Stroke

Researchers from the Departments of Neurology and Anatomy and Neurobiology at the University of California, Irvine, examined the neural correlates of motor imagery when used in conjunction with movement of the paretic arm after stroke. Subjects were 7 patients in the chronic phase of stroke recovery (median (range): age: 58 years (37-73); time post-stroke: 9 months (4-42); upper extremity Fugl-Meyer motor score: 48 (36-64)).

Participants actively moved the paretic/right arm under two conditions while undergoing functional magnetic resonance imaging. In the motor condition, pronation/supination movements were made in response to a visual cue. In the motor + imagery condition, the same movements were performed in response to a visual cue but the participants were instructed to imagine opening and closing a doorknob during performance of the movement.

Researchers from the Department of Physical Medicine & Rehabilitation at the University of Cincinnati’s Academic Medical Center looked at the impact of “mental practice” (the imaginal rehearsal of physical movements) on affected arm movements in stroke patients, as well as changes in cortical mapping in the brain.

Mental practice (MP) is a noninvasive, inexpensive method of enabling repetitive, task-specific practice (RTP) which has been shown in past studies to increase affected arm use and function significantly more than just RTP alone. 

As a next step, this 10-subject case series examined the possibility that cortical plasticity is a mechanism underlying the positive treatment effect from mental practice (MP) when combined with RTP (repetitive task-specific practice). Ten chronic stroke patients (mean = 36.7 months) exhibiting stable, moderate motor deficits, received 30-minute therapy sessions for their affected arms 3 days/week for 10 weeks, emphasizing valued activities of daily living (ADLs).

A stroke survivor in rehab who has used guided imagery successfully in the past for other health challenges wonders if the TBI imagery can help her with her recovery  from a recent stroke…

Question:

Dear Belleruth,

I love your recordings and use many for health problems, as I have had a lot of them.  The CFS and M.S. guided imagery are just so healing for me. The Affirmations are as if you were reading my mind!

I have had a stroke and used the heart guided imagery, and I was wondering if the new Brain Trauma would help me, as I have many of these problems too.

Thank you for your work.

Jeanette

Adam at Ease is a video blog created by former Army Sergeant Adam Anicich, a current Department of Veterans Affairs employee, a service-disabled vet, and someone living with a brain injury.

He now works as the assistant director of the Congressional Liaison Service for the Department of Veterans Affairs (VA), where he and his team communicate the Secretary’s initiatives to members of Congress, provide information on all programs and services the VA provides, annually resolve over 21,000 Congressional Inquiries dealing from casework to policy, and act as on-site liaisons between 541 members of Congress and the VA.  As a former Army Sergeant and polytrauma patient, he’s uniquely qualified to identify and communicate the needs of our vets to Congress.

And he’s getting married this fall.  

In this video, he tells the story of his injury and recovery. His blog is filled with practical tips for day to day coping with brain injury, and provides a lot of support and inspiration.  Check it out!

We’ve gotten half a dozen questions like this one in the last week alone, so we figured we’d best post this question and answer this question from a program manager of a Kingston, Ontario agency that provides community-based services to adults with brain injury:

Question:

Dear Belleruth,

Thank you for your efforts with producing a guided imagery for TBI.  I am a Program Manager in Kingston, Ontario, providing community-based services to adults affected by brain injury. I have been an admirer of your work for many years and have been pleased with your more recent focus on brain injury.
 
You may remember I had hoped to have you come to Kingston for a conference on TBI, particularly from military service. Unfortunately, the government funding did not come through and we had to cancel your engagement. I still hope this can happen some day.

My question to you is about the TBI guided imagery. Do you think it would also be helpful to people with acquired brain injury? Our referral base is about 50% TBI and 50% ABI with the causes of ABI being infection, tumours, and stroke (with diffuse effects).

Thank you,

Deirdre

Researchers from the Oxford Brookes University in the United Kingdom investigated the feasibility of integrating a motor imagery program into a treatment regimen of physiotherapy and occupational therapy for patients diagnosed with stroke, brain injury or multiple sclerosis.

Thirty inpatients and outpatients in treatment at a neurologic rehabilitation center participated in the study. A parallel-group, phase II, assessor-blind randomized controlled trial compared motor imagery embedded in treatment as usual with treatment as usual only. Subjects were assessed at baseline, after 6 weeks (post-intervention), and after 12 weeks (follow-up).

A motor imagery strategy was developed and integrated into treatment as usual (physiotherapy and occupational therapy) which was tailored to individual goals, and applied to any activity. The control group received standard care (physiotherapy and occupational therapy).

Researchers from the University of Cincinnati Academic Medical Center evaluated and compared the efficacy of 20-, 40-, and 60-minute mental practice (guided imagery) sessions on affected upper extremity impairment and functional limitation, using a randomized, controlled study with a multiple baseline design.

Twenty-nine subjects with chronic stroke, exhibiting stable, mild hemiparesis (weakness on one side), were given 30-minute rehabilitative sessions, 3 days/week for 10 weeks, emphasizing affected upper extremity use during valued activities.

Researchers from Northumbria University in Newcastle upon Tyne, UK, conducted a randomized, controlled trial to evaluate the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness.
 
Recent studies have suggested that mental rehearsal of movement can produce effects normally attributed to practicing 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.

Hello,

I am an occupational therapist working with elders who have suffered a stroke. I am interested in incorporating your stroke CD in my treatment. While I have used your guided imagery CDs myself and found them very helpful, I'm wondering whether there are any precautions I should be aware of prior to using them with my patients.

Thanks for your response, and for your important work!

Warmly,
Daria

Dear Daria,

There are no special counter-indications for stroke patients that I’m aware of or that have ever been reported to me.  One consideration, however, is that some of your elderly patients may suffer from hearing loss - especially in the lower registers – and this could mean they have trouble hearing my voice over the music. It’s something to be alert for.

The usual orientation should be fine: reminding people to sit comfortably, relax to it, to not try too hard or think too hard about it, but rather just let the images soak in, in an easy, open, receptive way.  Over time, they will take hold below the thinking brain, deep in the body.

Hello,

I am an occupational therapist working with elders who have suffered a stroke. I am interested in incorporating your stroke CD in my treatment. While I have used your guided imagery CDs myself and found them very helpful, I'm wondering whether there are any precautions I should be aware of prior to using them with my patients.

Thanks for your response, and for your important work!

Warmly,
Don