Dawn M. Nilsen, Glen Gillen, Andrew M. Gordon; Use of Mental Practice to Improve Upper-Limb Recovery After Stroke: A Systematic Review. Am J Occup Ther 2010;64(5):695-708. doi: 10.5014/ajot.2010.09034.
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© 2015 American Occupational Therapy Association
OBJECTIVE. We sought to determine whether mental practice is an effective intervention to improve upper-limb recovery after stroke.
METHOD. We conducted a systematic review of the literature, searching electronic databases for the years 1985 to February 2009. We selected studies according to specified criteria, rated each study for level of evidence, and summarized study elements.
RESULTS. Studies differed with respect to design, patient characteristics, intervention protocols, and outcome measures. All studies used imagery of tasks involving movement of the impaired limb. The length of the interventions and number of practice hours varied. Results suggest that mental practice combined with physical practice improves upper-limb recovery.
CONCLUSION. When added to physical practice, mental practice is an effective intervention. However, generalizations are difficult to make. Further research is warranted to determine who will benefit from training, the dosing needed, the most effective protocols, whether improvements are retained, and whether mental practice affects perceived occupational performance.
The participant receiving MP regressed on this measure. One participant receiving MP plus CIMT increased from 21 to 37, and the other remained stable.
The participant receiving MP only showed a slight but not meaningful improvement (a 0.1-s decrease). One participant receiving MP plus CIMT showed a 1.8-s improvement, and the other patient regressed by 6.2 s.
The participant receiving only MP showed a slight but not meaningful improvement on the MAL scales. One participant receiving MP plus CIMT showed a clinically meaningful improvement on both scales (2.3 and 1.08).
14% increase in experimental group compared with 6% for control group (p < .05).
Consistently increased during the 4 wk of intervention (21% improvement compared with baseline) with modest increases during the home-based training
Consistently increased during the 4 wk of intervention (23% improvement compared with baseline) with modest increases during the home-based training
Subtests reflected a trend of better recovery for the MP group and the physical practice group but not the conventional group. A significant difference was observed for the writing and simulated feeding subtests for the MP group vs. the conventional therapy group (p < 0.01).
Significant differences were found between the MP group and the conventional therapy group (p < .02). No differences were found between the MP and physical practice group.
The experimental group exhibited a 35.98% improvement compared with a 21.15% improvement in control group. The experimental group exhibited a significantly greater improvement (p = .002).
Mean change score = 3.8
Mean change = 4.9
After intervention, participants became eligible for mCIMT on the basis of improved motor status.
Significantly greater changes for the experimental group (10.7) vs. control group (4.6); p = .004
Greater changes for the experimental group (+1.6) vs. control group (+0.4)
Greater changes for the experimental group (+2.2) vs. control group (+0.2)
Scores of 46 (Pretest 1), 38 (Pretest 2), and 53 (Posttest); improvements were noted on the wrist and finger items in particular.
At the posttest, participant improved on 6 of the 10 items.
Participant obtained scores of 15 at Pretest 1, 17 at Pretest 2, and 40 at posttest.
Experimental change score: 13.8; control change score: 2.9
Experimental change score: 16.4; control change score: 0.7
Baseline mean = 72.33 (21.63); outcome mean = 78.83 (17.10); follow-up mean = 76.67 (15.88)
Baseline mean = 0.17 (0.15); outcome mean = 0.17 (0.14); follow-up mean = 0.18 (0.11)
Baseline mean = 0.42 (2.95); outcome mean = 0.46 (0.28); follow-up mean = 0.53 (0.31)
Baseline mean = 1.6 (1.19); outcome mean = 2.28 (1.32); follow-up mean = 2.01 (1.26)
Baseline mean = 39.83 (21.33); outcome mean = 43.17 (19.5); follow-up mean = 46.67 (20.54)
Consistently increased during intervention and modest increases during the 3 follow-up months
Improved during intervention with minimal decreases at follow-up
1-point increases during the intervention that diminished during the 1st month postintervention
Decreases in movement time during intervention and generally maintained at follow-up for 3 subtests
Mean line-length errors were 3.33, 7.38, and 0.30 in. at baseline and 1.41, 2.70, and 0.24 in., respectively, after MP training.
Mean line-length errors were 3.15, 6.56, and 0.52 in. at baseline and 1.85, 4.36, and 0.80 in. after intervention. Shorter tracing times and improved tracing quality were also noted.
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