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 MP is “the symbolic rehearsal of a physical activity in the absence of any gross muscular movements”.[1]

 MP has been proven to be useful and well documented in sports training and other skills training . Athletes and musicians have long known the benefits of mental practice - sometimes called Mental Imagery or "motor imagery" - in improving their performance. [2] 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 [3].

Evidence of Mental Practice in Stroke Rehabilitation

Barclay-Goddard et al has conducted a systematic review of RCT to investigate mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Results has shown mental practice in combination with other treatment to be more effective in improving upper extremity function than the other treatment alone. [4] Though in other systematic review Braun et al in 2006 did not find out the implementation of mental practise in stroke rehabilitation and took conclusions that standardized measurement of outcome are needed. [5] But in 2013 Braun et al in a meta-analysis has found that mental practice might have positive effects on performance of activities in patients with neurological diseases. [6] Cha et al in the first meta-analysis on the effectiveness of functional task training with mental practice in stroke has also found favorable results of mental practice. The results indicate the clinical effectiveness of functional task training with mental practice provided by occupational and physical therapists in stroke rehabilitation.[7]


References

  1. Richardson, A. (1967). Mental practice: A review and discussion (Part II). Research Quarterly, 38, 263-273.
  2. Behncke L. Mental Skills Training For Sports: A Brief Review. Athletic Insight 2004; 6:6-7.
  3. Calayan LMS, Dizon JM. A systematic review of effectiveness of the mental practice with motor imagery in the neurologic rehabilitation of the stroke patients. The Internet Journal of Allied Health Sciences and Practice 2009; 7:8-9. 
  4. 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. 
  5. 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.
  6. 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.
  7. Cha YJ1, 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.