title: Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy.
abstract: This randomized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness. There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements. Imagining hand movements could stimulate restitution and redistribution of brain activity, which accompanies recovery of hand function, thus resulting in a reduced motor deficit. Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to methodological limitations. This randomized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke (on average <3 months post-stroke). Randomization was performed using an automated statistical minimizing procedure. The primary outcome measure was a blinded rating on the Action Research Arm test. The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week, compared to 31 patients who performed equally intensive non-motor mental rehearsal, and 32 patients receiving normal care without additional training. No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test (ANCOVA statistical P=0.77, and effect size partial η2=0.005) or any of the secondary outcome measures. Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke. In light of the evidence, it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right.
authors.affiliation: Department of Psychology, School of Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK. magdalena.ietswaart@unn.ac.uk
authors.forename: Magdalena
authors.initials: M
authors.lastname: Ietswaart
authors.forename: Marie
authors.initials: M
authors.lastname: Johnston
authors.forename: H Chris
authors.initials: HC
authors.lastname: Dijkerman
authors.forename: Sara
authors.initials: S
authors.lastname: Joice
authors.forename: Clare L
authors.initials: CL
authors.lastname: Scott
authors.forename: Ronald S
authors.initials: RS
authors.lastname: MacWalter
authors.forename: Steven J C
authors.initials: SJ
authors.lastname: Hamilton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001288:Attention / Q000502:physiology; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy / Q000379:methods*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D009048:Motor Skills / Q000502:physiology; D026741:Physical Therapy Modalities; D020127:Recovery of Function / Q000502:physiology*; D016037:Single-Blind Method; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome