اثربخشي تصويرسازي PETTLEP در يادگيري فورهند تنيس روي ميز در بيماران مالتيپل اسكلروزيس

Effectiveness of PETTLEP Imagery in Table Tennis Forehand Learning of Multiple Sclerosis Patients

زمينه و هدف تصويرسازي حركتي، اخيرا به عنوان روش جايگزين در بيماران نورولوژيكي، به صورت تمرين عملكردهاي حركتي مورد توجه قرارگرفته است. با اين حال تاكنون شيوه نوين تصوير سازي پتلپ در بيماران مالتيپل اسكلروزيس (MS) مورد بررسي قرار نگرفته است. لذا، هدف اين مقاله بررسي تاثير تصويرسازي پتلپ و تمرين بدني بر عملكرد و يادگيري ضربه فورهند تنيس در بيماران MS بود. روش بررسي در اين مطالعه نيمه تجربي با طرح درون / بين گروهي، 33 نفر از زنان مبتلا به بيماري MS شهرستان كرمانشاه به صورت در دسترس به عنوان نمونه آماري در تحقيق حاضر مشاركت داشتند. ابتدا آزمون دقت ضربه ي فورهند تنيس روي ميز ليو و مسترز، از آزمودني ها گرفته شد. سپس، به روش همتا سازي بر اساس نمرات پيش آزمون، در سه گروه تصويرسازي پتلپ، تمرين بدني و گروه تركيبي (تمرين بدني با تصويرسازي پتلپ) تخصيص يافتند. شركت كنندگان 18 جلسه ضربه فورهند تنيس روي ميز را متناسب با گروهي كه در آن بودند، تمرين كردند. يك هفته پس از مداخله، آزمون يادداري و انتقال از آزمودني ها به عمل آمد. براي تجزيه و تحليل داده ها در جلسات اكتساب از تحليل واريانس با اندازه گيري مكرر و براي مقايسه گروه ها در جلسات پيش آزمون، پس آزمون، يادداري و انتقال از تحليل واريانس يك راهه (با سطح معني داري 0/05) به وسيله نرم افزار SPSS نسخه 16 استفاده شد. يافته ها نتايج تحليل واريانس با اندازه گيري مكرر در جلسات اكتساب نشان داد دقت آزمون فورهند تنيس در تمامي گروه ها در طول جلسات بهبود معني داري داشت (0/0001=P)؛ همچنين نتايج آزمون تعقيبي LSD نشان داد، دقت فورهند گروه تصويرسازي پتلپ، به طور معني داري كمتر از دو گروه تمرين بدني (0/014=P) و گروه تركيبي ديگر بود (0/001=P)؛ اما نتايج تحليل واريانس يك راهه در آزمون يادداري نشان داد كه گروه تركيبي بهتر از دو گروه تصويرسازي پتلپ (0/0005=P)، و گروه تمرين بدني بودند (0/001=P،). نتيجه گيري براساس يافته هاي اين پژوهش، به نظر مي رسد تركيب تمرين بدني با تصويرسازي پتلپ مي تواند به عنوان يك مداخله براي بيماران مالتيپل اسكلروزيس، اثر بخش تر باشد.

Background and Objective: Motor imagery is widely used in sports skill instruction. It has recently gained attention as a compensation way in the form of motor performance training for Parkinson and brain stroke patients. However, a novel way of imagery called PETTLEP (Physical, Environment, Task, Timing, Learning, Emotion and Perspective) has not been investigated in multiple sclerosis patients. Therefore, the purpose of this study was to investigate the effect of PETTLEP and physical training on the performance and learning of tennis forehand in multiple sclerosis (MS) patients. Methods: The present study was semi-experimental, including intra/inter group design. For this purpose, 33 patients with MS (37.5±3.02) were participated as a statistical sample in this study, who purposively selected among referrals to MS Society of Kermanshah city (Krmanshah province, West of Iran). First, Kinestatic and visual imagery questionnaire (Malouin et al, 2007) was used to examine the imagery ability of MS patients. Then Edinburgh Handedness Inventory Questionnaire was used to confirm the right-handedness of the subjects. After that, a table tennis forehand pre-test was taken from the subjects. They were divided to three groups of PETTLEP imagery, physical training and PETTLEP imagery and physical training (combined group) based on pre-test scores with Peer-matching method. The PETTLEP imagery group intervention included mental imagery practice of table tennis forehand using the PETTLEP method during 30 minutes. The physical training group performed practically table tennis forehand skill during the same time in each session. Combined group were placed under the PETTLEP imagery (15 minutes) and physical training (15 minutes). All groups 3 sessions each week (for 6 weeks) performed related intervention. After one week from intervention, retention (similar to pre-test) and transfer (parallel forehand; change direction of forehand) tests were performed. The research tool included the accuracy test of the table tennis forehand, which was designed by Lio and Master. The repeated measure ANOVA test was used to analyze the acquisition sessions. Observed significant effects were further assessed with LSD posthoc tests. As well as, one-way was used to compare the groups in pre-test, post-test, retention and transfer tests. These analyses were based on Shapiro-Wilk's of normality and homogeneity of variance tests for all analyses, the level of significance was set at p<0.05. Results: For MS patients, repeated measures ANOVA in acquisition sessions showed effects of groups (p=0.003, η2=0.324), sessions (p<0.001, η2 =0.0865), and interaction (p<0.001, η2=0.208) was significant. Post hoc test showed that that tennis forehand accuracy of the all groups improved during acquisition sessions (p<0.05), and the tennis forehand accuracy of the PETTLEP imagery group was significantly less than the physical training (p=0.014), and combined groups (p=0.001). Whereas, there was no significant difference between the physical training and Combined groups (p>0.05). In addition, results of one-way ANOVA in retention test showed that the tennis forehand accuracy of the combined group was better than the physical training (p=0.001), and PETTLEP imagery groups (p<0.001). As well as the physical training group was better than the PETTLEP imagery groups (p=0.001). Results of transfer test showed that the forehand accuracy of the PETTLEP imagery group was significantly less than the physical training (p<0.001), and combined groups (p=0.002), whereas, there was no significant difference between the physical training and Combined groups (p=0.125). Conclusion: Based on the findings, it seems the combination of physical exercises with PETTLEP imagery could be more effective as a treatment for multiple sclerosis patients. Only PETTLEP imagery could not be a suitable alternative for physical training alone.