four participants in each center received five weeks of the experimental intervention, consisting of group-based motor imagery exercises of gait tasks, followed by five weeks of control treatment of motor imagery exercises for the affected upper extremity. Four other subjects in each center received the same treatments in reverse order. Pre- and post intervention measurements included clinical and biomechanical gait parameters. RESULTS: Comparisons within (pre- vs. post) and between treatments (experimental vs. control) indicated no significant change in any gait variable. Nevertheless, the verbal reports of most participants alluded to satisfaction with the experimental intervention and to an increase in self-confidence. CONCLUSIONS: Despite the lack of evidence for the effectiveness of group-based motor imagery practice in improving gait among individuals with chronic hemiparesis, the contrast between the measured outcomes and the positive verbal reports merits further inquiry.

Weight bearing on the affected lower limb in residents of a geriatric rehabilitation hospital.

OBJECTIVES: The purpose of the study was to determine whether and to what extent the treatment goal of enhancement of weight bearing on an affected lower limb is achieved in the gait rehabilitation of patients with poststroke hemiparesis, postprosthetic fitting due to unilateral transtibial amputation, or postunilateral hip or knee arthroplasty. DESIGN: Nonrandomized prepost study. Subjects were 26 residents of a geriatric rehabilitation hospital in the initial stage of gait rehabilitation after poststroke hemiparesis (n = 9), unilateral total hip or knee joint replacement (n = 11), or unilateral transtibial amputation with a fitted prosthesis (n = 6). Weight bearing on the hindfoot and forefoot of the affected limb was measured by using the SmartStep system version 2.2.0, at least once a week, both before and immediately after a gait-training session. Measurements were performed with the patients using their assistive devices. RESULTS: In the patients with hemiparesis, there was no significant difference found between the initial pretraining maximal weight bearing on the afflicted limb (39% and 50% of body weight on the hindfoot and forefoot, respectively) and that at discharge (47% and 50% of body weight, respectively). In patients after hip or knee arthroplasty and in those who underwent prosthetic fitting, there was a substantial increase found in the loading of the forefoot, but not of the hindfoot, from the initial evaluation to the time of discharge (from 43% to 54% of body weight, P = 0.05, in the arthroplasty group, and from 49.6% to 69.5%, P = 0.09, in the prosthetic group). CONCLUSIONS: For elderly individuals belonging to the studied diagnostic groups, the goal of enhancing normal weight bearing on the afflicted limb during the time course of 2-3 wks might be unrealistic.

Coronary artery disease and risk factors in people with posttraumatic vision loss.

OBJECTIVE: To examine the prevalence of coronary artery disease (CAD) and its risk factors in people with posttraumatic vision loss (PTVL). DESIGN: Cross-sectional, controlled study. SETTING: The general community. PARTICIPANTS: Study groups included 82 subjects with PTVL, 49 siblings, 58 blind subjects with retinitis pigmentosa (RP), and the general population in Israel. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sociodemographic and biomedical data collected by using a structured questionnaire and medical records. RESULTS: The prevalence of CAD among subjects with PTVL (24%) was 2 to 3 times higher than the control groups ( P <.001). However, the prevalence of the CAD risk factors in these subjects was similar to or lower than those in the control groups. For example, significantly fewer subjects with PTVL were physically inactive (16%) than patients with RP (55%, P <.01). The only variable that was significantly associated with CAD prevalence was the cause of blindness-that is, trauma versus disease; the odds of having CAD after traumatic vision loss was 3.75 times higher than after RP. CONCLUSIONS: People with PTVL exhibit elevated rates of risk for CAD similar to those of other groups with physical disability. The traumatic injury that caused vision loss might be an important factor underlying that risk.