Articles
Effects of mental practice on affected limb use and function in chronic stroke

https://doi.org/10.1016/j.apmr.2004.10.002Get rights and content

Abstract

Page SJ, Levine P, Leonard AC. Effects of mental practice on affected limb use and function in chronic stroke.

Objective

To determine the efficacy of a mental practice (MP) protocol in increasing the function and use of the more affected limb in stroke patients.

Design

Randomized, controlled, multiple baseline, pre-post, case series.

Setting

Outpatient rehabilitation hospital.

Participants

Eleven patients who had a stroke more than 1 year before study entry (9 men; mean age, 62.3±5.1y; range, 53–71y; mean time since stroke, 23.8mo; range, 15–48mo; 10 strokes exhibiting upper-limb hemiparesis on the dominant side) and who exhibited affected arm hemiparesis and nonuse.

Intervention

All patients received 30-minute therapy sessions 2 days a week for 6 weeks. The sessions emphasized activities of daily living (ADLs): 6 subjects randomly assigned to the MP condition concurrently received sessions requiring daily MP of the ADLs; 5 subjects (control group) received an intervention consisting of relaxation techniques.

Main outcome measures

The Motor Activity Log and Action Research Arm (ARA) test.

Results

Affected limb use as rated by MP patients and their caregivers increased (1.55, 1.66, respectively), as did patient and caregiver ratings of quality of movement (2.33, 2.15, respectively) and ARA scores (10.7). In contrast, the controls showed nominal increases in the amount they used their affected limb and in limb function. A Wilcoxon test on the ARA scores revealed significantly (P=.004) greater changes in the MP group’s scores.

Conclusions

Participation in an MP protocol may increase a stroke patient’s use of his/her more affected limb. Data further support that the protocol resulted in correlative, MP-induced, motor function improvements. The mechanisms whereby MP increases affected arm use are unknown. Perhaps using the more affected limb becomes more salient through MP, or perhaps motor schema are altered during MP to integrate limb use.

Section snippets

Participants

Subjects for this study were recruited as part of a larger MP study. We placed advertisements in therapy clinics and gave them to therapists in the midwestern United States. A research team member screened volunteers according to the following inclusion criteria: (1) 10° or more of active flexion in the more affected wrist, as well as in 2 digits of the more affected hand; (2) stroke experienced more than 1 year before study enrollment; (3) a score 70 or higher on the modified Mini-Mental

Results

Before the intervention, none of the subjects used their more affected upper limb for ADLs, as indicated by self-rated pretest mean AOU scores of 1.1 and 0.9 for the MP and control groups, respectively. The caregivers’ mean AOU ratings for the preintervention MAL closely corroborated patient estimates, with scores of 1.05 and 1.15 for MP and control groups, respectively. After the intervention, AOU ratings by MP patients and their caregivers were 2.60 and 2.71, respectively. Mean change scores

Discussion

Stroke patients often do not use their more affected arms for ADLs, even when they are capable of doing so. In addition to causing a greater handicap level, this nonuse can undermine motor return, because limb use appears to be related to cortical reorganization and, ultimately, to reacquisition of motor function. This case series examined MP as a strategy to increase use and function of the more affected limb after stroke.

The MAL AOU scores showed that all subjects not only met the criterion

Conclusions

MP appears to be a promising protocol for improving more affected upper-limb motor function in stroke patients. Our data also suggest that MP participation increases more affected limb use. These use patterns may be altered by demonstrating to patients that they are capable of performing more with the affected limb than they believed. It is also plausible that more affected limb use becomes more salient through MP use because new motor schema are developed, or preexisting motor schema are

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  • Cited by (0)

    Supported by the Retirement Research Foundation (grant no. 2001-037).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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