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, prepost, case series. Setting: Outpatient rehabilitation hospital. Participants: Eleven patients who had a stroke more than I 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. (C) 2005 by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.