Anne Durand

The Kinesthetic and Visual Imagery Questionnaire (KVIQ) for assessing motor imagery in persons with physical disabilities: a reliability and construct validity study.

Purpose: To benefit from mental practice training after stroke, one must be able to engage in motor imagery, and thus reliable motor imagery assessment tools tailored to persons with sensorimotor impairments are needed. The aims of this study were to (1) examine the test-retest reliability of the Kinesthetic and Visual Imagery Questionnaire (KVIQ-20) and its short version (the KVIQ-10) in healthy subjects and subjects with stroke, (2) investigate the internal consistency of both KVIQ versions, and (3) explore the factorial structure of the two KVIQ versions. Methods: The KVIQ assesses on a five-point ordinal scale the clarity of the image (visual: V subscale) and the intensity of the sensations (kinesthetic: K subscale) that the subjects are able to imagine from the first-person perspective. Nineteen persons who had sustained a stroke (CVA group) and 46 healthy persons (CTL group) including an age-matched (aCTL: n = 19) control group were assessed twice by the same examiner 10 to 14 days apart. The test-retest reliability was assessed using intraclass correlation coefficients (ICCs). The internal consistency (Cronbach &agr;) and the factorial structure of both KVIQ versions were studied in a sample of 131 subjects. Results: In the CVA group, the ICCs ranged from 0.81 to 0.90, from 0.73 to 0.86 in the aCTL group, and from 0.72 to 0.81 in the CTL group. When imagining movements of the affected and unaffected limbs (upper and lower limbs combined) ICCs in the CVA group ranged, respectively, from 0.71 to.87 and from 0.86 to 0.94. Likewise, when imagining movement of the dominant and nondominant limbs, ICCs in the aCTL group ranged, respectively, from 0.75 to 0.89 and from 0.81 to.92. Cronbach &agr; values were, respectively, 0.94 (V) and 0.92 (K) for the KVIQ-20 and 0.89 (V) and 0.87(K) for the KVIQ-10. The factorial analyses indicated that two factors explained 63.4% and 67.7% of total variance, respectively. Conclusion: Both versions of the KVIQ present similar psychometric properties that support their use in healthy individuals and in persons post-stroke. Because the KVIQ-10 can be administered in half the time, however, it is a good choice when assessing persons with physical disabilities.

Evaluating motor recovery early after stroke: Comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale

This study compared the measurements of the Motor Assessment Scale (MAS) to that of the Fugl-Meyer Assessment (FMA), a reliable and valid test for motor function in stroke patients. Thirty-two patients (20 men, 12 women) with a mean age of 60 years, and a mean time since stroke of 64.5 days, were tested with the FMA and MAS on two consecutive days. The Spearman correlation coefficient for total FMA and total MAS scores was 0.96. For selected items, significant (p < 0.001) correlations ranged from 0.65 to 0.93, except for sitting balance (-0.10). Low negative correlations between sitting balance scores and other items (motor and sensation) were found only for the FMA test, suggesting that the FMA sitting balance test is not valid for measuring balance and is likely responsible for the low correlation. Comparison of scores (normalized in percent of maximal value) for corresponding items of the two instruments also indicated that the FMA measured a higher (Wilcoxon = p < 0.0001) level of motor recovery, (especially in more disabled patients), for both the upper (15.7%) and lower extremities (27.5%). Lastly, a cumulative frequency distribution analysis indicated that a larger proportion of patients was found in the lower class interval scores of the MAS in comparison to the FMA. These results (1) support the concurrent validity of the MAS for measuring motor recovery in acute stroke patients; (2) demonstrate the poor validity of the FMA sitting balance test, and (3) suggest that the FMA scale can better discriminate the level of motor recovery than the MAS in the early stage of recovery or in the more disabled subjects.

Clinical Assessment of Motor Imagery After Stroke

Objective . The aim of this study was to investigate: (1) the effects of a stroke on motor imagery vividness as measured by the Kinesthetic and Visual Imagery Questionnaire (KVIQ-20); (2) the influence of the lesion side; and (3) the symmetry of motor imagery. Methods. Thirty-two persons who had sustained a stroke, in the right (n = 19) or left (n = 13) cerebral hemisphere, and 32 age-matched healthy persons participated. The KVIQ-20 assesses on a 5-point ordinal scale the clarity of the image (visual scale) and the intensity of the sensations (kinesthetic scale) that the subjects are able to imagine from the first-person perspective. Results. In both groups, the visual scores were higher (P = .0001) than the kinesthetic scores and there was no group difference. Likewise, visual scores remained higher than kinesthetic scores irrespective of the lesion side. The visual scores poststroke were higher (P = .001) when imagining upper limb movements on the unaffected side than those on the affected side. When focusing on the lower limb only, however, the kinesthetic scores were higher (P = .001) when imagining movements of the unaffected compared to those on the affected side. Conclusions. The vividness of motor imagery poststroke remains similar to that of age-matched healthy persons and is not affected by the side of the lesion. However, after stroke motor imagery is not symmetrical and motor imagery vividness is better when imagining movements on the unaffected than on the affected side, indicating an overestimation possibly related to a hemispheric imbalance or a recalibration of motor imagery perception.

