• The Use of Mental Practice in Occupational Therapy for Stroke Patients

• Sarah Freeman

• [email_address]

Mental Practice

• 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

Objectives

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

• 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

Types of mental imagery

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

• Sarah Freeman

• [email_address]

Mental Practice

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.