Towards efficient motor imagery interventions after lower-limb amputation.

BACKGROUND: The therapeutic benefits of motor imagery (MI) are now well-established in different populations of persons suffering from central nervous system impairments. However, research on similar efficacy of MI interventions after amputation remains scarce, and experimental studies were primarily designed to explore the effects of MI after upper-limb amputations. OBJECTIVES: The present comparative study therefore aimed to assess the effects of MI on locomotion recovery following unilateral lower-limb amputation. METHODS: Nineteen participants were assigned either to a MI group (n = 9) or a control group (n = 10). In addition to the course of physical therapy, they respectively performed 10 min per day of locomotor MI training or neutral cognitive exercises, five days per week. Participants' locomotion functions were assessed through two functional tasks: 10 m walking and the Timed Up and Go Test. Force of the amputated limb and functional level score reflecting the required assistance for walking were also measured. Evaluations were scheduled at the arrival at the rehabilitation center (right after amputation), after prosthesis fitting (three weeks later), and at the end of the rehabilitation program. A retention test was also programed after 6 weeks. RESULTS: While there was no additional effect of MI on pain management, data revealed an early positive impact of MI for the 10 m walking task during the pre-prosthetic phase, and greater performance during the Timed Up and Go Test during the prosthetic phase. Also, a lower proportion of participants still needed a walking aid after MI training. Finally, the force of the amputated limb was greater at the end of rehabilitation for the MI group. CONCLUSION: Taken together, these data support the integration of MI within the course of physical therapy in persons suffering from lower-limb amputations.

Efficacy of mental practice on paralyzed upper extremity function in the acute phase of stroke: a case study.

[Purpose] Mental practice (MP) is a method of rehabilitating upper extremity function on the affected side of the body post-stroke, with the aim of improving motor task performance through the sustained repetition of motor imagery (MI). However, most studies thus far have investigated MP for post-stroke paralytic upper limb function in patients in the chronic phase. Therefore, it is necessary to obtain evidence regarding whether MP is an effective intervention modality in the acute phase of stroke. In the present study, we examined the effects of an intervention combining mirror therapy and MP initiated during the acute phase of cerebral infarction. [Participant and Methods] A female patient >80 years of age with a cerebral infarction was studied. Prior to cerebral infarction, the patient was independent in her activities of daily living. [Results] As a result of MP, sufficient improvement was observed in the upper extremity function on the paralyzed side, as assessed using the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL). [Conclusion] In patients with MP initiated during the acute stroke phase, a combination of mirror therapy and action observation to enable vivid MI may elicit a more significant intervention effect.

Timing-specific patterns of cerebral activations during motor imagery: A case study of the expert brain signature.

Brain activations elicited during motor imagery (MI) in experts are typically reduced compared to novices, which is interpreted as a neurophysiological correlate of increased neural efficiency. However, the modulatory effects of MI speed on expertise-related differences in brain activation remains largely unknown. In the present pilot study, we compared the magnetoencephalographic (MEG) correlates of MI in an Olympic medallist and an amateur athlete under conditions of slow, real-time and fast MI. Data revealed event-related changes in the time course of alpha (8-12 Hz) power of MEG oscillations, for all timing conditions. We found that slow MI was associated with a corollary increase in neural synchronization, in both participants. Sensor-level and source-level analyses however disclosed differences between the two expertise levels. The Olympic medallist achieved greater activation of cortical sensorimotor networks than the amateur athlete, particularly during fast MI. Fast MI elicited the strongest event-related desynchronization of alpha oscillations, which was generated from cortical sensorimotor sources in the Olympic medallist, but not in the amateur athlete. Taken together, data suggest that fast MI is a particularly demanding form of motor cognition, putting a specific emphasis on cortical sensorimotor networks to achieve the formation of accurate motor representations under demanding timing constraints.

Pain, No Gain: Acute Pain Interrupts Motor Imagery Processes and Affects Mental Training-Induced Plasticity.

