Graded Motor Imagery for Patients Within a Year After Stroke. "GMI"

Recruiting

Phase N/A Results N/A

Trial Description

The aim of the study is to evaluate whether a graded rehabilitation approach including Implicit and explicit motor imagery training and mirror therapy is more effective than other treatments commonly provided in a neuro-rehabilitation department.

Detailed Description

Graded Motor Imagery is a graded approach recently proposed for treating chronic pain patients. It included three subsequent steps:
1. Implicit Motor Imagery training (IMI), using a body part laterality discrimination task
2. Explicit Motor Imagery training, using pictures and videos for improving patient's ability in imagining movements
3. Mirror box therapy, using a 35x40 cm mirror,
We are transferring this approach into stroke rehabilitation in order to improve patients' upper limb motor functions.
All the patients, in both groups, will be training 2 hours a day, 5 days/week for 4 weeks. The first hour is standard treatment, the clinician in charge will decide treatment's priorities and the aim(s) of the treatment for each specific patient. The second hour will be focused on patient's upper limb function.
The treatment group will be treated accordingly to the GMI protocol. The control group will receive a second hour of standard treatment, centred on the upper limb. Standard treatments are decided by the interdisciplinary team and might include motor rehabilitation, bilateral arm training, virtual reality training or occupational therapy.

Conditions

Interventions

  • Graded Motor Imagery Other
    Other Names: GMI
    Intervention Desc: GMI program includes three steps: Implicit Motor Imagery (IMI); Explicit Motor Imagery (EMI) and Mirror Box Therapy (MT). IMI included a training based on Hand Laterality Discrimination Tasks. During these tasks 60 pictures of right and left hands are projected randomly on a 15" screen. Patients are asked to choose whether the images seen are right or left and therefore to click respectively the right or the left button on a mouse. EMI training consists in imagining a movement without actual performing it. It will be introduced during IMI's last two sessions and gradually enhanced increasing the complexity of motor skills to be imagined. The therapist shows or explains in details the movements the patient have to mentally rehearsed. MT treatments will start with simply watching the unaffected hand in the mirror and increased toward functional movement. When possible, gentle movement with the affected hand will be encouraged behind the reflecting part of the mirror.
    ARM 1: Kind: Experimental
    Label: Graded Motor Imagery
    Description: GMI program includes three steps: Implicit Motor Imagery (IMI); Explicit Motor Imagery (EMI) and Mirror Box Therapy (MT). IMI included a training based on Hand Laterality Discrimination Tasks. During these tasks 60 pictures of right and left hands are projected randomly on a 15" screen. Patients are asked to choose whether the images seen are right or left and therefore to click respectively the right or the left button on a mouse. EMI training consists in imagining a movement without actual performing it. It will be introduced during IMI's last two sessions and gradually enhanced increasing the complexity of motor skills to be imagined. The therapist shows or explains in details the movements the patient have to mentally rehearsed. MT treatments will start with simply watching the unaffected hand in the mirror and increased toward functional movement. When possible, gentle movement with the affected hand will be encouraged behind the reflecting part of the mirror.
  • Standard treatment Other
    Intervention Desc: Patients will undergo to a standard treatment, that is thought to be the best option for that specific patients. In our hospital, treatment options include: motor training, functional training, occupational therapy, bilateral arm training or motor treatment using virtual reality devices.
    ARM 1: Kind: Experimental
    Label: Standard treatment
    Description: Patients will undergo to a standard treatment, that is thought to be the best option for that specific patients. In our hospital, treatment options include: motor training, functional training, occupational therapy, bilateral arm training or motor treatment using virtual reality devices.

Trial Design

  • Allocation: Randomized
  • Masking: Double Blind (Subject, Outcomes Assessor)
  • Purpose: Treatment
  • Endpoint: Efficacy Study
  • Intervention: Parallel Assignment

Outcomes

Type Measure Time Frame Safety Issue
Primary Change in Fugl Meyer Assessment Scale (FM) Before and after the 4-weeks treatment No
Primary Change in Reaching Performance Scale (RPS) before and after the 4-weeks treatment No
Secondary Change in Wolf's Motor Function Test (WMFT) before and after the 4-weeks treatment No
Secondary Change in Functional Independence Measure (FIM) before and after the 4-weeks treatment No
Secondary Change in Transcranic Magnetic Stimulation (TMS) before and after the 4-weeks treatment No
Secondary Change in Transcranial Magnetic Stimulation (TMS) before and after the 4-weeks treatment No
Primary Change in Fugl Meyer Assessment Scale for upper extremity (FMA) Before and after the 4-weeks treatment No

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