Influence of functional task-oriented mental practice on the gait of transtibial amputees: a randomized,clinical trial

Background: mental practice (mp) through motor imagery is a cognitive training strategy used to improve locomotor skills during rehabilitation programs. recent works have used mp tasks to investigate the neurophysiology of human gait; however,its effect on functional performance has not been evaluated. in the present study,the influence of gait-oriented mp tasks on the rehabilitation process of gait in transtibial amputees was investigated by assessing the vertical (v),anterior-posterior (ap),and medio-lateral (ml) ground reaction forces (grfs) and the time duration of the support phase of the prosthetic limb. methods: unilateral transtibial amputees,who were capable of performing motor imagination tasks (miq-rs score ≥4),were randomly divided into two groups: group a (n = 10),who performed functional gait-oriented mp combined with gait training,and group b (n = 5),who performed non-motor task mp. the mp intervention was performed in the first-person perspective for 40 min,3 times/week,for 4 weeks. the grf outcome measures were recorded by a force platform to evaluate gait performance during 4 distinct stages: at baseline (bl),1 month before the mp session; pre-mp,1-3 days before the mp session; post-mp,1-3 days after the mp session; and follow-up (fu),1 month after mp session. the gait variables were compared inter- and intra-group by applying the mann-whitney and friedman tests (alpha = 0.05). results: all volunteers exhibited a homogenous gait pattern prior to mp intervention,with no gait improvement during the bl and pre-mp stages. only group a showed significant improvements in gait performance after the intervention,with enhanced impact absorption,as indicated by decreased first v and ap peaks; propulsion capacity,indicated by increasing second v and ap peaks; and balance control of the prosthetic limb,indicated by decreasing ml peaks and increasing duration of support. this gait pattern persisted until the fu stage. conclusions: mp combined with gait training allowed transtibial amputees to reestablish independent locomotion. since the effects of mp were preserved after 1 month,the improvement is considered related to the specificity of the mp tasks. therefore,mp may improve the clinical aspect of gait rehabilitation when included in a training program. © 2017 the author(s).