Pain influences both motor behavior and neuroplastic adaptations induced by physical training. Motor imagery (MI) is a promising method to recover motor functions, for instance in clinical populations with limited endurance or concomitant pain. However, the influence of pain on the MI processes is not well established. This study investigated whether acute experimental pain could modulate corticospinal excitability assessed at rest and during MI (Exp. 1) and limit the use-dependent plasticity induced by MI practice (Exp. 2). Participants imagined thumb movements without pain or with painful electrical stimulations applied either on digit V or over the knee. We used transcranial magnetic stimulation to measure corticospinal excitability at rest and during MI (Exp. 1) and to evoke involuntary thumb movements before and after MI practice (Exp. 2). Regardless of its location, pain prevented the increase of corticospinal excitability that is classically observed during MI. In addition, pain blocked use-dependent plasticity following MI practice, as testified by a lack of significant posttraining deviations. These findings suggest that pain interferes with MI processes, preventing the corticospinal excitability facilitation needed to induce use-dependent plasticity. Pain should be carefully considered for rehabilitation programs using MI to restore motor function.

Unraveling Transformative Effects after tDCS and BCI Intervention in Chronic Post-Stroke Patient Rehabilitation-An Alternative Treatment Design Study.

Stroke is a debilitating clinical condition resulting from a brain infarction or hemorrhage that poses significant challenges for motor function restoration. Previous studies have shown the potential of applying transcranial direct current stimulation (tDCS) to improve neuroplasticity in patients with neurological diseases or disorders. By modulating the cortical excitability, tDCS can enhance the effects of conventional therapies. While upper-limb recovery has been extensively studied, research on lower limbs is still limited, despite their important role in locomotion, independence, and good quality of life. As the life and social costs due to neuromuscular disability are significant, the relatively low cost, safety, and portability of tDCS devices, combined with low-cost robotic systems, can optimize therapy and reduce rehabilitation costs, increasing access to cutting-edge technologies for neuromuscular rehabilitation. This study explores a novel approach by utilizing the following processes in sequence: tDCS, a motor imagery (MI)-based brain-computer interface (BCI) with virtual reality (VR), and a motorized pedal end-effector. These are applied to enhance the brain plasticity and accelerate the motor recovery of post-stroke patients. The results are particularly relevant for post-stroke patients with severe lower-limb impairments, as the system proposed here provides motor training in a real-time closed-loop design, promoting cortical excitability around the foot area (Cz) while the patient directly commands with his/her brain signals the motorized pedal. This strategy has the potential to significantly improve rehabilitation outcomes. The study design follows an alternating treatment design (ATD), which involves a double-blind approach to measure improvements in both physical function and brain activity in post-stroke patients. The results indicate positive trends in the motor function, coordination, and speed of the affected limb, as well as sensory improvements. The analysis of event-related desynchronization (ERD) from EEG signals reveals significant modulations in Mu, low beta, and high beta rhythms. Although this study does not provide conclusive evidence for the superiority of adjuvant mental practice training over conventional therapy alone, it highlights the need for larger-scale investigations.

Mental training in dentistry: A scoping review.

INTRODUCTION: Clinical motor skills are essential to train dental students. There is evidence that imagery serves to acquire and improve motor skills, but there is scarce information on its application in dental education. In order to broadly map the available evidence and to detect knowledge gaps in the mental training used to develop motor skills in dentistry, a scoping review was conducted. MATERIALS AND METHODS: A structured search was conducted to identify relevant references from the Web of Science, Scopus and MEDLINE/PubMed databases for studies addressing mental training methods applied to develop motor skills in dentistry. RESULTS: A total of 758 articles were screened and four were selected, all of which were randomized clinical trials. Three studies investigated the effectiveness of visual imagery, and one investigated kinesthetic imagery. The research theme identified was motor skill acquisition. CONCLUSION: The reviewed studies indicate the usefulness of mental training for skill acquisition in dentistry. To improve the generalizability of the results, further research with standardized mental training on motor skills in dentistry is needed.

[Modern view on upper limb physical rehabilitation after stroke. Literature review]. / Sovremennyi podkhod k fizicheskoi reabilitatsii funktsii verkhnei konechnosti posle insul'ta. Obzor literatury.

