Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy

Magdalena Ietswaart, Marie Johnston, H Chris Dijkerman, Sara Joice, Clare L Scott, Ronald S MacWalter, Steven J C Hamilton, Magdalena Ietswaart, Marie Johnston, H Chris Dijkerman, Sara Joice, Clare L Scott, Ronald S MacWalter, Steven J C Hamilton

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.

Figures

Figure 1
Figure 1
Flow diagram summarizing the passage of participants through the stages of the trial.

References

    1. Altschuler EL, Wisdom SB, Stone L, Foster C, Galasko D, Llewellyn DME, et al. Rehabilitation of hemiparesis after stroke with a mirror. Lancet. 1999;353:2035–6.
    1. Annett J. Motor imagery - perception or action. Neuropsychologia. 1995;33:1395–417.
    1. Barsalou LW. Grounded cognition. Ann Rev Psychol. 2008;59:617–45.
    1. Bonetti D, Johnston M. Perceived control predicting the recovery of individual-specific walking behaviours following stroke: testing psychological models and constructs. Br J Health Psychol. 2008;13:463–78.
    1. Bovend’Eerdt TJ, Dawes H, Sackley C, Izadi H, Wade DT. An integrated motor imagery program to improve functional task performance in neurorehabilitation: a single-blind randomized controlled trial. Arch Phys Med Rehab. 2010;91:939–46.
    1. Braun SM, Beurskens AJ, Borm PJ, Schack T, Wade DT. The effects of mental practice in stroke rehabilitation: a systematic review. Arch Phys Med Rehab. 2006;87:842–52.
    1. Butler AJ, Page SJ. Mental practice with motor imagery: evidence for motor recovery and cortical reorganization after stroke. Arch Phys Med Rehab. 2006;87:S2–11.
    1. Carey JR, Kimberley TJ, Lewis SM, Auerbach EJ, Dorsey L, Rundquist P, et al. Analysis of fMRI and finger tracking training in subjects with chronic stroke. Brain. 2002;125:773–88.
    1. Cohen J. A power primer. Psychol Bull. 1992;112:155–9.
    1. Crosbie JH, McDonough SM, Gilmore DH, Wiggam MI. The adjunctive role of mental practice in the rehabilitation of the upper limb after hemiplegic stroke: a pilot study. Clin Rehab. 2004;18:60–8.
    1. de Vries S, Mulder T. Motor imagery and stroke rehabilitation: a critical discussion. J Rehab Med. 2007;39:5–13.
    1. Decety J. The neurophysiological basis of motor imagery. Behav Brain Res. 1996;77:45–52.
    1. Decety J, Chaminade T. When the self represents the other: a new cognitive neuroscience view on psychological identification. Consciousness Cogn. 2003;12:577–96.
    1. Decety J, Grezes J. Neural mechanisms subserving the perception of human actions. Trends Cogn Sci. 1999;3:172–8.
    1. De Renzi E, Faglioni P. Normative data and screening power of a shortened version of token test. Cortex. 1978;14:41–9.
    1. Dijkerman HC, Ietswaart M, Johnston M, MacWalter RS. Does motor imagery training improve hand function in chronic stroke patients? A pilot study. Clin Rehab. 2004;18:538–49.
    1. Dijkerman HC, Ietswaart M, Johnston M. Motor imagery and the rehabilitation of movement disorders: an overview. In: Guillot A, Collet C, editors. The neurophysiological foundations of mental and motor imagery. Oxford: Oxford University Press; 2010. pp. 127–44.
    1. Dimitrov DM, Rumrill PD. Pretest-posttest designs and measurement of change. Work. 2003;20:159–65.
    1. Dromerick AW, Edwards DF, Hahn M. Does the application of constraint-induced movement therapy during acute rehabilitation reduce arm impairment after ischemic stroke? Stroke. 2000;31:2984–8.
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Br Med J. 1997;13:629–34.
    1. Gaggioli A, Meneghini A, Morganti F, Alcaniz M, Riva G. A strategy for computer-assisted mental practice in stroke rehabilitation. Neurorehab Neural Repair. 2006;20:503–7.
    1. Giraux P, Sirigu A. Illusory movements of the paralyzed limb restore motor cortex activity. Neuroimage. 2003;20:S107–11.
    1. Grafton ST. Embodied cognition and the simulation of action to understand others. Ann NY Acad Sci. 2009;1156:97–117.
    1. Grezes J, Decety J. Functional anatomy of execution, mental simulation, observation, and verb generation of actions: a meta-analysis. Hum Brain Map. 2001;12:1–19.
    1. Handy TC, Borg JS, Turk DJ, Tipper CM, Grafton ST, Gazzaniga MS. Placing a tool in the spotlight: spatial attention modulates visuomotor responses in cortex. Neuroimage. 2005;26:266–76.
