Logs (one per week) were handed to the participants http://www.selleckchem.com/products/mi-773-sar405838.html to record unguided

mental practice behaviour. In principle, a maximum of six logs could be completed. The main goal of the mental practice intervention was to improve locomotor tasks like walking, standing up from a chair or the floor. Therapists were trained to teach and monitor mental practice according to the framework in which four steps are distinguished: explaining the concept, developing imagery techniques, applying mental practice, and consolidating (Braun et al 2008). Figure 1 presents the time frame over which these four stages were utilised. Unlike a fixed treatment regimen, the mental imagery framework allowed the physiotherapist to tailor the content to each participant’s abilities and preferences. Examples of tailoring are the chosen view and the ratio of actual to imagined attempts at movements. Participants were told

that imagery inherently involved a point of view. They were advised to try first person (as if looking through their own eyes) and third person (as if looking at oneself from a distance), and were then allowed to choose whichever view they preferred (Milton et al 2008). LEE011 During therapy, imagery attempts and overt movements were combined, ie, movements were performed to generate sensory information. This information was then embedded in the imagery attempts to make them as vivid as possible. The proportions of actual movements and imagery attempts were based on individual preferences (Malouin Thymidine kinase et al 2004). The ratio of actual to imagined attempts could change over time or differ depending on the task or its difficulty. The success of a participant in imagining the actions correctly and vividly was judged by the therapist in several ways: self-report by the participant, comparing the time taken to perform a task mentally against the time in reality, and by checking that the participant

could recite the order of actions correctly. The control therapy was used to control for attention and consisted of treatment according to the national Dutch guidelines (Keus et al 2004) with relaxation therapy being incorporated into each session. The amount of relaxation incorporated matched the amount of mental practice in the experimental group. Relaxation was chosen to enable comparison with the trial by Tamir and colleagues and followed the principles of progressive muscle relaxation according to Jacobson (Gessel 1989). Participants were encouraged to do relaxation homework outside of therapy as well, using unguided progressive muscle relaxation or by listening to a relaxation CD. Improvement in walking was assessed with a visual analogue scale (Donnelly and Carswell 2002, Stratford et al 1995, Wewers and Lowe 1990). Participants and therapists were asked to score on a scale from 0 to 10 how well they thought the participant walked with 0 being ‘poor’ and 10 being ‘excellent’.

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