Using mental practice in stroke rehabilitation: a framework

Introduction: Motor imagery and mental practice are getting increased attention in neurological rehabilitation. Several different mental practice intervention protocols have been used in studies on its effect on recovery in stroke rehabilitation. The content of the intervention protocols itself is rarely discussed or questioned. Objective: To give a practical framework of how mental practice could be integrated into therapy, drawing on available evidence and theory. The aim of the treatment programme described is to enhance both the patient's physical performance and their empowerment and self-determination. The framework: Based on evidence from sports rehabilitation and our own experiences the framework will eventually be evaluated in a randomized controlled trial. Five steps are described to teach and upgrade the patient's imagery technique: (1) assess mental capacity to learn imagery technique; (2) establish the nature of mental practice; (3) teach imagery technique; (4) embed and monitor imagery technique; (5) develop self-generated treatments. The description is not, however, a recipe that should be followed precisely. It leaves enough room to tailor the mental practice intervention to the specific individual possibilities, skills and needs of the patient in accordance with evidence-based practice. Discussion: Different aspects of the described protocol are discussed and compared with experiences from sports and evidence available in rehabilitation.

[1]  Nichola Callow,et al.  Imagery use by injured athletes: A qualitative analysis , 2006, Journal of sports sciences.

[2]  T. Schack.  The cognitive architecture of complex movement , 2004 .

[3]  S. Page,et al.  Effects of mental practice on affected limb use and function in chronic stroke. , 2005, Archives of physical medicine and rehabilitation.

[4]  Julien Doyon,et al.  Training Mobility Tasks after Stroke with Combined Mental and Physical Practice: A Feasibility Study , 2004, Neurorehabilitation and neural repair.

[5]  S. McDonough,et al.  The adjunctive role of mental practice in the rehabilitation of the upper limb after hemiplegic stroke: a pilot studya , 2004, Clinical rehabilitation.

[6]  S. Page,et al.  Mental Practice in Chronic Stroke: Results of a Randomized, Placebo-Controlled Trial , 2007, Stroke.

[7]  M. Denis,et al.  Reopening the Mental Imagery Debate: Lessons from Functional Anatomy , 1998, NeuroImage.

[8]  C. Richards,et al.  Potential role of mental practice using motor imagery in neurologic rehabilitation. , 2001, Archives of physical medicine and rehabilitation.

[9]  Imagery and motor performance: what do we really know? , 1994 .

[10]  Thomas Schack,et al.  Is it possible to use the Structural Dimension Analysis of Motor Memory (SDA-M) to investigate representations of motor actions in stroke patients? , 2007, Clinical rehabilitation.

[11]  C. Hall,et al.  Imagery and the acquisition of motor skills. , 1992, Canadian journal of sport sciences = Journal canadien des sciences du sport.

[12]  H. C. Dijkerman,et al.  Does motor imagery training improve hand function in chronic stroke patients? A pilot study , 2004, Clinical rehabilitation.

[13]  C. Richards,et al.  Brain activations during motor imagery of locomotor‐related tasks: A PET study , 2003, Human brain mapping.

[14]  D. Wade,et al.  Personal context as a focus for rehabilitation , 2000, Clinical rehabilitation.

[15]  Sjoerd J de Vries,et al.  Motor imagery and stroke rehabilitation: a critical discussion. , 2007, Journal of rehabilitation medicine.

[16]  E. Procyk,et al.  Brain activity during observation of actions. Influence of action content and subject's strategy. , 1997, Brain : a journal of neurology.

[17]  T. Weiss,et al.  Activation processes during mental practice in stroke patients. , 1994, International Journal of Psychophysiology.

[18]  J. Baron,et al.  Motor Imagery: A Backdoor to the Motor System After Stroke? , 2006, Stroke.

[19]  R. Dickstein,et al.  Motor Imagery in Physical Therapist Practice , 2007, Physical Therapy.

[20]  Robert C. Wagenaar,et al.  Therapy Impact on Functional Recovery in Stroke Rehabilitation , 1999 .

[21]  C. Trombly,et al.  Effect of rehabilitation tasks on organization of movement after stroke. , 1999, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[22]  E. Wist,et al.  A mental route to motor learning: Improving trajectorial kinematics through imagery training , 1998, Behavioural Brain Research.

[23]  D. Sackett,et al.  Evidence based medicine: what it is and what it isn't , 1996, BMJ.

[24]  Kathleen A. Martin,et al.  Imagery Use in Sport: A Literature Review and Applied Model , 1999 .

[25]  S. Satya‐Murti.  Evidence-based Medicine: How to Practice and Teach EBM , 1997 .

[26]  F. Schmidt.  Meta-Analysis , 2008 .

[27]  G. Moseley,et al.  Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial , 2004, Pain.

[28]  Peter R. Giacobbi,et al.  The Four Ws of Imagery Use: Where, When, Why, and What , 2000 .

[29]  C. Richards,et al.  Working memory and mental practice outcomes after stroke. , 2004, Archives of physical medicine and rehabilitation.

[30]  Ruth Dickstein,et al.  Integration of Motor Imagery and Physical Practice in Group Treatment Applied to Subjects With Parkinson’s Disease , 2007, Neurorehabilitation and neural repair.

[31]  D. Gould,et al.  Imagery training for peak performance. , 2002 .

[32]  S. H. Johnson,et al.  Intact Motor Imagery in Chronic Upper Limb Hemiplegics: Evidence for Activity-Independent Action Representations , 2002, Journal of Cognitive Neuroscience.

[33]  Chetwyn C. H. Chan,et al.  Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. , 2004, Archives of physical medicine and rehabilitation.

[34]  M. Jeannerod.  Mental imagery in the motor context , 1995, Neuropsychologia.

[35]  Peter Langhorne,et al.  Effects of Augmented Exercise Therapy Time After Stroke: A Meta-Analysis , 2004, Stroke.

[36]  Carolyn Copper,et al.  Does mental practice enhance performance , 1994 .

[37]  D. Wade,et al.  The effects of mental practice in stroke rehabilitation: a systematic review. , 2006, Archives of physical medicine and rehabilitation.

[38]  G. Kwakkel,et al.  Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial , 1999, The Lancet.

[39]  J. Decety.  The neurophysiological basis of motor imagery , 1996, Behavioural Brain Research.

[40]  John Annett,et al.  Imagery and motor processes: Editorial overview , 1995 .

[41]  Scott H. Johnson,et al.  Imagining the impossible: intact motor representations in hemiplegics , 2000, Neuroreport.

[42]  D. Wade,et al.  Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial , 2007, BMC neurology.