Mental Practice in Stroke Rehabilitation

Original Editor - Venkata Nagaraj Mummadisetty Top Contributors - Rochelle Dsouza, Ilona Malkauskaite, Rucha Gadgil, Kim Jackson, Nikhil Benhur Abburi, Venkata Nagaraj Mummadisetty, Lauren Lopez, Scott Buxton, Naomi O'Reilly, Vanessa Rhule and Ally Youssouf

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”.

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. 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 the 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.

Evidence of Mental Practice in Stroke Rehabilitation

There have been multiple studies done to study the role of Mental Practice in Rehabilitation of Stroke:

1. A systematic review by Braun et al could not find any positive effects of implementation of mental practice in stroke rehabilitation and concluded that standardized outcome measures are needed for further investigations.
2. Barclay-Goddard et al conducted a systematic review to investigate mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Results showed that mental practice in combination with other treatment methods were more effective in improving upper extremity function than the MP alone.
3. Cha et al in the first meta-analysis on the effectiveness of functional task training with mental practice in stroke found that functional task training with mental practice provided by occupational and physical therapists in stroke rehabilitation were functionally effective.
4. Braun et al in a meta-analysis later on found that mental practice might have positive effects on the performance of activities in patients with neurological diseases.
5. Parks et al evaluated the effects of mental practice on stroke patients’ upper extremity function and activities of daily living (ADL) using the Action Research Arm Test (ARAT), the Fugl-Meyer assessment (FMA), and the Modified Barthel Index (MBI) as outcome measures. Their results demonstrated that of mental practice intervention is effective at improving stroke patients’ upper extremity function and daily activity performance.
6. Another systematic review in 2016 studied the the clinical effectiveness of MP in rehabilitation and functional recovery. They found MP to be effective when used in conjunction with conventional physical therapy for functional rehabilitation of both upper and lower limbs, and for the recovery of daily activities and skills. However, they concluded that due to the heterogeneity of the studies with regard to the intervention protocol, specific imagery technique, time spent practicing, patient characteristics, etc., more studies were needed to determine the optimal treatment protocol.