Currently submitted to: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Aug 23, 2026
Open Peer Review Period: Sep 1, 2026 - Oct 27, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Motor Imagery for Prosthetic Gait Retraining in Acute Transtibial Amputees: A Feasibility Pilot Randomized Controlled Trial
ABSTRACT
Background:
People undergoing transtibial amputation (TTA) face various impairments, including in gait, balance, confidence, pain, and prosthesis embodiment. Current rehabilitative approaches focus on motor-functional retraining. The role of cognitive approaches in TTA rehabilitation has been suggested. Motor imagery (the mental rehearsal of a motor task; MI) is one cognitive approach for enhancing motor and cognitive spheres of performance. However, the potential of MI in TTA amputation has not been thoroughly investigated, especially in regards to initial prosthetic gait retraining.
Objective:
The current study aimed to (1) explore the feasibility of MI for individuals with acute TTA; (2) investigate the preliminary effects of MI on participants’ functional status, gait, pain, prosthesis embodiment and imagery ability; and (3) to assess the comparative effect of MI training protocols prior to or alongside initial prosthetic training.
Methods:
Institutional Ethical Committee and Helsinki committee (0017-22-LOE) approvals were granted prior to the commencement of the study. This pilot randomized controlled trials was registered (ClinicalTrials.gov NCT076526198; https://clinicaltrials.gov/ct2/show/ NCT076526198). Ten participants (age range: 46-68 years, eight males) with acute unilateral TTA were randomly allocated into two groups based on delivery timing of MI in relation to initial temporary prosthesis (Vessa) training: prior to (pre-Vessa) or alongside (w-Vessa). Both interventions were delivered concurrently with conventional physical therapy. Participants underwent eight individualized MI sessions over two weeks. Data were collected at four timepoints: before and after MI, first independent prosthesis gait, and discharge from the hospital. Outcome measures included intervention feasibility, functional status, pain, prosthesis embodiment and MI ability.
Results:
The MI intervention was feasible. Both groups showed trends toward improvements across all the measures following the intervention. The p-Vessa group exhibited somewhat greater gains.
Conclusions:
Individuals with acute TTA seem to benefit from MI in both motor and cognitive aspects. Additional research is warranted to further explore the benefits of MI and its delivery timing in post-amputation rehabilitation. Clinical Trial: This study was registered at ClinicalTrials.gov (ClinicalTrials.gov NCT076526198; https://clinicaltrials.gov/ct2/show/ NCT076526198).
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