Article

This case report describes the clinical reasoning
process used to examine a person after stroke and intervene with a novel
integrated motor imagery treatment designed for the rehabilitation of walking and
delivered in the home through telerehabilitation. The integrated motor imagery
treatment consisted of patient-centered goal setting and physical practice
combined with motor and motivational imagery. CASE DESCRIPTION: /b> The patient
was a 38-year-old woman who had had a diffuse left subarachnoid hemorrhagic
stroke 10 years earlier. She lived independently in an assisted living complex
and carried a straight cane during long walks or in unfamiliar environments.
Examination revealed a slow gait speed, reduced walking endurance, and decreased
balance confidence. Although she was in the chronic phase, patient-centered
integrated motor imagery was predicted to improve her community mobility.
Treatment sessions of 45 to 60 minutes were held 3 times per week for 4 weeks.
The practiced tasks included transitioning from sitting to standing, obstacle
clearance, and navigation in interior and exterior environments; these tasks were
first executed and then imagined at ratios of 1:5. Task execution allowed the
creation of a scene based on movement observation. Imagery scenarios were
customized to address the patient's goals and observed movement problems.
Motivational elements of arousal, problem solving, and reward were embedded in
the imagery scenarios. Half of the sessions were provided on site, and the
remaining sessions were delivered remotely. Seven sessions were delivered by the
clinician in the home, and 5 sessions were delivered using telerehabilitation.
OUTCOMES: /b> Improvements in motor imagery ability, gait parameters, and balance
were observed after training. Most gains were retained at the 3-month follow-up.
Compared with on-site delivery, the telerehabilitation sessions resulted in less
therapist travel time and cost, as well as shorter therapy sessions. DISCUSSION:
/b> The delivery of integrated motor imagery practice for walking recovery was
feasible both on site and remotely.

Langue : ANGLAIS