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Meta-Analysis
. 2011 May 11;2011(5):CD005950.
doi: 10.1002/14651858.CD005950.pub4.

Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke

Ruth E Barclay-Goddard  1 , Ted J Stevenson, William Poluha, Leyda Thalman
Affiliations
Meta-Analysis

Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke

Ruth E Barclay-Goddard et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Activity limitations of the upper extremity are a common finding for individuals living with stroke. Mental practice (MP) is a training method that uses cognitive rehearsal of activities to improve performance of those activities.

Objectives: To determine if MP improves the outcome of upper extremity rehabilitation for individuals living with the effects of stroke.

Search strategy: We searched the Cochrane Stroke Group Trials Register (November 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, November 2009), PubMed (1965 to November 2009), EMBASE (1980 to November 2009), CINAHL (1982 to November 2009), PsycINFO (1872 to November 2009), Scopus (1996 to November 2009), Web of Science (1955 to November 2009), the Physiotherapy Evidence Database (PEDro), CIRRIE, REHABDATA, ongoing trials registers, and also handsearched relevant journals and searched reference lists.

Selection criteria: Randomised controlled trials involving adults with stroke who had deficits in upper extremity function.

Data collection and analysis: Two review authors independently selected trials for inclusion. We considered the primary outcome to be the ability of the arm to be used for appropriate tasks (i.e. arm function).

Main results: We included six studies involving 119 participants. We combined studies that evaluated MP in addition to another treatment versus the other treatment alone. Mental practice in combination with other treatment appears more effective in improving upper extremity function than the other treatment alone (Z = 3.48, P = 0.0005; standardised mean difference (SMD) 1.37; 95% confidence interval (CI) 0.60 to 2.15). We attempted subgroup analyses, based on time since stroke and dosage of MP; however, numbers in each group were small. We evaluated the quality of the evidence with the PEDro scale, ranging from 6 to 9 out of 10; we determined the GRADE score to be moderate.

Authors' conclusions: There is limited evidence to suggest that MP in combination with other rehabilitation treatment appears to be beneficial in improving upper extremity function after stroke, as compared with other rehabilitation treatment without MP. Evidence regarding improvement in motor recovery and quality of movement is less clear. There is no clear pattern regarding the ideal dosage of MP required to improve outcomes. Further studies are required to evaluate the effect of MP on time post stroke, volume of MP that is required to affect the outcomes and whether improvement is maintained long-term. Numerous large ongoing studies will soon improve the evidence base.

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Conflict of interest statement

None known.

Figures

Figure 1
Figure 1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 2
Figure 2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Analysis 1.1
Analysis 1.1
Comparison 1 Mental practice in addition to other treatment versus other treatment, Outcome 1 Activity: upper extremity function.
Analysis 1.2
Analysis 1.2
Comparison 1 Mental practice in addition to other treatment versus other treatment, Outcome 2 Impairment: motor recovery.
Analysis 2.1
Analysis 2.1
Comparison 2 Mental practice in addition to other treatment versus other treatment: time post stroke subgroup, Outcome 1 Activity: upper extremity function.
Analysis 2.2
Analysis 2.2
Comparison 2 Mental practice in addition to other treatment versus other treatment: time post stroke subgroup, Outcome 2 Impairment: motor recovery.
Analysis 3.1
Analysis 3.1
Comparison 3 Mental practice in addition to other treatment versus other treatment: dosage MP subgroup, Outcome 1 Activity: upper extremity function: dosage MP subgroup.
Analysis 3.2
Analysis 3.2
Comparison 3 Mental practice in addition to other treatment versus other treatment: dosage MP subgroup, Outcome 2 Impairment: motor recovery: dosage MP subgroup.
Analysis 4.1
Analysis 4.1
Comparison 4 Mental practice with conventional treatment versus placebo mental activity with conventional treatment, Outcome 1 Activity: upper extremity function: Action Research Arm Test (greater than 6 months post stroke).
Analysis 4.2
Analysis 4.2
Comparison 4 Mental practice with conventional treatment versus placebo mental activity with conventional treatment, Outcome 2 Impairment: motor recovery: Fugl‐Meyer (greater than 6 months post stroke).
Analysis 5.1
Analysis 5.1
Comparison 5 Mental practice with conventional treatment versus conventional treatment alone, Outcome 1 Activity: upper extremity function: Arm Function Test or Action Research Arm Test.
Analysis 5.2
Analysis 5.2
Comparison 5 Mental practice with conventional treatment versus conventional treatment alone, Outcome 2 Impairment: motor recovery: Motricity Index or Fugl Meyer.
Analysis 6.1
Analysis 6.1
Comparison 6 Mental practice versus motor practice, Outcome 1 Activity: Jebsen test: stacking.
Analysis 6.2
Analysis 6.2
Comparison 6 Mental practice versus motor practice, Outcome 2 Impairment: pinch grip.
See this image and copyright information in PMC