    1. Heller A, Wade DT, Wood VA, Sunderland A, Hewer RL, Ward E. Arm function after stroke - measurement and recovery over the 1st 3 months. J Neurol Neurosurg Psychiat. 1987;50:714–9.
    1. Holmes PS, Collins DJ. The PETTLEP approach to motor imagery: a functional equivalence model for sport psychologists. J Appl Sport Psychol. 2001;13:60–83.
    1. Ietswaart M, Johnston M, Dijkerman HC, Scott CL, Joice SA, Hamilton S, et al. Recovery of hand function through mental practice: A study protocol. BMC Neurol. 2006;6:39.
    1. Jackson PL, Doyon J, Richards CL, Malouin F. The efficacy of combined physical and mental practice in the learning of a foot-sequence task after stroke: a case report. Neurorehab Neural Repair. 2004;18:106–11.
    1. Jackson PL, Lafleur MF, Malouin F, Richards CL, Doyon J. Functional cerebral reorganization following motor sequence learning through mental practice with motor imagery. Neuroimage. 2003;20:1171–80.
    1. Jackson PL, Lafleur AF, Malouin F, Richards C, Doyon J. Potential role of mental practice using motor imagery in neurologic rehabilitation. Arch Phys Med Rehab. 2001;82:1133–41.
    1. Jang SH, Kim YH, Cho SH, Lee JH, Park JW, Kwon YH. Cortical reorganization induced by task-oriented training in chronic hemiplegic stroke patients. Neuroreport. 2003;14:137–41.
    1. Jeannerod M. The representing brain - neural correlates of motor intention and imagery. Behav Brain Sci. 1994;17:187–202.
    1. Jeannerod M. Mental-imagery in the motor context. Neuropsychologia. 1995;33:1419–32.
    1. Jeannerod M. Neural simulation of action: a unifying mechanism for motor cognition. Neuroimage. 2001;14:S103–9.
    1. Jeannerod M, Decety J. Mental motor imagery: a window into the representational stages of action. Curr Opin Neurobiol. 1995;5:727–32.
    1. Johnson-Frey SH. Stimulation through simulation? Motor imagery and functional reorganization in hemiplegic stroke patients. Brain Cogn. 2004;55:328–31.
    1. Johnston M, Bonetti D, Joice S, Pollard B, Morrison V, Francis JJ, MacWalter R. Recovery from disability after stroke as a target for a behavioural intervention: results of a randomized controlled trial. Disabil Rehab. 2007;29:1117–27.
    1. Johnston M, Pollard B, Morrison V, Macwalter R. Functional limitations and survival following stroke: psychological and clinical predictors of 3-year outcome. Int J Behav Med. 2004;11:187–96.
    1. Johnston M, Morrison V, Macwalter R, Partridge C. Perceived control, coping and recovery from disability following stroke. Psychol Health. 1999;14:181–92.
    1. Kahn RL, Goldfarb AI, Pollack KM, Peck A. Mental status questionnaire [MSQ] In: Kane RA, Kane RL, editors. Assessing the elderly: a practical guide to measurement. Lexington, MA: Lexington Books; 1981. pp. 92–94.
    1. Liu KP, Chan CC, Lee TM, Hui-Chan CW. Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Arch Phys Med Rehab. 2004;85:1403–8.
    1. Liu KP, Chan CC, Wong RS, Kwan IW, Yau CS, Li LS, Lee TM. A randomized controlled trial of mental imagery augment generalization of learning in acute poststroke patients. Stroke. 2009;40:2222–5.
    1. Lyle RC. A performance-test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehab Res. 1981;4:483–92.
    1. Mahony FL, Barthel DW. Functional evaluation. The Barthel Index. Maryland State Med J. 1965;14:61–5.
    1. Malouin F, Richards CL, Durand A, Doyon J. Reliability of mental chronometry for assessing motor imagery ability after stroke. Arch Phys Med Rehab. 2008;89:311–9.
    1. Marshall RS, Perera GM, Lazar RM, Krakauer JW, Constantine RC, DeLaPaz RL. Evolution of cortical activation during recovery from corticospinal tract infarction. Stroke. 2000;31:656–61.
    1. Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1:2.
    1. Moseley GL. Graded motor imagery for pathologic pain - a randomized controlled trial. Neurology. 2006;67:2129–34.
    1. Mueller K, Butefisch CM, Seitz RJ, Homberg V. Mental practice improves hand function after hemiparetic stroke. Restor Neurol Neurosci. 2007;25:501–11.
    1. Nelles G, Jentzen W, Jueptner M, Muller S, Diener HC. Arm training induced brain plasticity in stroke studied with serial positron emission tomography. Neuroimage. 2001;13:1146–54.
    1. Nico D, Daprati E, Rigal F, Parsons L, Sirigu A. Left and right hand recognition in upper limb amputees. Brain. 2004;127:120–32.