Stroke is the world's second leading cause of death and the first cause of disability among all diseases. The most common complication of a stroke is a violation of the motor function of the limbs, which significantly worsens the quality of life and the level of self-care and independence of patients. Restoring the function of the upper limb is one of the priority tasks of rehabilitation after a stroke. A large number of factors, such as the location and size of the primary brain lesion, the presence of complications in the form of spasticity, impaired skin and proprioceptive sensitivity, and comorbidities, determine the patient's rehabilitation potential and the prognosis of ongoing rehabilitation measures. Of particular note are the timing of the start of rehabilitation measures, the duration and regularity of the treatment methods. A number of authors propose scales for assessing the rehabilitation prognosis, as well as algorithms for compiling rehabilitation programs for restoring the function of the upper limb. A fairly large number of rehabilitation methods and their combinations have been proposed, including special methods of kinesitherapy, robotic mechanotherapy with biofeedback, the use of physiotherapeutic factors, manual and reflex effects, as well as ready-made programs that include sequential and combined use of various methods. Dozens of studies have been devoted to comparative analysis and evaluation of the effectiveness of these methods. The purpose of this work is to review current research on a given topic and draw up our own conclusion on the appropriateness of using and combining these methods at various stages of rehabilitation in stroke patients.

Mental practice for laparoscopic salpingectomy.

Mental practice (MP) is a method of enhancing surgical training by rehearsal of a task without physical action. The primary objective of the study was to develop and validate a MP tool for laparoscopic salpingectomy (LS). An imagery script for LS was developed and used to facilitate a structured MP session for trainees in Obstetrics and Gynaecology and expert gynaecologists across three teaching hospitals in the UK. A virtual platform was used for one trainee group to assess its feasibility compared to a face-to-face approach. Pre- and post-session assessments were conducted to evaluate the impact of the script on motivation, confidence, preparedness and quality of imagery and demonstrated a significant improvement in global imagery scores for both novice groups. The expert group scored significantly higher than the face-to-face novice group on all items both before and after MP, indicating construct validity. There were no significant differences demonstrated between the two novice groups, thus demonstrating the virtual platform to be a non-inferior approach - an important consideration in the current COVID era.

Effectiveness of synchronous action observation and mental practice on upper extremity motor recovery after stroke.

The purpose of this quasi-experimental pretest-posttest control group study was to examine the effect of group synchronous action observation/mental practice intervention compared to usual rehabilitation care on upper extremity motor recovery after stroke. The intervention group (n = 25) received usual care, consisting of a minimum of 3 hours of rehabilitation services per day, 5 days a week, plus group synchronous action observation/mental practice sessions 3 times per week and the control group (n = 26) received usual care. Outcome measures included the Kinesthetic and Visual Imagery Questionnaire Short Version (KVIQ-10), the Fugl-Meyer Assessment (FMA-UE) of affected upper extremity motor function only and The Box and Block Test (BBT). Although there were no statistically significant differences in upper extremity motor function between the two groups, a subgroup analysis of the intervention group identified statistically significant (FMA-UE: p < .001; BBT: p = .04) and Minimally Important Clinical Differences on upper extremity motor recovery between patients with behaviors demonstrating more versus less commitment to the intervention. Group synchronous action observation/mental practice is a promising intervention for patients demonstrating commitment to actively participating in the intervention to improve outcomes on upper extremity motor recovery after stroke.

Using motor imagery practice for improving motor performance - A review.

Motor imagery practice is a current trend, but there is a need for a systematic integration of neuroscientific advances in the field. In this review, we describe the technique of motor imagery practice and its neural representation, considering different fields of application. The current practice of individualized motor imagery practice schemes often lacks systematization and is mostly based on experience. We review literature related to motor imagery practice in order to identify relevant modulators of practice effects like previous experience in motor training and motor imagery practice, the type of motor task to be trained, and strategies to increase sensory feedback during physical practice. Relevant discrepancies are identified between neuroscientific findings and practical consideration of these findings. To bridge these gaps, more effort should be directed at analyzing the brain network activities related to practically relevant motor imagery practice interventions.

A Randomized Controlled Trial Comparing Physical and Mental Lingual Exercise for Healthy Older Adults.

