Mental Practice in Stroke Rehabilitation

 


Introduction[edit | edit source]

Mental-practice.jpeg

Mental practice (MP) of tasks is a relatively new therapy that is receiving increasing attention within rehabilitation research. Mental practice often described as Motor Imagery or Mental Imagery involves an individual visualising performing a task or any bodily movement without having to physically perform it and thus resulting in stimulation of the neural system.

Richardson explains MP as “the symbolic practice of a physical activity in the absence of any gross muscular movements”[1].

While athletes and musicians have long known the benefits of the mental practice which is proven to be useful and well documented in improving their performance and thereby enhancing their sports training and other skills.[2] [3] [4][5] [6] [7] Several studies have been conducted among Stroke patients to determine the effectiveness of MP to improve the functional independence and performance of activities of daily activity[8][9][10], to enhance gait speed[11] and improve balance[12].

What is Mental Practice?[edit | edit source]

The primary theoretical interest of MP is, when we mentally rehearse an activity, the same muscles are activated as if we are performing the activity [1] So, over time, the mental rehearsal of such activities would induce some degree of motor learning as seen while physically rehearsing a task. Motor imagery can be started in the acute phase, subacute phase or chronic phase of rehabilitation. It is been shown that while motor imagery is helpful by itself [13], it's best when used as an adjunct to physical therapy.[14] [15]Many of the primary studies on motor imagery were designed to analyse whether motor imagery improved motor performance in athletes.


Types of Mental Practice[edit | edit source]

  • Kinaesthetic motor imagery(KMI)– KMI is described as the ability to visualise the feeling associated with performing the movement.[16]
  • Visual motor imagery(VMI) –VMI is described as the ability to visualise the movement.[16]

Evidence of Mental Practice in Stroke Rehabilitation[edit | edit source]

Multiple studies have been done to study the effectiveness of Mental Practice in Rehabilitation of Stroke :

Upper Limb Rehabilitation after Stroke[edit | edit source]
  1. Park et al[14] conducted a systematic review and meta-analysis suggesting that MP is an effective , safe resource and based on the requirements of the therapist and the patient, it could be a feasible adjunct rather than an outright alternative to conventional rehabilitation, either given with neurofeedback or not. The results varied depending on the therapy given. Considering the potential benefit of Brain Computer Interface(BCI) in clinical application of MP, further development of MP is requested.
  2. Braun et al [17] conducted a systematic review to determine the effectiveness of mental practice as an additional therapy on the recovery of arm function after stroke. Although, the single case studies indicated that mental practice was promising for the improvement of leg function. They concluded that further research, using clear definitions of the content of mental practice and standardized measurement of outcome, are needed to establish MP as an effective therapy.
  3. A systematic review was carried out by Barclay-Goddard et al[15] to investigate the effectiveness of mental practice to treat the upper extremity deficits in individuals with hemiparesis after stroke. The results showed that mental practice as an adjunct to other treatment methods was more effective in improving upper extremity function than the MP alone.
  4. Park et al [13] evaluated the effects of mental practice on stroke patients' upper extremity function and activities of daily living (ADL). Their results demonstrated significant improvements in the Action Research Arm Test (ARAT), the Fugl-Meyer assessment (FMA), and the Modified Barthel Index (MBI) scored which concluded that the mental practice is effective at improving stroke patients’ upper extremity function and daily activity performance.


Functional Recovery and Performance of Activities of Daily Living[edit | edit source]
  1. A systematic review was carried out by et al[10] to investigate the effectiveness of mental practice to treat the upper extremity deficits in individuals with hemiparesis after stroke. The results showed that mental practice as an adjunct to other treatment methods was more effective in improving upper extremity function than the MP alone.
  2. Cha et al [9] performed a meta-analysis to evaluate the efficiency of functional task training with mental practice in stroke. Results showed that functional task training with mental practice provided by occupational and physical therapists in stroke rehabilitation was functionally effective.
  3. Braun et al [8] conducted a meta-analysis further on to conclude that mental practice might have positive effects on the performance of activities in patients with neurological diseases given they have a good imagery ability, adherence and compliance to the intervention.
  4. D Gracia[18] conducted a systematic review to examine the potential practicality and clinical effectiveness of MP in rehabilitation and functional recovery. They found MP to be effective, safe when used in conjunction with conventional physical therapy for functional rehabilitation of both upper and lower limbs, and the recovery of daily activities and skills. However, they concluded that further studies were needed to determine the optimal treatment protocol.
Lower Limb Rehabilitation after Stroke[edit | edit source]
  1. Oostra et al[11] carried out a randomized controlled trial to assess the influence of motor imagery on gait rehabilitation and to investigate the effect of mental practice on motor imagery ability in sub-acute stroke patients. This trial randomized patients to receive muscle relaxation or lower extremity mental imagery practice.The outcome used to measure gait speed was the 10 Metre Walk Test at Post-treatment (6 weeks). Significant differences between the two groups were found at post-treatment, supporting lower extremity mental imagery practice vs. muscle relaxation.
  2. To determine whether locomotor imagery training led to clinical improvements in gait after stroke Cho et al[12] carried out a randomised controlled trial .This trial randomized patients to receive gait training or mental imagery along with gait.The outcome used to measure gait speed was the 10 Metre Walk Test at Post-treatment (4 weeks). Significant differences between the two groups were found at post-treatment, supporting mental imagery along with gait training vs. gait training alone.

