The effects of mental practice in stroke rehabilitation: a systematic review.
OBJECTIVE
To assess the effects of a mental practice intervention on recovery in stroke patients.


METHODS
A systematic literature search of the Cochrane Database of Systematic Reviews, PubMed/Medline, PsycINFO, Pedro, Rehadat, and RehabTrials was performed by 2 researchers independently. Eligible studies published through August 2005 were selected.


METHODS
Four randomized controlled trials (RCTs), 1 controlled clinical trial (CCT), 2 patient series, and 3 case reports that investigated the effects of a mental practice intervention on recovery of stroke patients were included.


METHODS
The selected RCTs and CCT were assessed on a methodologic quality rating scale. Important characteristics and outcomes were extracted and summarized. Results and characteristics from the patient series and case reports were only provided if they added information.


RESULTS
Included studies differed clearly from one another with regard to patient characteristics, intervention protocol, and outcome measures. Four different mental practice strategies were used. Most tasks involved mentally rehearsing movements of the arm. Intervention periods varied from 2 to 6 weeks, frequencies ranged from multiple sessions per day to 3 times a week. Studies were limited in size. Power could not be increased by pooling or meta-analysis because studies were not comparable. Three of the 4 RCTs were of reasonable methodologic quality. There was some evidence that mental practice as an additional therapy intervention had positive effects on recovery of arm function after stroke. Two mental practice techniques appeared to be effective-tape instruction and self-regulation. Results from the single case studies indicate that mental practice is also promising for improvement of leg function.


CONCLUSIONS
No definite conclusions could be drawn except that further research, using clear definitions of the content of mental practice and standardized measurement of outcome, are needed.
Braun
Susy M
SM
Centre of Expertise in Life Sciences, School of Professional Education, Zuyd University, Nieuw Eyckholt 300, 6400 AN Heerlen, The Netherlands. s.braun@hszuyd.nl
Beurskens
Anna J
AJ
Borm
Paul J
PJ
Schack
Thomas
T
Wade
Derick T
DT
D000203:Activities of Daily Living; D002986:Clinical Trials as Topic; D006801:Humans; D019018:Imagery, Psychotherapy; D008606:Mental Processes; D009048:Motor Skills; D011788:Quality of Life; D020127:Recovery of Function; D020521:Stroke / Q000523:psychology*; D000071939:Stroke Rehabilitation