Mental practice using motor imagery (MP-MI) has been shown to improve motor outcomes of upper and lower extremities especially when combined with physical exercise. Here, we studied community-dwelling, healthy older adults to determine the effects of including an MP-MI component with lingual strengthening exercise. In this pilot study, twenty-nine typically aging participants were assigned to an intervention group: physical lingual exercise (n = 7), physical and MP-MI lingual exercise (n = 8), MPMI lingual exercise (n = 7), or a control group (placebo exercise) (n = 7). All participants completed the assigned exercise regimen with three sessions per day, three days a week, for 6 consecutive weeks. Maximum isometric pressure (MIP) and regular effort saliva swallowing (RESS) pressure were collected at baseline and weeks 2, 4, and 6. A post hoc Bonferroni corrected treatment effect from baseline to week 6 was shown for only participants in the MP-MI/Physical exercise group for MIP (p = 0.003 MPMI/ Physical group; p = 0.11 Control group; p = 0.32 Physical only group; p = 0.14 MP-MI only group) and RESS (p = 0.009 MP-MI/Physical group; p = 0.14 Control group; p = 0.10 Physical only group; p = 0.04 MP-MI only group). Findings also indicate spontaneous carryover of significantly increased swallowing pressure when mental and physical exercise are combined. In conclusion, the potential effect of including an MPMI lingual exercise component in preventative and rehabilitative frameworks with older persons to possibly enhance functional swallowing improvement is promising and should be investigated.

Effects of Motor Imagery as a Complementary Resource on the Rehabilitation of Stroke Patients: A Meta-Analysis of Randomized Trials.

BACKGROUND: Stroke is the second leading cause of death and a leading cause of disability worldwide. Motor imagery is a technique that can be utilized in the rehabilitation process to improve the lives of patients with a functional disability acquired by this pathology. AIM: To evaluate the effects of motor imagery as a complementary intervention for the rehabilitation of stroke patients. METHODS: We conducted a systematic review in MEDLINE/PubMed, Scopus, Web of Science, and PEDro databases. We included randomized controlled trials (RCTs) that used motor imagery as a complementary resource for the rehabilitation of patients affected by stroke, who had motor function and functional independence as outcomes. RESULTS: Of the 1,473 studies found, ten RCTs were included. Regarding the interventions, motor imagery was associated with traditional rehabilitation, virtual reality, physical practice, structured progressive circuit class therapy, and electromyography. The upper and lower extremity performance were accessed through the Fugl-Meyer Assessment (FMA) and gait speed, respectively. Although the practice of motor imagery at least twice a week during three weeks showed to be effective in improving the motor performance of post-stroke patients, the studies' protocols present a high heterogeneity, with training session times lasting between 30 to 180 minutes and a post-stroke invention window of one to 12 months. CONCLUSIONS: Motor imagery has been shown to be an efficacious technique in the treatment of post-stroke patients when used as a complement to traditional rehabilitation techniques. However, greater standardization of interventions and studies with higher methodological quality are required to determine further conclusions.

Cerebral haemodynamics during motor imagery of self-feeding with chopsticks: differences between dominant and non-dominant hand.

Purpose: Motor imagery is defined as a dynamic state during which a subject mentally simulates a given action without overt movements. Our aim was to use near-infrared spectroscopy to investigate differences in cerebral haemodynamics during motor imagery of self-feeding with chopsticks using the dominant or non-dominant hand.Materials and methods: Twenty healthy right-handed people participated in this study. The motor imagery task involved eating sliced cucumber pickles using chopsticks with the dominant (right) or non-dominant (left) hand. Activation of regions of interest (pre-supplementary motor area, supplementary motor area, pre-motor area, pre-frontal cortex, and sensorimotor cortex was assessed.Results: Motor imagery vividness of the dominant hand tended to be significantly higher than that of the non-dominant hand. The time of peak oxygenated haemoglobin was significantly earlier in the right pre-frontal cortex than in the supplementary motor area and left pre-motor area. Haemodynamic correlations were detected in more regions of interest during dominant-hand motor imagery than during non-dominant-hand motor imagery.Conclusions: Haemodynamics might be affected by differences in motor imagery vividness caused by variations in motor manipulation.

