The Use of Mental Practice in Occupational Therapy for Stroke Patients Sarah Freeman sarah@sarahfreeman.co.uk

Objectives Definition of mental practice Types of mental imagery The effectiveness of mental practice The use of mental practice in stroke rehabilitation and in occupational therapy Areas for further research

What is mental practice? ‘the symbolic rehearsal of a physical activity in the absence of any gross muscular movements’ (Richardson, 1967) Mental practice is achieved through the use of mental imagery The effects of mental and physical practice are functionally similar

Types of mental imagery Visual eg Imagining the movement of a visual form Motor eg imagining your own hand moving Kinaesthetic eg imagining the feeling of your hand moving

Types of mental imagery Internal Imagery- an internal recreation of the task: Effective for planning a task External Imagery- an outside perspective of performance: More effective for learning & subsequent retention

The effectiveness of mental practice Combined with physical practice, mental practice: improves performance to the same, or a higher extent than physical practice alone increases the rate of skill acquisition may facilitate greater performance than that of a control condition of no input

Stroke rehabilitation approaches All approaches involve the process of re-learning Eg: Neurodevelopmental treatment (Bobath) Motor re-learning (Carr & Shepherd) Task- oriented approaches Compensatory

Mental practice theories It is debated whether mental practice relies on motor, cognitive or motivational processes Mental practice is more effective when learning simple tasks Imagery abilities may vary Tasks learned must be meaningful & prior experience of the activity is necessary

How mental imagery can promote functional independence through relearning

Mental practice used in occupational therapy Page, Levine & Leonard (2005) Investigated the efficacy of mental practice in increasing the function & use of the affected upper limb of 11 stroke patients. Randomized, controlled pre-post case series study Tasks were reaching & grasping a cup, turning pages & using a pen.

Mental practice used in occupational therapy Page, Levine & Leonard (2005) Results showed: Increased affected limb use and function Skills had been generalized to other ADLs after intervention

Mental practice used in occupational therapy Smania, et al. (1997) Studied the effectiveness of visuomotor imagery practice in rehabilitation of unilateral neglect Before / after trial on 2 participants Mental imagery included imagining patients at home, geographical areas, reverse spelling & mental representation.

Mental practice used in occupational therapy Smania, et al. (1997) Outcomes assessed using functional tests & neuropsychological tests Visuomotor imagery training found to improve performance deficits related to neglect

Mental practice used in occupational therapy Liu et al., (2004) Studied the efficacy of mental imagery at promoting relearning for people after a stroke Prospective, randomized controlled trial, of 46 stroke inpatients aged over 60 years. MP Protocol used picture cards, visualizing performance and watching videotaped performance

Mental practice used in occupational therapy Liu et al., (2004) Outcome measures used were the performance of 15 trained and 5 untrained daily living tasks Patients who engaged in mental practice improved their attention & sequencing ability Increased their relearning of familiar and new tasks

Benefits of using mental practice Increases affected limb use and function Can improve cognitive skills (eg attention, sequencing) Creates opportunities for clients to problem-solve Uses a client-centred approach Time / cost -effective

Areas for further research Establishing guidelines and protocols Motivational aspects of relearning through mental practice Long-term occupational benefits

Mental Practice Sarah Freeman sarah@sarahfreeman.co.uk

References Bell, A. & Murray, B (2004) Improvement in Upper Limb Motor Performance following Stroke: the Use of Mental Practice. British Journal of Occupational Therapy 67 (11): 501-507. Kosslyn,S.M. (1994) Image and brain : the resolution of the imagery debate. Cambridge, Mass. ; London : MIT Press Liu, K. P., Chan, C. C., Lee, T., Hui-Chan, C. W. (2004) Mental Imagery for Promoting Relearning for People After Stroke: A Randomized Controlled Trial. Archives of Physical Medical Rehabilitation 85:1403-8. Page, S. Levine, P. Leonard, A. (2005) Effects of Mental Practice on Affected Limb Use and Function in Chronic Stroke. Archives of Physical & Medical Rehabilitation 86 399-402. Richardson, A (1967) Mental Practice: a review and discussion (part 1). Research Quarterly (38): 95-107 Smania, N., Bazoli, .F, Piva, D., Guidetti, G. (1997) Visuomotor imagery and rehabilitation of neglect. Archives of Physical & Medical Rehabilitation, 78:430-6. Van Leeuwen, R., Inglis, J.T. (1998) Mental practice and imagery: a potential in stroke rehabilitation. Physical Therapy Reviews 3:47-52.