Mental practice in chronic stroke- results of a randomized, placebo- controlled trial

Background& purpose Mental practice (MP) = motor imagery Similarity between MP and physical practice  Neural and muscular structures activation  Time taken to mentally and physically perform movement  Speed accuracy tradeoff is maintained  Autonomic events Addition of MP rather than conventional motor therapy only is better for both subacute and acute stroke p’t

Hypothesis MP group would show significantly greater fine motor function changes MP+ physical practice group would exhibited lager score increase on the Fugl- Meyer impairment score

Method Outcome measures: 66-point, upper extremity section of the Fugl-Meyer assessment of motor recovery after stroke (FM) Action research arm test (ARA): grasp, grip pinch, and gross movement

Method Participants Volunteers recruited by advertisement posted in neurological and physical clinics. Inclusion: No more than one stroke Able to flex at least 10 ∘ from neutral at the affected wrist and MP and IP joints Stroke experience > 12 months score≥69 on the MMSE Age > 18 and <80 years

Method Exclusion: Excessively spasticity (MAS≥3) Excessive pain (VAS≥4) Still in any form of rehab. Participating in any experiment

Method R+PP MP+PP 30-minute tape of progressive relaxation program 30-minute tape of mental practice Single-blinded, multiple baseline, randomized, pre- and post-test control group 2 days per week, 30 min segments for 6 weeks One week after therapy completion, each subject returned to the laboratory to do the post- test

Result The group did not differ significantly on any of the interval level baseline measures, which were age, time poststroke, FM score, and ARA score. ARA: MP+PP improved average of 7.81 points R+PP improved average of 0.44 points FM: MP+PP improved mean of 6.72 points R+PP improved mean of 1 point

Discussion MP is thought to render its impact by at least 2 independent but interrelated mechanism 1.Increase affected arm use 2.Use-dependent brain reorganization  new cortical areas are recruited to assist in the movement of the affected arm. First randomized controlled, appropriately powered support to the hypothesis.

Limitation Did not use objective measures of affected arm use, such as activity monitors Did not use neuroimaging to confirm the neural mechanism of the treatment effect Measurement of the duration of the MP effect

Conclusion Traditional rehab. + mental practice during therapy increases outcomes significantly.