Critical analysis of evidence about the impacts on surgical teams of 'mental practice' in systematic reviews: a systematic rapid evidence assessment (SREA).

BACKGROUND: Mental Rehearsal (MR) the cognitive act of simulating a task in our heads to pre-experience events imaginatively. It has been used widely to improve individual and collective performance in fields outside healthcare and offers potential for more efficient training in time pressured surgical and medical team contexts. The study aims to review the current systematic review literature to determine the impact of MP on surgical performance and learning. METHODS: Medline, Embase, British Educational Index, CINAHL, Web of Science PsycINFO, Cochrane databased were searched in the period 1994-2018. The primary outcomes measure were performance improvements in surgical technical skills, stress reduction, confidence and team performance. Study quality of the Systematic Reviews was assessed using AMSTAR 2, a critical appraisal tool for systematic reviews. The reported impacts of MP in all included studies were mapped onto Kirkpatrick's framework for the evaluation of educational interventions. RESULTS: Six Systematic reviews were identified which met the inclusion criteria, of which all reported positive and varying benefits of MP on surgical performance, confidence, and coping strategies. However, reported impacts on a modified Kirkpatrick's framework did not exceed level 3. Mental practice was described in terms of mental imagery and mental rehearsal with most authors using each of the terms in their search strategies. The impacts on transfer to practice and the long- term acquisition of skills, but also personal uptake of mental practice routines were not reported. CONCLUSION: The majority of studies demonstrate benefits of MP for technical performance. Overall the systematic reviews were of medium to high quality. However, studies lacked a sufficiently articulated evaluation methodology to examine impacts beyond the immediate experimentations. This is also due to the limitations found in the primary studies. Future research should look at longitudinal mixed method evaluation designs and focus on real clinical teams.

Motor imagery during action observation enhances automatic imitation in children with and without developmental coordination disorder.

Developmental coordination disorder (DCD) is a neurodevelopmental condition characterized by uncoordinated movement relative to age. While action observation (AO) and motor imagery (MI) can both independently enhance movement skills in children, we report the first study to assess the effects of combined action observation and motor imagery (AO + MI) on automatic imitation in children aged 7-12 years both with DCD (n = 12) and without DCD (n = 12). On each trial, participants planned to execute an instructed rhythmical action (face washing or paint brushing). Before responding, participants observed a rhythmical distractor showing the same or a different action with a subtle speed manipulation across trials (fast vs. slow). Automatic imitation was quantified as an imitation bias in subsequent response cycle times. Across blocks of trials, participants engaged in AO, MI, or combined AO + MI during the distractor phase or intentionally imitated the distractor speeds. Although there were no between groups differences, combined AO + MI instructions produced a significantly greater imitation bias (115%) than both AO (109%) and MI (109%), with intentional imitation yielding the strongest effects overall (128%). Within groups analyses revealed a significant bias for AO and MI in both groups. Combined AO + MI effects were significantly greater than AO in typically developing children and were greater than both AO and MI in children with DCD. These results demonstrate a clear capacity for different forms of motor simulation in children both with and without DCD. Moreover, combined AO + MI instructions represent an advantageous method for training movements in children with different motor abilities compared with separate AO and MI instructions.

Team Action Imagery and Team Cognition: Imagery of Game Situations and Required Team Actions Promotes a Functional Structure in Players' Representations of Team-Level Tactics.

A team's cognitions of interpersonally coordinated actions are a crucial component for successful team performance. Here, we present an approach to practice team action by way of imagery and examine its impact on team cognitions in long-term memory. We investigated the impact of a 4-week team action imagery intervention on futsal players' mental representations of team-level tactics. Skilled futsal players were assigned to either an imagery training group or a no imagery training control group. Participants in the imagery training group practiced four team-level tactics by imagining team actions in specific game situations for three times a week. Results revealed that the imagery training group's representations were more similar to that of an expert representation after the intervention compared with the control group. This study indicates that team action imagery training can have a significant impact on players' tactical skill representations and thus order formation in long-term memory.