Reliability of Mental Chronometry for Assessing Motor Imagery Ability After Stroke

OBJECTIVE To examine the reproducibility of 2 chronometric tests: time-dependent motor imagery (TDMI) screening test and temporal congruence test. DESIGN Test-retest 10 to 14 days apart. SETTING Laboratory of a university-affiliated center for research in rehabilitation. PARTICIPANTS Twenty persons post cerebrovascular accident (CVA) and 46 healthy persons (controls). INTERVENTION The reproducibility of the TDMI screening test, wherein the number of stepping movements (performed in sitting) imagined over 15, 25, and 45 seconds is recorded, and of the temporal congruence test wherein the duration of physically executed (E) and imagined (I) stepping movements is recorded, was evaluated. MAIN OUTCOME MEASURES The test-retest reliability of the number of imagined movements (TDMI screening test), movement duration and I/E time ratios (temporal congruence test), and intrasession reliability of the temporal congruence test were assessed by using intraclass correlation coefficients (ICCs). RESULTS For the TDMI screening test, the ICCs ranged from .88 to .93 (CVA, n=20) and from .87 to .92 (controls, n=9). For the temporal congruence test, when the total duration of 2 series of 5 stepping movements was averaged, ICCs ranged from .76 to .97 (CVA, n=20) and from .77 to .93 (controls, n=46), whereas for 1 series the ICCs ranged from .71 to .95 and from .63 to .95 in the CVA and control groups, respectively. The ICCs for intrasession reliability for the CVA (n=20) and control (n=46) groups, respectively, ranged from .90 to .98 and .95 to .97. CONCLUSIONS The present findings support the reproducibility of both tests in both groups. Mental chronometry can be used reliably for the screening of patients capable of motor imagery or for measuring temporal congruence between real and imagined movements poststroke.

Effects of Practice, Visual Loss, Limb Amputation, and Disuse on Motor Imagery Vividness

Background. The ability to generate vivid images of movements is variable across individuals and likely influenced by sensorimotor inputs. Objectives. The authors examined (1) the vividness of motor imagery in dancers and in persons with late blindness, with amputation or an immobilization of one lower limb; (2) the effects of prosthesis use on motor imagery; and (3) the temporal characteristics of motor imagery. Methods. Eleven dancers, 10 persons with late blindness, 14 with amputation, 6 with immobilization, and 2 groups of age-matched healthy individuals (27 in control group A; 35 in control group B) participated. The Kinesthetic and Visual Imagery Questionnaire served to assess motor imagery vividness. Temporal characteristics were assessed with mental chronometry. Results. The late blindness group and dance group displayed higher imagery scores than respective control groups. In the amputation and immobilization groups, imagery scores were lower on the affected side than the intact side and specifically for imagined foot movements. Imagery scores of the affected limb positively correlated with the time since walking with prosthesis. Movement times during imagination and execution (amputation and immobilization) were longer on the affected side than the intact side, but the temporal congruence between real and imagined movement times was similar to that in the control group. Conclusions. The mental representation of actions is highly modulated by imagery practice and motor activities. The ability to generate vivid images of movements can be specifically weakened by limb loss or disuse, but lack of movement does not affect the temporal characteristics of motor imagery.

Normal aging and motor imagery vividness: implications for mental practice training in rehabilitation.

OBJECTIVE To investigate the effects of normal aging on motor imagery vividness and working memory. DESIGN Descriptive study with 3 groups. SETTING Laboratory of a university-affiliated research rehabilitation center. PARTICIPANTS A sample of healthy persons (N=80) divided into 3 age groups: young (26+/-5.0 y), intermediate (53.6+/-5.4 y), and elderly (67.6+/-4.6 y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The kinesthetic and visual imagery scores of the Kinesthetic and Visual Imagery Questionnaire and scores from 3 domains of working memory (visuospatial, kinesthetic, verbal). RESULTS Results revealed that visual motor imagery scores were higher than kinesthetic scores (imagery effect: P=.001); however, there was also a significant imagery x group interaction (P=.017). Post hoc analyses showed that only the young and intermediate groups had higher visual than kinesthetic motor imagery scores (P=.005 and .001, respectively), indicating a loss of visual motor imagery dominance in the elderly group. There was no group effect (P=.963) signifying that the level of motor imagery vividness was comparable between age groups. Significant decreases (17.3% and 22.5%, respectively) in visuospatial working memory scores were found in the intermediate (P=.011) and elderly (P=.001) groups, whereas a significant reduction (P=.01) in kinesthetic working memory scores was observed only in the elderly group (26.7%). There was also an age-related significant decline of visuospatial (r= -.50) and kinesthetic (r=-.34) working memory. CONCLUSIONS The level of motor imagery vividness does not diminish with age, but the quality changes. The dominance of visual motor imagery lessens with aging resulting in motor imagery modality-equivalence. These motor imagery alterations are associated with an age-related decline in visuospatial and kinesthetic working memory.

