Use of Mental Practice to Reduce Severe Upper Extremity Hemiparesis: A Pilot Study

Abstract

Date Presented 03/22/24

This study examined the efficacy and feasibility of a mental practice protocol to address severe upper extremity hemiparesis. The results suggest that mental practice is an efficacious, appropriate, and feasible intervention for this population.

Primary Author and Speaker: Teresa M. Green

Additional Authors and Speakers: Farida S. Gayle

Contributing Authors: Asha Vas

Mental practice (MP) is a cognitive adjunctive intervention that improves activity limitations of the hemiparetic upper extremity (UE; Stockley et al., 2021), and provides similar cortical benefits as physical practice (Page & Peters, 2014). Unfortunately, most MP protocols require active wrist or finger flexion to be eligible (Page et al., 2016) and the use of the intervention to address severe UE hemiparesis has not been thoroughly explored (Stockley et al., 2021). Therefore, the purpose of this study was to examine the efficacy of MP for individuals with severe UE hemiparesis and the feasibility of following a MP protocol in inpatient rehabilitation.

DESIGN: Single-group, pretest-posttest pilot study. 11 patients, <1 month post-stroke with severe UE hemiparesis, and 17 occupational therapists using convenience sampling.

METHOD: Patients completed MP 5 days/week for 2 weeks. The Wolf Motor Function Test (WMFT) and Fugl Meyer Assessment (FMA) measured UE recovery. The Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) assessed MP perceptions.

RESULTS: Wilcoxon signed-rank test demonstrated a statistically significant difference in FMA scores from pretest (Mdn = 7.00, M = 8.36, SD = 5.46) to posttest (Mdn = 13.00, M = 16.27, SD = 11.11), n = 11, Z = 2.70, p = .007, r = .57. There was a statistically significant change in WMFT Functional Ability Scores from pretest (Mdn = 1.00, M = .91, SD = .83) to posttest (Mdn = 1.00, M = 1.55, SD = 1.29), Z = 2.07, p = .041, r = .44. MP improved UE impairments with less effect on functional abilities. AIM, IAM, and FIM demonstrated patients and therapists were largely agreeable to the appropriateness and feasibility of MP, while less agreeable to the acceptability of MP.

CONCLUSION: MP is a feasible, appropriate, and effective treatment for severe UE hemiparesis. A randomized controlled trial is now needed to substantiate this pilot work.

References

Page, S., Hade, E., & Pang, J. (2016). Retention of the spacing effect with mental practice in hemiparetic stroke. Experimental Brain Research, 234(10), 2841–2847. https://doi.org/10.1007/s00221-016-4686-5

Page, S. J., & Peters, H. (2014). Mental practice: Applying motor PRACTICE and neuroplasticity principles to increase upper extremity function. Stroke (1970), 45(11), 3454–3460. https://doi.org/10.1161/STROKEAHA.114.004313

Stockley, R. C., Jarvis, K., Boland, P., & Clegg, A. J. (2021). Systematic review and meta-analysis of the effectiveness of mental practice for the upper limb after stroke: Imagined or real benefit? Archives of Physical Medicine and Rehabilitation, 102(5), 1011–1027. https://doi.org/10.1016/j.apmr.2020.09.391