References[edit | edit source]

  1. 1.0 1.1 Richardson, A. Mental practice: A review and discussion (Part II). Research Quarterly, 1967; 38, 263-273.
  2. Behncke L. Mental Skills Training For Sports: A Brief Review. Athletic Insight,2004; 6:6-7.
  3. Cocks, M., Moulton, C. A., Luu, S., & Cil, T. What surgeons can learn from athletes: mental practice in sports and surgery. Journal of surgical education, 2014.71(2), 262–269. https://doi.org/10.1016/j.jsurg.2013.07.002
  4. Mizuguchi N, Kanosue K. Changes in brain activity during action observation and motor imagery: Their relationship with motor learning. Prog Brain Res. 2017;234:189-204. doi:10.1016/bs.pbr.2017.08.008
  5. Battaglia C, D’Artibale E,Fiorilli G, Piazza M , Tsopani D, Giombini A, et al. Use of video observation and motor imagery on jumping performance in national rhythmic gymnastics athletes. Human Movement Science. 2014;38: 225-234. https://doi.org/10.1016/j.humov.2014.10.001.
  6. Fourkas, A.D.,Bonavolonta V., Avenanti, A., Aglioti, S.M.Kinesthetic Imagery and Tool-Specific Modulation of Corticospinal Representations in Expert Tennis Players.Cereb. Cortex 2008;18(10):2382-2390
  7. M Lotze, G Scheler, H.-R.M Tan, C Braun, N Birbaumer. The musician's brain: functional imaging of amateurs and professionals during performance and imagery. NeuroImage.2003; 20(3):1817-1829, https://doi.org/10.1016/j.neuroimage.2003.07.018.
  8. 8.0 8.1 Braun S, Kleynen M, van Heel T, Kruithof N, Wade D, Beurskens A. The effects of mental practice in neurological rehabilitation; a systematic review and meta-analysis. Frontiers in Human Neuroscience, 2013;7:390.
  9. 9.0 9.1 Cha YJ, Yoo EY, Jung MY, Park SH, Park JH. Effects of functional task training with mental practice in stroke: a meta analysis. NeuroRehabilitation, 2012;3:239-46.
  10. 10.0 10.1 López N., Pereira E, Centeno E, Miangolarra J(2019) Motor imagery as a complementary technique for functional recovery after stroke: a systematic review, Top Stroke Rehabil. 2019; 26:8:576-87. DOI: 10.1080/10749357.2019.1640000
  11. 11.0 11.1 Oostra, K.M., Oomen, A., Vanderstraeten, G., & Vingerhoets, G.Influence of motor imagery training on gait rehabilitation in sub-acute stroke: a randomized controlled trial. J Rehabil Med. 2015;7:204-9.
  12. 12.0 12.1 Cho, H. Y., Kim, J. S., & Lee, G. C.Effects of motor imagery training on balance and gait abilities in post-stroke patients: a randomized controlled trial. Clinical rehabilitation. 2012; 27(8):675-680. http://journals.sagepub.com/doi/abs/10.1177/0269215512464702
  13. 13.0 13.1 Park, J., Lee, N., Cho, M., Kim, D., Yang, Y. Effects of mental practice on stroke patients' upper extremity function and daily activity performance. Jrnl Of Phy Ther Sci,  2015; 27(4), 1075–1077. https://doi.org/10.1589/jpts.27.1075
  14. 14.0 14.1 Park SW, Kim JH, Yang YJ. Mental practice for upper limb rehabilitation after stroke: a systematic review and meta-analysis. Int J Rehabil Res. 2018 Sep;41(3):197-203. doi: 10.1097/MRR.0000000000000298. PMID: 29912022.
  15. 15.0 15.1 Barclay‐Goddard  RE, Stevenson  TJ, Poluha  W, Thalman  L. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Cochrane Database of Systematic Reviews 2011;5. 
  16. 16.0 16.1 Yang, Y.J., Jeon, E.J., Kim, J.S. et al. Characterization of kinesthetic motor imagery compared with visual motor imageries. Sci Rep 11, 3751 (2021). https://doi.org/10.1038/s41598-021-82241-0
  17. Braun SM, Beurskens AJ, Borm PJ, Schack T, Wade DT. The effects of mental practice in stroke rehabilitation: a systematic review. Archives of Physical Medicine and Rehabilitation, 2006;6: 842-852.
  18. García Carrasco D, Aboitiz Cantalapiedra J. Efectividad de la imaginería o práctica mental en la recuperación funcional tras el ictus: revisión sistemática. Neurología. 2016;31:43–52.