Added value of mental practice combined with a small amount of physical practice on the relearning of rising and sitting post-stroke: a pilot study.

Background and Purpose: The additional effects of combining mental practice with a small amount of physical practice on the relearning of a motor task post-stroke are unknown. This study investigated the added value of mental practice on the relearning of rising up from a chair and sitting down when combined with a small amount of physical practice. Methods: Twelve individuals with chronic stroke were randomly assigned to one of three groups: a group that combined mental practice with physical practice (MP), a group that combined physical practice with cognitive training (Cog) and a group without training (NOT.). Training was provided three times per week for four weeks, and participants were assessed at baseline, after training, and three weeks later. The vertical forces were recorded under each foot, and the vertical impulse was calculated for five trials and converted in percent of body weight. Results: The MP and Cog groups received the same amount of physical training. Significant gains (P < 0.04) in limb loading found only in the MP group were retained. Larger (P < 0.03) change scores in limb loading for rising up from a chair and sitting down were found in the MP group (median = rising up: 18.4%; sitting down: 12.2%) compared with Cog group (median = rising up: −6.8%; sitting down: 5.4%) and a group without training (median = rising up: 6.2%; sitting down: 5.4%). Conclusion: Combining series of mental repetitions (∼1100 repetitions) with minimal physical repetitions (∼120 repetitions) yielded significant gains and retention of those gains. These preliminary results provide some support to the added value of combining mental repetitions with a small number of physical repetitions to promote the relearning of motor strategies post-stroke and warrant further investigation in clinical trials.

Motor recovery after arthroscopic partial meniscectomy. Analyses of gait and the ascent and descent of stairs.

We studied motor recovery as shown by locomotor activities after arthroscopic partial medial meniscectomies in seventeen men who were twenty-five to forty-nine years old. The patients were evaluated before the operation and two, four, and eight weeks after the operation. Control values were obtained from twenty-two healthy men whose ages, weights, and heights were similar to those of the patients who had had a meniscectomy. Motion of the hip, knee, and ankle in the sagittal plane and the electromyographic activities (as measured with surface electrodes) in five muscles were recorded while each subject walked on a level walkway and then ascended and descended stairs at free speeds. The results showed that meniscal tears affect the motor-control mechanisms involved in the submaximum locomotor activities that were studied and that these abnormalities may persist for as long as eight weeks after a meniscectomy.

Slowing of motor imagery after a right hemispheric stroke.

The temporal congruence between real and imagined movements is not always preserved after stroke. We investigated the dependence of temporal incongruence on the side of the hemispheric lesion and its link with working memory deficits. Thirty-seven persons with a chronic stroke after a right or left hemispheric lesion (RHL : n = 19; LHL : n = 18) and 32 age-matched healthy persons (CTL) were administered a motor imagery questionnaire, mental chronometry and working memory tests. In contrast to persons in the CTL group and LHL subgroup, persons with a RHL had longer movement times during the imagination than the physical execution of stepping movements on both sides, indicating a reduced ability to predict movement duration (temporal incongruence). While motor imagery vividness was good in both subgroups, the RHL group had greater visuospatial working memory deficits. The bilateral slowing of stepping movements in the RHL group indicates that temporal congruence during motor imagery is impaired after a right hemispheric stroke and is also associated with greater visuospatial working memory deficits. Findings emphasize the need to use mental chronometry to control for movement representation during motor imagery training and may indicate that mental practice through motor imagery will have limitations in patients with a right hemispheric stroke.

Amount and Content of Sensorimotor Therapy Delivered in Three Stroke Rehabilitation Units in Quebec, Canada

Purpose: This study creates a baseline clinical portrait of sensorimotor rehabilitation in three stroke rehabilitation units (SRUs) as a first step in implementing a multi-centre clinical research platform. Method: Participants in this cross-sectional, descriptive study were the patients and rehabilitation teams in these SRUs. Prospective (recording of therapy time and content and a Web-based questionnaire) and retrospective (chart audit) methods were combined to characterize the practice of the rehabilitation professionals. Results: The 24- to 39-bed SRUs admitted 100-240 inpatients in the year audited. The mean combined duration of individual occupational and physical therapy was 6.3-7.5 hours/week/patient. When evening hours and the contributions of other professionals as well as group therapy and self-practice were included, the total amount of therapy was 13.0 (SD 3) hours/patient/week. Chart audit and questionnaire data revealed the Berg Balance Scale was the most often used outcome measure (98%-100%), and other outcome measure use varied. Clinicians favoured task-oriented therapy (35%-100%), and constraint-induced movement therapy (0%-15%), electrical stimulation of the tibialis anterior (0%-15%), and body weight-supported treadmill training (0%-1%) were less often used. Conclusions: This study is the first to provide objective data on therapy time and content of stroke rehabilitation in Quebec SRUs.