The influence of imagery capacity in motor performance improvement.

Motor imagery (MI) training improves motor performance, but the inter-individual variability of this improvement remains still unexplored. In this study, we tested the influence of imagery ability on the performance improvement following MI training. Twenty participants were randomly distributed into the MI or control group. They actually performed, at pre- and post-test sessions, a revisited version of the Nine Hole Peg Test, a speed-accuracy trade-off task, commonly used in clinics. Between the tests, the MI group mentally trained on the task (5 blocks of 10 trials), while the control group watched a non-emotional documentary. Before and during MI training, we tested the imagery ability of the MI group, by the revised version of Movement Imagery Questionnaire and by the estimation of vividness for the movement task at each block (subjective evaluation-SE). In the post-test, the MI group significantly decreased the movement duration by -12.1 ± 5.7% (P < 0.001), whereas the control group did not (-2.68 ± 5%, P = 0.68). For the MI group, the percentage of improvement was correlated neither to the MIQ-R nor to the SE reported after block 1. However, we observed an evolution of the SE during training, with a positive correlation between performance improvement and SE at block 4 (R = 0.61, P = 0.03) and at block 5 (R = 0.68, P = 0.04). The current study shows that motor performance may be positively influenced, whilst not predicted, by the capacity to form vivid movement images throughout the mental training. These findings are of interest for clinical interventions using MI as a complementary rehabilitation tool.

Mental practice with interactive 3D visual aids enhances surgical performance.

BACKGROUND: Evidence suggests that Mental Practice (MP) could be used to finesse surgical skills. However, MP is cognitively demanding and may be dependent on the ability of individuals to produce mental images. In this study, we hypothesised that the provision of interactive 3D visual aids during MP could facilitate surgical skill performance. METHODS: 20 surgical trainees were case-matched to one of three different preparation methods prior to performing a simulated Laparoscopic Cholecystectomy (LC). Two intervention groups underwent a 25-minute MP session; one with interactive 3D visual aids depicting the relevant surgical anatomy (3D-MP group, n = 5) and one without (MP-Only, n = 5). A control group (n = 10) watched a didactic video of a real LC. Scores relating to technical performance and safety were recorded by a surgical simulator. RESULTS: The Control group took longer to complete the procedure relative to the 3D&MP condition (p = .002). The number of movements was also statistically different across groups (p = .001), with the 3D&MP group making fewer movements relative to controls (p = .001). Likewise, the control group moved further in comparison to the 3D&MP condition and the MP-Only condition (p = .004). No reliable differences were observed for safety metrics. CONCLUSION: These data provide evidence for the potential value of MP in improving performance. Furthermore, they suggest that 3D interactive visual aids during MP could potentially enhance performance, beyond the benefits of MP alone. These findings pave the way for future RCTs on surgical preparation and performance.

Influence of functional task-oriented mental practice on the gait of transtibial amputees: a randomized, clinical trial.

BACKGROUND: Mental 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. METHODS: Unilateral 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). RESULTS: All 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. CONCLUSIONS: MP 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.

Improvement of darts performance following lucid dream practice depends on the number of distractions while rehearsing within the dream - a sleep laboratory pilot study.

In a lucid dream, the dreamer is aware of the dream state and can deliberately practice motor skills. Two field studies indicated that lucid dream practice can improve waking performance in simple motor tasks. The present pilot study investigated the effect of lucid dream practice in a controlled sleep laboratory setting, using a pre-post design with dart throwing in the evening and morning. The experimental group practiced darts in lucid dreams. Because some participants were distracted during lucid dream practice, the group was divided into lucid dreamers with few (n = 4) and many distractions (n = 5). Change of performance was compared to a physical practice group (n = 9) and a control group (n = 9), showing a significant interaction (P = .013, η2 = .368). Only the lucid dreamers with few distractions improved (18%) significantly over time (P = .005, d = 3.84). Even though these results have to be considered preliminary, the present study indicates that lucid dream practice can be an effective tool in sports practice if lucid dreamers find ways to minimise distractions during lucid dream practice. Moreover, the study emphasises the necessity to investigate lucid dream practice experiences on a qualitative level.