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The Use of Mental Practice in Occupational Therapy for Stroke
Patients
Sarah Freeman
[email_address]
Mental Practice
Definition of mental practice
Types of mental imagery
The effectiveness of mental practice
The use of mental practice in stroke rehabilitation and in
occupational therapy
Areas for further research
Objectives
What is mental practice?
the symbolic rehearsal of a physical activity in the absence of
any gross muscular movements (Richardson, 1967)
Mental practice is achieved through the use of mental
imagery
The effects of mental and physical practice are functionally
similar
Types of mental imagery
Visual
eg Imagining the movement of a visual form
Motor
eg imagining your own hand moving
Kinaesthetic
eg imagining the feeling of your hand moving
Internal Imagery- an internal recreation of the task:
Effective for planning a task
External Imagery- an outside perspective of performance:
More effective for learning & subsequent retention
Types of mental imagery
The effectiveness of mental practice
Combined with physical practice,
mental practice:
improves performance to the same, or a higher extent than
physical practice alone
increases the rate of skill acquisition
may facilitate greater performance than that of a control
condition of no input
Stroke rehabilitation approaches
All approaches involve the process of re-learning
Eg:
Neurodevelopmental treatment (Bobath)
Motor re-learning (Carr & Shepherd)
Task- oriented approaches
Compensatory
Mental practice theories
It is debated whether mental practice relies on motor,
cognitive or motivational processes
Mental practice is more effective when learning simple
tasks
Imagery abilities may vary
Tasks learned must be meaningful & prior experience of the
activity is necessary
How mental imagery can promote functional independence through
relearning
Mental practice used in occupational therapy
Page, Levine & Leonard (2005)
Investigated the efficacy of mental practice in increasing the
function & use of the affected upper limb of 11 stroke
patients.
Randomized, controlled pre-post case series study
Tasks were reaching & grasping a cup, turning pages &
using a pen.
Mental practice used in occupational therapy
Page, Levine & Leonard (2005)
Results showed:
Increased affected limb use and function
Skills had been generalized to other ADLs after
intervention
Mental practice used in occupational therapy
Smania, et al. (1997)
Studied the effectiveness of visuomotor imagery practice in
rehabilitation of unilateral neglect
Before / after trial on 2 participants
Mental imagery included imagining patients at home,
geographical areas, reverse spelling & mental
representation.
Mental practice used in occupational therapy
Smania, et al. (1997)
Outcomes assessed using functional tests &
neuropsychological tests
Visuomotor imagery training found to improve performance
deficits related to neglect
Mental practice used in occupational therapy
Liu et al., (2004)
Studied the efficacy of mental imagery at promoting relearning
for people after a stroke
Prospective, randomized controlled trial, of 46 stroke
inpatients aged over 60 years.
MP Protocol used picture cards, visualizing performance and
watching videotaped performance
Mental practice used in occupational therapy
Liu et al., (2004)
Outcome measures used were the performance of 15 trained and 5
untrained daily living tasks
Patients who engaged in mental practice improved their
attention & sequencing ability
Increased their relearning of familiar and new tasks
Benefits of using mental practice
Increases affected limb use and function
Can improve cognitive skills (eg attention, sequencing)
Creates opportunities for clients to problem-solve
Uses a client-centred approach
Time / cost -effective
Areas for further research
Establishing guidelines and protocols
Motivational aspects of relearning through mental practice
Long-term occupational benefits
Sarah Freeman
[email_address]
Mental Practice
References
Bell, A. & Murray, B (2004) Improvement in Upper Limb Motor
Performance following Stroke: the Use of Mental Practice. British
Journal of Occupational Therapy 67 (11): 501-507.
Kosslyn,S.M. (1994) Image and brain : the resolution of the
imagery debate. Cambridge, Mass. ; London : MIT Press
Liu, K. P., Chan, C. C., Lee, T., Hui-Chan, C. W. (2004) Mental
Imagery for Promoting Relearning for People After Stroke: A
Randomized Controlled Trial. Archives of Physical Medical
Rehabilitation 85:1403-8.
Page, S. Levine, P. Leonard, A. (2005) Effects of Mental
Practice on Affected Limb Use and Function in Chronic Stroke.
Archives of Physical & Medical Rehabilitation 86 399-402.
Richardson, A (1967) Mental Practice: a review and discussion
(part 1). Research Quarterly (38): 95-107
Smania, N., Bazoli, .F, Piva, D., Guidetti, G. (1997)
Visuomotor imagery and rehabilitation of neglect. Archives of
Physical & Medical Rehabilitation, 78:430-6.
Van Leeuwen, R., Inglis, J.T. (1998) Mental practice and
imagery: a potential in stroke rehabilitation. Physical Therapy
Reviews 3 :47-52.