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Mental Practice. The Use of Mental Practice in Occupational Therapy for Stroke Patients Sarah Freeman [email protected] Objectives. Definition of mental practice Types of mental imagery The effectiveness of mental practice

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Mental Practice

The Use of Mental Practice in Occupational Therapy for Stroke Patients

Sarah Freeman

[email protected]


Objectives

  • 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


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


Types of mental imagery

  • 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


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


Mental Practice

Sarah Freeman

[email protected]


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.


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