Abstract
With Motor imagery (MI), movements are mentally rehearsed without overt actions; this procedure has been adopted in motor rehabilitation, primarily in brain-damaged patients. Here we rather tested the clinical potentials of MI in purely orthopaedic patients who, by definition, should maximally benefit of mental exercises because of their intact brain. To this end we studied the recovery of gait after total knee arthroplasty and evaluated whether MI combined with physiotherapy could speed up the recovery of gait and even limit the occurrence of future falls. We studied 48 patients at the beginning and by the end of the post-surgery residential rehabilitation program: half of them completed a specific MI training supported by computerized visual stimulation (experimental group); the other half performed a non-motoric cognitive training (control group). All patients also had standard physiotherapy. By the end of the rehabilitation, the experimental group showed a better recovery of gait and active knee flexion-extension movements, and less pain. The number of falls or near falls after surgery was significantly lower in the experimental group. These results show that MI can improve gait abilities and limit future falls in orthopaedic patients, without collateral risks and with limited costs.
Highlights
With Motor imagery (MI), movements are mentally rehearsed without overt actions; this procedure has been adopted in motor rehabilitation, primarily in brain-damaged patients
Between group-analysis conducted on the delta measure of the time needed for the Timed up and go (TUG) execution showed a significant effect of Group [t(46) = 2.07, p = 0.04, Cohen’s d = 0.59]: this indicates a greater decrease of the time needed to perform the TUG in the experimental group
Motor imagery training, added to conventional physical rehabilitation, can improve gait and limit new falls in the long term in patients with recent Total knee arthroplasty (TKA) in the post-surgery acute phase, when practical limitations and increased perceived pain can limit the applicability of direct physical training
Summary
With Motor imagery (MI), movements are mentally rehearsed without overt actions; this procedure has been adopted in motor rehabilitation, primarily in brain-damaged patients. Post-surgery rehabilitation typically consists of physical therapy aimed at mechanically restoring the functionality of the musculoskeletal system and gait abilities, by integrating passive and active limb movements[2] Both osteoarthritis and the immobilization and pain after surgery induce a motor impairment that is associated with changes in the activation of motor brain circuits. We found similar results in patients with knee osteoarthritis, whose gait motor imagery (MI) was impoverished and associated with reduced activation of gait motor brain circuits[4,5] These findings suggest that training based on MI may complement standard physical therapy after orthopaedic surgery, to restore gait motor representations, speeding up rehabilitation. Patients with purely orthopaedic problems should maximally benefit of mental exercises based on MI because of their intact brains
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