Rehabilitation of the elbow extension with motor imagery in a patient with quadriplegia after tendon transfer.

OBJECTIVE: To test the effect of a postsurgical motor imagery program in the rehabilitation of a patient with quadriplegia. DESIGN: Crossover design with kinematic analysis. SETTING: Rehabilitation Hospital of Lyon. Study approved by the local Human Research Ethics Committee. PARTICIPANTS: C6-level injured patient (American Spinal Injury Association Impairment Scale grade A) with no voluntary elbow extension (triceps brachialis score 1). INTERVENTION: The surgical procedure was to transfer the distal insertion of the biceps brachii onto the triceps tendon of both arms. The postsurgical intervention on the left arm included 10 sessions of physical rehabilitation followed by 10 motor imagery sessions of 30 minutes each. The patient underwent 5 sessions a week during 2 consecutive weeks. The motor imagery content included mental representations based on elbow extension involved in goal-directed movements. The rehabilitation period of the right arm was reversed, with motor imagery performed first, followed by physical therapy. MAIN OUTCOME MEASURES: The kinematics of upper-limb movements was recorded (movement time and variability) before and after each type of rehabilitation period. A long-term retention test was performed 1 month later. RESULTS: Motor imagery training enhanced motor recovery by reducing hand trajectory variability-that is, improving smoothness. Motor performance then remained stable over 1 month. CONCLUSIONS: Motor imagery improved motor recovery when associated with physical therapy, with motor performance remaining stable over the 1-month period. We concluded that motor imagery should be successfully associated with classic rehabilitation procedure after tendon transfer. Physical sessions may thus be shortened if too stressful or painful.