The Use of Mental Practice in Occupational Therapy for Stroke Patients

Sarah Freeman

sarah@sarahfreeman.co.uk

The Use of Mental Practice in Occupational Therapy for Stroke Patients

Sarah Freeman

sarah@sarahfreeman.co.uk

Mental PracticeMental 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

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

ObjectivesObjectives

What is mental practice?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

‘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 imageryTypes 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

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 taskEffective for planning a task

External Imagery- an outside perspective of performance:

More effective for learning & More effective for learning & subsequent retentionsubsequent retention

Internal Imagery- an internal recreation of the task:

Effective for planning a taskEffective for planning a task

External Imagery- an outside perspective of performance:

More effective for learning & More effective for learning & subsequent retentionsubsequent retention

Types of mental imageryTypes of mental imagery

The effectiveness of mental practiceThe 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

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 approachesStroke rehabilitation approaches

All approaches involve the process of re-learning

Eg: Neurodevelopmental treatment (Bobath) Motor re-learning (Carr & Shepherd) Task- oriented approaches Compensatory

All approaches involve the process of re-learning

Eg: Neurodevelopmental treatment (Bobath) Motor re-learning (Carr & Shepherd) Task- oriented approaches Compensatory

Mental practice theoriesMental 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

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 relearningHow mental imagery can promote functional independence through relearning

Mental practice used in occupational therapyMental practice used in occupational therapyPage, 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.

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 therapyMental practice used in occupational therapyPage, Levine & Leonard (2005)

Results showed:

Increased affected limb use and function

Skills had been generalized to other ADLs after intervention

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 therapyMental 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.

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 therapyMental 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

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 therapyMental practice used in occupational therapyLiu 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

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 therapyMental practice used in occupational therapyLiu 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

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 practiceBenefits 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

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 researchAreas for further research

Establishing guidelines and protocols

Motivational aspects of relearning through mental practice

Long-term occupational benefits

Establishing guidelines and protocols

Motivational aspects of relearning through mental practice

Long-term occupational benefits

Sarah Freeman

sarah@sarahfreeman.co.uk

Sarah Freeman

sarah@sarahfreeman.co.uk

Mental PracticeMental Practice

ReferencesReferences

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.

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.