Dawn M. Nilsen, Glen Gillen, Theresa DiRusso, Andrew M. Gordon; Effect of Imagery Perspective on Occupational Performance After Stroke: A Randomized Controlled Trial. Am J Occup Ther 2012;66(3):320–329. https://doi.org/10.5014/ajot.2012.003475
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© 2021 American Occupational Therapy Association
OBJECTIVE. This preliminary study sought to determine whether the imagery perspective used during mental practice (MP) differentially influenced performance outcomes after stroke.
METHOD. Nineteen participants with unilateral subacute stroke (9 men and 10 women, ages 28–77) were randomly allocated to one of three groups. All groups received 30-min occupational therapy sessions 2×/wk for 6 wk. Experimental groups received MP training in functional tasks using either an internal or an external perspective; the control group received relaxation imagery training. Participants were pre- and posttested using the Fugl-Meyer Motor Assessment (FMA), the Jebsen–Taylor Test of Hand Function (JTTHF), and the Canadian Occupational Performance Measure (COPM).
RESULTS. At posttest, the internal and external experimental groups showed statistically similar improvements on the FMA and JTTHF (p < .05). All groups improved on the COPM (p < .05).
CONCLUSION. MP combined with occupational therapy improves upper-extremity recovery after stroke. MP does not appear to enhance self-perception of performance. This preliminary study suggests that imagery perspective may not be an important variable in MP interventions.
Whether occupational therapy combined with MP from either perspective would reduce impairment, improve function, and enhance self-perception of performance above a control condition;
Whether MP using an internal perspective would be more effective in reducing impairment and improving function than MP using an external perspective; and
Whether MP using an external perspective would be more effective in enhancing self-perception of occupational performance than MP using an internal perspective.
Primary measure 1: The UE section of the Fugl-Meyer Assessment of Motor Recovery (FMA; Fugl-Meyer, Jääskö, Leyman, Olsson, & Steglind, 1975) evaluates impairment using a 3-point ordinal scale (maximum score = 66 points; higher scores indicate less impairment). The FMA has high test–retest reliability (r = .99), interrater reliability (rs = .96–.97; Duncan, Propst, & Nelson, 1983), and construct validity (see Malouin, Pichard, Bonneau, Durand, & Corriveau, 1994).
Primary measure 2: The JTTHF evaluates hand function, and it has been shown to have strong test–retest reliability (rs = .67–.99; Jebsen et al., 1969; Stern, 1992) and validity in predicting functional hand use in ADLs (Lynch & Bridle, 1989). The durations of six of the seven subtests (the writing subtest was removed) were summed to generate a total time score; faster times indicate greater hand function.
Secondary measure: The Canadian Occupational Performance Measure (COPM; Law et al., 1994) evaluates a person’s self-perception of occupational performance and satisfaction with performance using two 10-point ordinal scales. The COPM has been shown to have strong test–retest reliability (intraclass correlation [ICC] = .63 for performance, ICC = .84 for satisfaction; Law et al., 1994), as well as content and concurrent validity (see Carswell et al., 2004). The COPM was modified from its original form in a manner consistent with previous research (see Gillen et al., 2007).
Introduction (approximately 2 min): Description of the task to be imagined and imagery perspective instructions. The internal group was instructed as follows: “You should imagine performing the movements from inside of your body, as if you were looking through your own eyes while performing the movements.” The external group was instructed as follows: “You should imagine watching yourself performing the movements from outside your body, as if you were watching a videotape of yourself on a TV screen.”
Relaxation (approximately 5 min): Suggestions for relaxation of various body parts.
Focused imagery (approximately 8 min): Stimulus and response propositions designed to generate imagery related to the specific task practice and to encourage maintenance of the instructed perspective. Key components of the task were repeated during this section.
Refocusing (approximately 3 min): Instruction to refocus into the room and instruction regarding use of mental practice, as follows: “Remember not to mentally practice on your own or to speak to anyone about the contents of your practice sessions.”
Mental practice of functional tasks should be incorporated into occupational therapy programs to improve arm and hand function during poststroke recovery.
Preliminary data suggest that clients may be able to self-select either imagery perspective from which to mentally practice functional tasks.
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