Motor Imagery for Prosthetic Gait Training in Transtibial Amputees

Experimental: Pre VESSA

Participants attended the motor imagery training prior to beginning actual temporary prosthetic (VESSA) training

Comportamental: Motor Imagery

The motor imagery intervention aimed to: (1) introduce rationale, mechanisms of action, and advantages of MI; (2) facilitate kinesthetic and functional familiarization with the prosthesis; and (3) enhance prosthetic gait, weight-bearing, balance and turning.

The protocol followed MI paradigms and methodologies (e.g., combining visual and kinesthetic modalities), including the PETTLEP model that was previously used in amputees. The MI contents addressed movement range of motion, quality, timing, and lower extremity and whole-body intersegmental coordination with motor tasks serving as outcome measures not being explicitly practiced.

The following components were included:

1. Introduction to MI- definition, mechanisms of effect, advantages, modalities, and perspectives.
2. Acquaintance with and embodiment of the stump, MI of the prosthesis and MI of the stump-prosthesis interaction (e.g., contact area, pressure).
3. Weight bearing and shifting during sit-to-stand, standing and gait.

Outros nomes:

• Imagens Mentais
• Motor Imagery Practice

Experimental: With VESSA

Participants attended the motor imagery training alongside actual temporary prosthetic (VESSA) training

Comportamental: Motor Imagery

The motor imagery intervention aimed to: (1) introduce rationale, mechanisms of action, and advantages of MI; (2) facilitate kinesthetic and functional familiarization with the prosthesis; and (3) enhance prosthetic gait, weight-bearing, balance and turning.

The protocol followed MI paradigms and methodologies (e.g., combining visual and kinesthetic modalities), including the PETTLEP model that was previously used in amputees. The MI contents addressed movement range of motion, quality, timing, and lower extremity and whole-body intersegmental coordination with motor tasks serving as outcome measures not being explicitly practiced.

The following components were included:

1. Introduction to MI- definition, mechanisms of effect, advantages, modalities, and perspectives.
2. Acquaintance with and embodiment of the stump, MI of the prosthesis and MI of the stump-prosthesis interaction (e.g., contact area, pressure).
3. Weight bearing and shifting during sit-to-stand, standing and gait.

Outros nomes:

• Imagens Mentais
• Motor Imagery Practice

Feasibility: Participants' Recruitement

The actual number of participants successfully recruited for each group

Feasiblity: Safety

The lack of adverse events or negative effects throughout the intervention.

Feasibility: Compliance

The percentage of MI sessions successfully complated by participants

Feasibility: Participants' Feedback

Opinions and insights expressed by the participants about the intervention.

Amputee Mobility Predictor

A functional assessment of mobility level for determining the appropriate prosthetic prescription. The test consists of 21 daily living functional motor tasks (e.g., turning, sitting down, and walking over an obstacle). Scores are "0" ('inability to perform the task'), "1" ('minimal level of achievement or that some assistance was required in completing the task'), or "2" ('complete independence or mastery of the task'). A higher score indicates a greater level of prosthesis function.

Daily Functioning Ability Test

An 18-item test for assessing patients' daily functioning inside and outside the hospital ward. Each item is rated on a 7-point scale, with higher scores representing less assistance needed by the patient. Scoring categories are: fully independent (109-126), independent with assistance devices (91-108), requiring supervision (73-90), requiring assistance (37-72), and fully dependent (nursing care; 18-36). Higher scores mean a better outcome.

Timed Up and Go

A functional test for quantifying functional mobility. The participants are asked to rise from a chair, walk 3 meters, turn around an obstacle, and return to take a seat as quickly and safely as possible. The average time (in seconds) of two trials was recorded using a stopwatch. Lower scores mean a better outcome.

Ten-meter Walk Test

A functional test for assessing early gait after amputation. The time (in seconds) for completing a ten-meter forward walk was recorded.

Prosthesis Embodiment Scale of Lower Limb Amputees

A 10-item questionnaire for assessing perceptual correlates of successful body-prosthesis interaction (i.e., acceptance). Scores for each item are on a 7-point Likert scale ranging from "-3" ('strongly disagree') to "+3" ('strongly agree'). Higher scores mean better outcome (i.e., higher prosthesis embodiment).

McGill Pain Questionnaire-Short Form

A 17-item self-administered questionnaire for assessing pain, including post amputation pain. The questionnaire includes three sections: pain visual analog scale (VAS; 0-10 scale), pain intensity index (PPI; 0-5 scale), and total McGill score (0-45 scale). Higher scores mean worse outcome (i.e., higher levels of pain).

Kinesthetic Visual Imagery Questionnaire

A 5-item questionnaire for assessing MI clarity (visual subscale) and intensity (kinesthetic subscale) of motor tasks, including the amputated ('affected') and intact ('unaffected') . Scores range between "1" ('no image at all') and "5" ('image as clear as seeing'). Higher scores mean a better outcome.