BackgroundMental practice (MP) through motor imagery is a cognitive training strategy used to improve locomotor skills during rehabilitation programs. Recent works have used MP tasks to investigate the neurophysiology of human gait; however, its effect on functional performance has not been evaluated. In the present study, the influence of gait-oriented MP tasks on the rehabilitation process of gait in transtibial amputees was investigated by assessing the vertical (V), anterior-posterior (AP), and medio-lateral (ML) ground reaction forces (GRFs) and the time duration of the support phase of the prosthetic limb.MethodsUnilateral transtibial amputees, who were capable of performing motor imagination tasks (MIQ-RS score ≥4), were randomly divided into two groups: Group A (n = 10), who performed functional gait-oriented MP combined with gait training, and Group B (n = 5), who performed non-motor task MP. The MP intervention was performed in the first-person perspective for 40 min, 3 times/week, for 4 weeks. The GRF outcome measures were recorded by a force platform to evaluate gait performance during 4 distinct stages: at baseline (BL), 1 month before the MP session; Pre-MP, 1–3 days before the MP session; Post-MP, 1–3 days after the MP session; and follow-up (FU), 1 month after MP session. The gait variables were compared inter- and intra-group by applying the Mann-Whitney and Friedman tests (alpha = 0.05).ResultsAll volunteers exhibited a homogenous gait pattern prior to MP intervention, with no gait improvement during the BL and Pre-MP stages. Only Group A showed significant improvements in gait performance after the intervention, with enhanced impact absorption, as indicated by decreased first V and AP peaks; propulsion capacity, indicated by increasing second V and AP peaks; and balance control of the prosthetic limb, indicated by decreasing ML peaks and increasing duration of support. This gait pattern persisted until the FU stage.ConclusionsMP combined with gait training allowed transtibial amputees to reestablish independent locomotion. Since the effects of MP were preserved after 1 month, the improvement is considered related to the specificity of the MP tasks. Therefore, MP may improve the clinical aspect of gait rehabilitation when included in a training program.

The well-known multivariate technique Principal Components Analysis (PCA) is usually applied to a sample, and so component scores are subjected to sampling variability. However, few studies address their stability, an important topic when the sample size is small. This work presents three validation procedures applied to PCA, based on confidence regions generated by a variant of a nonparametric bootstrap called the partial bootstrap: (i) the assessment of PC scores variability by the spread and overlapping of “confidence regions” plotted around these scores; (ii) the use of the confidence regions centroids as a validation set; and (iii) the definition of the number of nontrivial axes to be retained for analysis. The methods were applied to EEG data collected during a postural control protocol with twenty-four volunteers. Two axes were retained for analysis, with 91.6% of explained variance. Results showed that the area of the confidence regions provided useful insights on the variability of scores and suggested that some subjects were not distinguishable from others, which was not evident from the principal planes. In addition, potential outliers, initially suggested by an analysis of the first principal plane, could not be confirmed by the confidence regions.

In this work, the effect of a dynamic visual stimulation (DS) protocol was used to induce egomotion, the center of pressure (COP) displacement response. Methods: DS was developed concerning the scenario structure (chessboard-pattern floor and furniture) and luminance. To move the scenario in a discrete forward (or backward) direction, the furniture is expanded (or reduced) and the black and white background is reversed during floor translation while the luminance is increased (or reduced) by steps of 2 cd/m 2. This protocol was evaluated using COP signals from 29 healthy volunteers: standing on a force platform observing the virtual scene (1.72 × 1.16 m) projected 1 m ahead (visual incidence angle: θl = 81.4° and θv = 60.2°), which moves with constant velocity (2 m/s) during 250 ms. A set of 100 DS was applied in random order, interspersed by a 10 s of static scene. Results: The Tukey post-hoc test (p < 0.001) indicated egomotion in the same direction of DS. COP displacement increased over stimulation (8.4 ± 1.7 to 22.6 ±5.3 mm), as well as time to recover stability (4.1 ± 0.4 to 7.2 ± 0.6 s). The peak of egomotion during DS F occurred 200 ms after DS B (Wilcoxon, p = 0.002). Conclusion: The dynamic configuration of this protocol establishes virtual flow effects of linear egomotion dependent on the direction of the dynamic visual stimulation. This finding indicates the potential application of the proposed virtual dynamic stimulation protocol to investigate the cortical visual evoked response in postural control studies.

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