Date Presented 4/21/2018
We were the first group to show that mental practice increases ability to perform valued occupations in chronic stroke survivors. This study found long-term benefits associated with its use with this population.
Primary Author and Speaker: Stephen Page
Contributing Authors: Peter Levine, Anthony Leonard
PURPOSE: The purpose of this study was to determine retention of motor changes 3 mo after participation in a regimen of mental practice combined with repetitive task-specific practice (MP + RTP). Upper extremity hemiparesis is one of the most frequent disabling stroke-induced impairments. MP + RTP efficacy has previously been determined; however, as with any treatment, identifying the approaches that confer sustained benefits is desirable in stroke rehabilitation.
METHOD: In this prospective, blinded, cohort, pretest–posttest study, participants were 21 adults in the chronic stage of stroke (M age = 66.1 ± 8.1, range = 56–76; M time since stroke at study enrollment = 58.7 mo, range = 13–129 mo) exhibiting mild to moderate impairments in hand function. All participants had been randomly assigned to receive a 10-wk regimen of MP emphasizing paretic upper extremity use during valued activities. Directly after each of these sessions, participants were administered audiotaped MP. We assessed this group’s paretic upper extremity motor levels before, after, and 3 mo after intervention by administering the upper extremity section of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), the Arm Motor Ability Test (AMAT), and the Box and Block Test (BB).
Paired samples t tests were conducted to compare total scores on each of the measures (i.e., FMA total scores; ARAT total scores; Functional Ability, Quality of Movement, and Time scale scores of the AMAT; and BB total scores) at posttest and 3-mo follow-up. Differences between means (rejection of the null hypothesis) were considered significant when p < .05.
RESULTS: None of the scores changed significantly from the period directly after intervention to the 3-mo posttesting period (FMA, t = .817; ARAT, t = .923; AMAT Functional Ability, t = .898; AMAT Quality of Movement, t = .818; AMAT Time, t = .967; BB, t = .892).
CONCLUSION: Changes in paretic upper extremity movement realized through MP + RTP participation were retained 3 mo after the intervention concluded.
IMPACT STATEMENT: Mental practice effects are retained well after the intervention has concluded. This easy-to-use, efficacious intervention thus can wield a substantial effect on practice outcomes long after it has been rendered. Stroke-induced hemiparesis is one of the main impairments encountered by occupational therapy practitioners, and stroke is primarily a disease of the aged population. These are thus critical practice areas in which knowledge of best clinical practices needs to be forwarded.
References
Page, S. J., Levine, P., & Leonard, A. (2007). Mental practice in chronic stroke: Results of a randomized, placebo-controlled trial. Stroke, 38, 1293–1297. https://doi.org/10.1161/01.STR.0000260205.67348.2b
Peters, H. T., & Page, S. J. (2015). Integrating mental practice with task-specific training and behavioral supports in poststroke rehabilitation: Evidence, components, and augmentative opportunities. Physical Medicine and Rehabilitation Clinics of North America, 26, 715–727. https://doi.org/10.1016/j.pmr.2015.06.004
