Mental Practice in Stroke Rehabilitation

Introduction:

Mental practice [MP] of tasks is a relatively new therapy that is receiving increasing attention within rehabilitation research. According to Richardson, (1967) MP is “the symbolic rehearsal of a physical activity in the absence of any gross muscular movements”.

 MP has been proven to be useful and well documented in sports training and other skills training (Athletic Insight, 2004). Athletes and musicians have long known the benefits of mental practice - sometimes called "mental imagery" or "motor imagery" - in improving their performance. The reason that this technique works so well seems to be because, when we mentally rehearse an activity, the same muscles are activated as if we are actually performing the activity. So, over time, repeated use of mental practice should provide some of the same benefits as physically rehearsing a task. This has encouraged the application of mental practice for other skills development for normal individuals’ such as surgical skills, playing instruments, or balance training for elderly. Still, much is yet to be determined if the same assuring results may be derived when this training method is used in persons with brain lesions, like stroke (Dizon and Calayan, 2009).

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Background:

Stroke is one of the leading causes of death worldwide and a major cause of acquired disability in adults (Johnston et al., 2009, Richard et al., 2011). It is a very limiting condition for the patient and a major health problem in most parts of the world (AHA, 1997).

Stroke is defined as a sudden loss of brain function. It is caused by the interruption of flow of blood to the brain (ischaemic stroke) or the rupture of blood vessels in the brain (haemorrhagic stroke) (Heart and Stroke, 2009).

Stroke accounts for approximately 17 million people in 2010 and 33 million people have previously had a stroke and are still alive.Between 1990 and 2010 the number of strokes decrease by approximately 10% in the developed world and increased by 10% in the developing world.

There is some evidence that People who experience a stroke may undergo sudden and intense changes in perception, cognition, mood, speech, health-related quality of life, and function ( difficulty walking or using the arm) (Mayo, 1999).

Treating patients after stroke is challenging: patients are often very vulnerable, and stroke is a complex pathology that can lead to a variety of symptoms (Lawrence, 1992).

Much research on effectiveness of treatments within stroke has been performed, but there is no evidence supporting most specific rehabilitation treatments (Langhorne et al., 2009).

Neurological conditions play a significant role in economic, social and personal burden on the health services and patients families, as most of the neurological conditions need long term rehabilitation (Neurological Alliance, 2003).

Only a small percentage of the day in organized stroke units is spent with therapists (Bernhardt, 2007), which may not be optimal as a higher amount of practice is known to be related to more improvement (Kwakkel et al., 1999).