Is motor imagery effective for gait rehabilitation after stroke?

Stroke is considered a common cause of disability and one of the leading causes of death worldwide. People after a stroke often experience a reduction in walking speed, with low independence in activities of daily living.  In this scenario, rehabilitation interventions and, in particular, restoration of gait pattern help with patient recovery and functioning, improving the quality of life. 


Description of intervention

Motor imagery (MI) is a movement representation technique defined as a mentally rehearsed task in which movement is imagined but not performed. MI for rehabilitation can be external or visual, in which people imagine from a third-person perspective and internal or kinesthetic, where people imagine the sensation of their body moving (first-person perspective). From a neurophysiological point of view, MI activates the mirror neuron system, a class of visuomotor neurons located in the inferior parietal lobule and the premotor cortex, activated during execution or observation of movements. 

MI is considered an easy, safe, and low-cost tool useful to promote reorganization and functional recovery in post-stroke patients.


Key outcomes of the review

The review included 11 studies with 762 people after stroke, ages 50 to 78 years. The primary outcome was the ability to walk, in terms of walking speed, measured by biomechanical analysis and/or walking tests and dependence on personal assistance. Other outcomes were walking endurance (distance covered in meters), motor function, functional mobility, and any possible adverse events related to the treatment (including pain, falls, and all-cause deaths).

All studies compared MI training versus other therapies, and the treatment time for the experimental groups ranged from two to eight weeks.


Authors' conclusion

The authors found very low-certainty evidence regarding the short-term benefits of MI on walking speed, dependence on personal assistance, walking endurance, motor function, and functional mobility in people after stroke compared to other therapies. Moreover, both MI and other therapies included in these studies may not cause significant adverse events, even if it is impossible to assess the certainty of the evidence.


Future recommendations

This review showed some inconsistencies regarding methodology, lacking statistical data and including incomplete intervention descriptions. Moreover, no studies compared MI to placebo or no intervention. Finally, further randomized control trials are needed, aiming to standardize the timing of MI and providing long-term follow-up, to bolster confidence in both the clinical and biological effects of this practice.

Comment by Maria soriano Micò