    1. Nudo RJ, Wise BM, SiFuentes F, Milliken GW. Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science. 1996;272:1791–4.
    1. Page SJ. Imagery improves upper extremity motor function in chronic stroke patients: a pilot study. Occupat Ther J Res. 2000;20:200–15.
    1. Page SJ, Levine P, Khoury JC. Modified constraint-induced therapy combined with mental practice thinking through better motor outcomes. Stroke. 2009;40:551–4.
    1. Page SJ, Levine P, Leonard A. Mental practice in chronic stroke - results of a randomized, placebo-controlled trial. Stroke. 2007;38:1293–7.
    1. Page SJ, Levine P, Leonard AC. Effects of mental practice on affected limb use and function in chronic stroke. Arch Phys Med Rehab. 2005;86:399–402.
    1. Page SJ, Levine P, Sisto SA, Johnston MV. Mental practice combined with physical practice for upper-limb motor deficit in subacute stroke. Phys Ther. 2001a;81:1455–62.
    1. Page SJ, Levine P, Sisto S, Johnston MV. A randomized efficacy and feasibility study of imagery in acute stroke. Clin Rehab. 2001b;15:233–40.
    1. Page SJ, Szaflarski JP, Eliassen JC, Pan H, Cramer SC. Cortical plasticity following motor skill learning during mental practice in stroke. Neurorehab Neural Repair. 2009;23:382–8.
    1. Parsons LM. Temporal and kinematic properties of motor behavior reflected in mentally simulated action. J Exp Psychol Hum Percep Perf. 1994;20:709–30.
    1. Parsons LM. Integrating cognitive psychology, neurology and neuroimaging. Acta Psychol. 2001;107:155–81.
    1. Parsons LM, Gabrieli JDE, Phelps EA, Gazzaniga MS. Cerebrally lateralized mental representations of hand shape and movement. J Neurosci. 1998;18:6539–48.
    1. Partridge C, Johnston M. Perceived control and recovery from stroke. Br J Clin Psychol. 1989;28:53–9.
    1. Pascual-Leone A, Dang N, Cohen LG, Brasilneto JP, Cammarota A, Hallett M. Modulation of muscle responses evoked by transcranial magnetic stimulation during the acquisition of new fine motor-skills. J Neurophysiol. 1995;74:1037–45.
    1. Pocock ST. Clinical trials: a practical guide. Chichester: Wiley; 1983.
    1. Pollard B, Johnston M. Problems with the sickness impact profile: a theoretically based analysis and a proposal for a new method of implementation and scoring. Soc Sci Med. 2001;52:921–35.
    1. Pulvermuller F. Brain mechanisms linking language and action. Nat Rev Neurosci. 2005;6:576–82.
    1. Ramachandran VS, Rogers-Ramachandran D. Synaesthesia in phantom limbs induced with mirrors. Proc Roy Soc Lond Ser B Biol Sci. 1996;263:377–86.
    1. Rizzolatti G, Craighero L. The mirror-neuron system. Annu Rev Neurosci. 2004;27:169–92.
    1. Robertson IH, Murre JMJ. Rehabilitation of brain damage: brain plasticity and principles of guided recovery. Psychol Bull. 1999;125:544–75.
    1. Sharma N, Pomeroy VM, Baron JC. Motor imagery: a backdoor to the motor system after stroke? Stroke. 2006;37:1941–52.
    1. Sirigu A, Cohen L, Duhamel JR, Pillon B, Dubois B, Agid Y, et al. Congruent unilateral impairments for real and imagined hand movements. Neuroreport. 1995;6:997–1001.
    1. Sirigu A, Duhamel JR, Cohen L, Pillon B, Dubois B, Agid Y. The mental representation of hand movements after parietal cortex damage. Science. 1996;273:1564–8.
    1. Stevens JA, Stoykov MEP. Using motor imagery in the rehabilitation of hemiparesis. Arch Phys Med Rehab. 2003;84:1090–2.
    1. van der Lee JH, Wagenaar RC, Lankhorst GJ, Vogelaar TW, Deville WL, Bouter LM. Forced use of the upper extremity in chronic stroke patients - results from a single-blind randomized clinical trial. Stroke. 1999;30:2369–75.
    1. Weiller C. Recovery from motor stroke - human positron emission tomography studies. Cerebrovasc Dis. 1995;5:282–91.
    1. Yavuzer G, Selles R, Sezer N, Sutbeyaz S, Bussmann JB, Koseoglu F, et al. Mirror therapy improves hand function in subacute stroke: A randomized controlled trial. Arch Phys Med Rehab. 2008;89:393–8.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiat Scand. 1983;67:361–70.
    1. Zimmermann-Schlatter A, Schuster C, Puhan MA, Siekierka E, Steurer J. Efficacy of motor imagery in post-stroke rehabilitation: a systematic review. J Neuroeng Rehab. 2008;5:8.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere