title: Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate and compare efficacy of 20-, 40-, and 60-minute mental practice sessions on affected upper extremity impairment and functional limitation.
  
  
  METHODS
  Randomized controlled study with multiple baseline design.
  
  
  METHODS
  Twenty-nine subjects with chronic stroke and exhibiting stable, mild hemiparesis.
  
  
  METHODS
  Subjects were given 30-minute rehabilitative sessions 3 days/week for 10 weeks, emphasizing affected upper extremity use during valued activities. Directly after these sessions, randomly selected subjects were given audiotaped mental practice for 20, 40, or 60 minutes. Subjects assigned to a control group received the same therapy as the mental practice groups, and an audiotaped sham intervention directly after therapy sessions.
  
  
  METHODS
  Fugl-Meyer (FM) motor assessment and Action Research Arm Test (ARAT).
  
  
  RESULTS
  No pre-existing differences were found between groups on any demographic variable or movement scale. On the FM, mental practice duration significantly predicted pretesting to post change (P = 0.05), with increasing duration related to larger FM score increases (5.4 point score increase for the 60-minute duration group). On the ARAT, a non-significant trend was seen (P = 0.78), favoring the 20-minute dosing condition (4.5 point increase). Importantly, regardless of dosing condition, subjects administered mental practice exhibited markedly larger score changes on both the FM and ARAT than subjects not receiving mental practice.
  
  
  CONCLUSIONS
  Sixty minutes of mental practice appears to most significantly reduce affected arm impairment. However, no clear change pattern was seen in affected arm functional limitation according to mental practice duration. Results suggest that a stroke rehabilitative regimen augmented by mental practice renders a greater functional impact than therapy only.
authors.affiliation: Departments of Rehabilitation Sciences, Physical Medicine and Rehabilitation, Neurosciences, and Neurology, University of Cincinnati Academic Medical Center (UCAMC), Cincinnati, OH, USA. Stephen.Page@uc.edu
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Page
authors.forename: Kari
authors.initials: K
authors.lastname: Dunning
authors.forename: Valerie
authors.initials: V
authors.lastname: Hermann
authors.forename: Anthony
authors.initials: A
authors.lastname: Leonard
authors.forename: Peter
authors.initials: P
authors.lastname: Levine
mesh_terms: D000328:Adult; D000368:Aged; D001288:Attention; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000379:methods*; D010291:Paresis / Q000534:rehabilitation; D012063:Relaxation; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome; D034941:Upper Extremity