This Chinese study explores the impacts and efficacy of acupuncture and motor imagery on fine movement of an upper extremity for stroke patients in the flaccid paralysis stage of recovery.
Sixty-two cases of flaccid, upper extremity paralysis were randomized into an observation group (30 cases) and a control group (32 cases).
The control group was treated with conventional western medication plus passive movement of the extremity. Additionally, penetrating acupuncture was applied. The needles were retained for 30 min.
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).
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 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.
Researchers from McGill University in Montreal analyzed research data on the effectiveness of Virtual Reality for retraining motor function of the upper limbs in stroke patients. They posed two questions to examine: (1) Is the use of immersive VR more effective than conventional therapy or no therapy in the rehabilitation of the UL in patients with hemiplegia? and (2) Is the use of nonimmersive VR more effective than conventional therapy or no therapy in the rehabilitation of the UL in patients with hemiplegia?
Interested in building upon recent studies showing that imagery helps post-stroke patients relearn daily tasks, researchers from the Hong Kong Polytechnic University in Kowloon, Hong Kong, China investigated whether imagery could also help with generalizing skills on trained and untrained tasks in new environments in a small, randomized, controlled clinical trial.
Thirty-five acute post-stroke patients were randomly assigned to an imagery training group (n=18) or conventional functional rehabilitation (n=17) group. The imagery intervention was 3-weeks of standardized practices and daily tasks using chunking-regulation-rehearsal strategies.
Outcome measurements were the performances on trained and untrained tasks in the training and novel environments.
Researchers from the All India Institute of Medical Sciences in New Delhi examined the short-term impact of a brief yoga intervention on some of the biochemical risk indicators for cardiovascular disease and diabetes mellitus.
Ninety-eight subjects (67 male, 31 female), ages 20-74, with hypertension, coronary artery disease, diabetes mellitus, and a variety of other illnesses, participated in a lifestyle training program that consisted of yoga asanas (postures), pranayama (breathing exercises), relaxation techniques, group support, individualized advice, lectures and films on the philosophy of yoga and the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about their disease.
If you thought I was exaggerating about the recent spike in research on motor imagery for stroke, check out these 3 recent studies, and then click here for a whole other stash of them, already archived....
IMAGERY SHOWS BIG GAINS FOR POST-STROKE HEMIPARESIS
Researchers from the Wingate Institute in Netanya, Israel, tested the feasibility of using a home-based motor imagery gait training program to improve walking performance of people suffering from chronic poststroke hemiparesis.
Seventeen community-dwelling volunteers with hemiparesis caused by a unilateral stroke that occurred at least 3 months before the study were recruited. They received 15 minutes of supervised imagery gait training in their homes 3 days a week for 6 weeks. The intervention addressed gait impairments of the affected lower limb and task-specific gait training.
Walking ability was evaluated by kinematics and functional scales twice before the intervention, 3 and 6 weeks after the intervention began, and at the 3-week follow-up.
Imagery Rehearsal Found Critical in Motor Rehab for Stroke, Better than Physical Practice Alone
Researchers from the University of Lyon in Bron Cedex, France tested whether "mental rehearsal" (motor imagery) is equivalent to physical learning in restoring motor function in hemiplegic patients (paralyzed on one side), and examined what would be optimal proportions of real execution vs. rehearsal.
Subjects were asked to grasp an object and insert it into an adapted slot. One group (G0) practiced the task only by physical execution (240 trials); three groups imagined performing the task in different rates of trials (25%, G25; 50%, G50; 75%, G75), and physically executed movements for the remaining trials; a fourth, control group imagined a visual rotation task in 75% of the trials and then performed the same motor task as the other groups.
Guided Motor Imagery Helps with Athletic Performance, Neurological Conditions
Investigators at the University of Haifa in Israel reviewed the literature to determine the positive effects of guided motor imagery practice on motor performance. There is abundant evidence that motor performance is improved in athletes, people who are healthy, and people with neurological conditions, such as stroke, spinal cord injury and Parkinson’s disease. This article discusses how to integrate motor imagery into a physical therapy practice and goes into particulars of visual and kinesthetic motor imagery, factors that modify motor imagery practice, the design of motor imagery protocols, and potential applications of motor imagery.
Citation: Dickstein R, Deutsch JE. Motor imagery in physical therapist practice. Physical Therapy. 2007 Jul; 87 (7): pages 942-53. Epub 2007 May 1 [email protected].