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Title: Motor imagery in neurological rehabilitation
Author: Bovend'Eerdt, Thamar J. H.
ISNI:       0000 0004 2688 561X
Awarding Body: Oxford Brookes University
Current Institution: Oxford Brookes University
Date of Award: 2009
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Background Rehabilitation interventions have been shown to benefit individuals with neurological disorders. More intensive treatments, whilst being expensive on resources, have been observed to attain greater impact. Motor imagery is a promising intervention for use in rehabilitation as it can be used to safely increase treatment dose at low cost. However, motor imagery is a complex intervention and there is limited evidence on the optimal content and delivery of the motor imagery intervention and on the effectiveness of motor imagery in neurological rehabilitation. Methodology/Principal findings A literature review was performed to make an inventory of the content of motor imagery interventions used in neurological rehabilitation. This showed that the interventions were heterogeneous and often poorly described with evidence from other fields rarely implemented. To effectively embed motor imagery in clinical practice it should be client-tailored. The literature review and experiences from a pilot study resulted in a comprehensive client-tailored motor imagery strategy for increasing motor function. Goal attainment scaling is a client-centred outcome measure evaluating the attainment of goals. The attainment of goals can be scored by the clinician but in a randomised controlled trial scoring is preferably performed by an independent person. This thesis, whilst demonstrating low agreement (ICC(A,k)=.478; Limits of Agreement -1.52 ± 24.54) between the clinician and the independent assessor in scoring the goal attainment, found that change scores in goal attainment scaling scored by the Independent assessor were stronger correlated with change scores on the Barthel Index (r=O.36, P=.049) and the Rivermead Mobility Index (r=0.41, P=.025) than the change scores by the clinician. The developed client-tailored motor imagery strategy and goal attainment scaling were employed in a phase II randomised clinical trial which investigated the effectiveness and feasibility of service-delivered motor imagery in neurological rehabilitation. The experimental as well as the control group improved significantly over time (F(2, 27) = 45.159, P=.OOO).The group by time effect was not significant: F(2, 27) = 0.OS5, P=.919 and the main effect of Group was not significant: F(l, 2S) = 0.039, P=.S45. Conclusions/Significance In this thesis a comprehensive motor imagery strategy and a standardisation of the goal attainment scaling method were developed and tested. Although the intervention did not demonstrate statistically significant positive benefits, it also did not show a negative effect, whereas the patients in the motor imagery group employed less physical practice. It does show that the goal attainment scaling method can be used as a client-centred outcome measure in clinical practice and that the motor imagery strategy can be client-tailored and service-delivered.
Supervisor: Sackley, Cath Sponsor: Oxford Brookes University
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral