Mental practice based rehabilitation training to improve arm function and daily activity performance: a randomized clinical trial

Rehabilitation Foundation Limburg, Hoensbroek, The Netherlands.
BMC Neurology (Impact Factor: 2.04). 02/2008; 8(1):7. DOI: 10.1186/1471-2377-8-7
Source: PubMed


Over 50% of patients with upper limb paresis resulting from stroke face long-term impaired arm function and ensuing disability in daily life. Unfortunately, the number of effective treatments aimed at improving arm function due to stroke is still low. This study aims to evaluate a new therapy for improving arm function in sub-acute stroke patients based on mental practice theories and functional task-oriented training, and to study the predictors for a positive treatment result. It is hypothesized that a six-week, mental practice-based training program (additional to regular therapy) targeting the specific upper extremity skills important to the individual patient will significantly improve both arm function and daily activity performance, as well as being cost effective.
One hundred and sixty sub-acute stroke patients with upper limb paresis (MRC grade 1-3) will participate in a single-blinded, multi-centre RCT. The experimental group will undertake a six-week, individually tailored therapy regime focused on improving arm function using mental practice. The control group will perform bimanual upper extremity exercises in addition to regular therapy. Total contact time and training intensity will be similar for both groups. Measurements will be taken at therapy onset, after its cessation and during the follow-up period (after 6 and 12 months). Primary outcome measures will assess upper extremity functioning on the ICF level of daily life activity (Wolf Motor Function Test, Frenchay Arm Test, accelerometry), while secondary outcome measures cover the ICF impairment level (Brunnstrom-Fu-Meyer test). Level of societal participation (IPA) and quality of life (EuroQol; SS-Qol) will also be tested. Costs will be based on a cost questionnaire, and statistical analyses on MAN(C)OVA and GEE (generalized estimated equations).
The results of this study will provide evidence on the effectiveness of this mental practice-based rehabilitation training, as well as the cost-effectiveness.
Current Controlled Trials [ISRCTN33487341).

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Available from: Henk A M Seelen,
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    • "Mental training can be successfully applied in helping a person to regain lost movement patterns after joint operations or joint replacements and in neurological rehabilitation. Mental practice has also been used in combination with actual practice to rehabilitate motor deficits in a patient with sub-acute stroke [13], and several studies have also shown improvement in strength, function, and use of both upper and lower extremities in chronic stroke patients [14] [15]. "
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    • "c 2013 – IOS Press and the authors. All rights reserved (CIMT) [42], mental practice [3] [38], task-oriented training [33], and technology-supported rehabilitation [2] [31]. Although these approaches have been proven successful, most approaches have been evaluated in patients who are able to execute functional grasp-and-release tasks with their impaired arm and hand without assistance, i.e. in patients with voluntary wrist and finger extension in the paretic arm and hand [20]. "

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