References

References to studies included in this review

    1. Müller K, Bütefisch CM, Seitz RJ, Hömberg V. Mental practice improves hand function after hemiparetic stroke. Restorative Neurology and Neuroscience 2007;25:501‐11. - PubMed
    1. Page SJ, Levine P, Sisto SA, Johnstone MV. A randomized efficacy and feasibility study of imagery in acute stroke. Clinical Rehabilitation 2001;15:233‐40. - PubMed
    1. Page SJ, Levine P, Leonard AC. Effects of mental practice on affected limb use and function in chronic stroke. Archives of Physical Medicine and Rehabilitation 2005;86:399‐402. - PubMed
    1. Page SJ, Levine P, Leonard A. Mental practice in chronic stroke. Results of a randomized, placebo‐controlled trial. Stroke 2007;38:1293‐7. - PubMed
    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. - PubMed

References to studies excluded from this review

    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. Archives of Physical Medicine and Rehabilitation 2010;91:939‐46. - PubMed
    1. Hemmen B, Seelen HAM. Effects of movement imagery and electro‐myography‐triggered feedback on arm‐hand function in stroke patients in the subacute phase. Clinical Rehabilitation 2007;21:587‐94. - PubMed
    1. Liu KP, Chan CC, Lee TM, Hui‐Chan CW. Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2004;85:1403‐8. - PubMed
    1. Miltner R, Simon U, Netz J, Hömberg V. Motor imagery in the therapy of patients with central motor deficit [Bewegungsvorstellung in der Therapie von Patienten mit Hirninfarkt]. Neurologie und Rehabilitation 1999;5(2):66‐72.

References to ongoing studies

    1. Braun SM, Beurskens AJ, Kroonenburgh SM, Demarteau J, Schols JM, Wade DT. Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial. BMC Neurology2007; Vol. 7, issue 34. - PMC - PubMed
    1. Butler AJ. Mental imagery to reduce motor deficits in stroke. ClinicalTrials.gov 2008 last updated.
    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 Neurology2006; Vol. 6, issue 1:1‐7. [DOI: 10.1186/1471-2377-6-39] - DOI - PMC - PubMed
    1. Johnston M. Can motor recovery imagery enhance recovery of hand function after stroke?. ClinicalTrials.gov 2006 last updated.
    1. Page S. Mental practice efficacy in stroke‐induced hemiparesis. ClinicalTrials.gov 2009 last updated.

Additional references

    1. Alberts JL, Butler AJ, Wolf SL. The effects of constraint‐induced therapy on precision grip: a preliminary study. Neurorehabilitation and Neural Repair 2004;18:250‐8. - PMC - PubMed
    1. Andrews AW, Bohannon RW. Short‐term recovery of limb muscle strength after acute stroke. Archives of Physical Medicine and Rehabilitation 2003;84:125‐30. - PubMed
    1. Andrisani J. Think like Tiger: an analysis of Tiger Woods' mental game. Berkley, 2003.
    1. Batson G. Motor imagery for stroke rehabilitation ‐ current research as a guide to clinical practice. Alternative and Complimentary Therapies 2004;10:84‐9.
    1. Bernhardt J, Dewey H, Thrift A, Donnan G. Inactive and alone. Physical activity within the first 14 days of acute stroke unit care. Stroke 2004;35:1005‐9. - PubMed