Objective: To assess the feasibility and practicalities of using the technique of mental practice as an adjunct in the rehabilitation of the upper limb following stroke.
Design: A series of single-case studies.
Setting: A stroke rehabilitation unit in Belfast.
Subjects: Fourteen patients admitted for rehabilitation of their first stroke: six men and four women, aged 45–81 between 10 and 176 days post stroke.
Intervention: Each patient underwent a single-case design, with two weeks baseline, two weeks intervention and one week withdrawal. The intervention consisted of structured daily mental practice sessions of a reach and grasp task, in addition to their usual therapy.
Main outcome measures: The upper limb component of the Motricity Index was used to grade motor activity sequentially across the timescale of the study.
Results: Of the 14 patients recruited, four withdrew and 10 completed the study. Nine showed improvement in upper limb Motricity Index score with mental practice as measured by the two-band standard deviation method. One of these cases demonstrated an unstable baseline such that changes could not be attributed to intervention.
Conclusions: This pilot study suggests that mental practice may be useful as an adjunct to physiotherapy after stroke.
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References
1.
Cohn PJ. Pre-performance routines in sport: Theoretical support and practice applications. Sport Psychol1990; 4: 301–312.
2.
Warner L, McNeill ME. Mental imagery and its potential for physical therapy. Phys Ther1987; 4: 516–521.
3.
Roland PE, Erickson L, Stone-Elander S, Widen L. Does mental activity change the oxidative metabolism of the brain. J Neurosci1987; 7: 2373–2389.
4.
Decety J, Ingvar DH. Brain structures participating in mental stimulation of motor behaviour. Acta Psychol1990; 73: 13–34.
5.
Hird JS, Landers DM, Thomas JR, Horan JJ. Physical practice is superior to mental practice in enhancing cognitive and motor task performance. J Sport Exerc Psychol1991; 8: 281–293.
6.
Feltz DL, Landers DM. The effects of mental practice on motor skill learning and performance: an article. J Sport Psychol1983; 5: 25–57.
7.
Smith MT, Baer G. Achievement of simple mobility milestones after stroke. Arch Phys Med Rehabil1999; 80: 442–447.
8.
Gowland C. Recovery of motor function following stroke: profile and predictors. Physiother Can1992; 34: 77–84.
9.
Dean C, Mackey F. Motor assessment scale scores as a measure of rehabilitation outcome following stroke. Aust J Physiother1992; 38: 31–35.
10.
Kraft GH, Filts SSM, Hammond MC. Techniques to improve function of the arm and hand in chronic hemiplegia. Arch Phys Med Rehabil1992; 73: 220–227.
11.
Tinson D. How stroke patients spend their days. Int Disabil Stud1989; 11: 45–49.
12.
Chae J, Berthoux F, Bohine T. Neuroluscular stimulation for upper extremity motor and functional recovery in acute hemiplegia. Stroke1998; 29: 975–979.
13.
Wade DT, Wood VA, Langton Hewer R. Recovery after stroke – the first three months. J Neurol Neurosurg Psychiatry1985; 48: 7–13.
14.
Johansson BB. Brain plasticity and stroke rehabilitation. Stroke2000; 31: 223–230.
15.
Langhorne P, Wagenaar R, Partridge C. Physiotherapy after stroke: more is better?Physiother Res Int1996; 1: 75–88.
16.
Shutter L, Whyte J, Lincoln NB, Parry R. Increased intensity of physiotherapy after stroke. Stroke1999; 30: 2242–2243.
17.
Kwakkel G, Wagenaar RC, Koelman TW, Lankhorst GH, Koetsier JC. Effects of intensity of rehabilitation after stroke: a research synthesis. Stroke1997; 28: 1550–1556.
18.
Kwakkel G, Wagenaar RC, Twisk JWR, Lankhorst GH, Koetsier JC. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet (North American Edition)1999; 354(9174): 191–196.
19.
Smith GV, Macko RF, Silver KHC, Goldberg AP. Treadmill aerobic exercise improves quadriceps strength in patients with chronic hemiparsis following stroke: a preliminary report. J Neurol Rehabil1998; 12: 111–118.
20.
Smith GV, Silver KHC, Goldberg AP, Macko RF. ‘Task-oriented’ exercise improves hamstring strength and spastic reflexes in chronic stroke patients. Stroke1999; 30: 2112–2118.
21.
Thompson ML, Thickbroom GW, Laing BA, Wilson SA, Mastaglia FL. Transcranial magnetic stimulation studies of the corticomotor projection to the hand after sub-cortical stroke. Mov Disord1996; 11: 251–251.
22.
Traversa R, Cicinelli P, Bassi A, Rossini PM, Bernardi G. Mapping of motor cortical reorganization after stroke. Stroke1997; 28: 110–117.
23.
Hashimoto R, Rothwell JC. Dynamic changes in corticospinal excitability during motor imagery. Exp Brain Res1999; 125: 75–81.
24.
Grouios G, Vakali M. The effect of mental practice on the performance of an eye-hand co-ordination task. J Hum Mov Stud2000; 38: 75–92.
25.
Korn ER. The use of altered states of consciousness and imagery in physical and pain rehabilitation. J Mental Imagery1983; 7: 25–34.
26.
Yoo E, Park E, Chung B. Mental practice effect on line-tracing accuracy in persons with hemiparetic stroke: a preliminary study. Arch Phys Med Rehabil2001; 82: 1213–1218.
27.
Page SJ. Imagery improves upper extremity motor function in chronic stroke patients: a pilot study. Occup J Res2000; 21: 200–215.
28.
Page SJ, Levine P, Sisto SA, Johnstone MV. A random efficacy and feasibility study of imagery in acute stroke. Clin Rehabil2001; 15: 233–240.
29.
Folstein MF, Folstein SE, McHugh PR. Mini Mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res1975; 12: 189–198.
30.
Bamford J, Sandercock P, Dennis M et al. Classification and natural history of clinically identifiable subtypes of cerebral infarct. Lancet1991; 337: 1521–1526.
31.
Ottenbacher KJ. Evaluating clinical change. Strategies for occupational therapists and physiotherapists. Baltimore: Williams and Wilkins, 1984.
32.
Weiss T, Hansen E, Beyer L et al. Activation processes during mental practice in stroke patients. Int J Psychophys1994; 17: 91–100.
33.
Wade D. Measurement in neurological rehabilitation. Oxford: Oxford University Press, 1992.
34.
Jackson PL, Lafleur MF, Malouin F et al. Potential role of mental practice using motor imagery in neurologic rehabilitation. Arch Phys Med Rehabil2001; 82: 1133–1141.
35.
Sackett RS. The influences of symbolic rehearsal upon the retention of a maze habit. J Gen Psychol1943; 10: 376–395.
36.
Janssen JJ, Sheikh AA. Enhancing athletic performance though imagery: and overview. In Sheikh AA, Korn ER eds. Imagery in sports and physical performance. New York. Baywood Publications, 1994: 1–22.
37.
Magill RA. Motor learning: concepts and applications, fifth edition. Madison: Brown and Benchmark, 1998.
38.
Jacobson E. Electrophysiology of mental activities. Am J Psychol1932; 44: 677–694.
39.
Mackay DG. The problem of rehearsal or mental practice. J Mot Behav1981; 13: 274–285.
