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The Use of Mental Practice in Occupational Therapy for Stroke Patients Sarah Freeman The Use of Mental Practice in Occupational.

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Presentation on theme: "The Use of Mental Practice in Occupational Therapy for Stroke Patients Sarah Freeman The Use of Mental Practice in Occupational."— Presentation transcript:

1 The Use of Mental Practice in Occupational Therapy for Stroke Patients Sarah Freeman The Use of Mental Practice in Occupational Therapy for Stroke Patients Sarah Freeman Mental Practice

2  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 Objectives

3 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

4 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  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

5  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  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 Types of mental imagery

6 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 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

7 Stroke 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

8 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 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

9 How mental imagery can promote functional independence through relearning

10 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. 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.

11 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 Page, Levine & Leonard (2005) Results showed:  Increased affected limb use and function  Skills had been generalized to other ADLs after intervention

12 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. 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.

13 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 Smania, et al. (1997)  Outcomes assessed using functional tests & neuropsychological tests  Visuomotor imagery training found to improve performance deficits related to neglect

14 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 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

15 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 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

16 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  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

17 Areas 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

18 Sarah Freeman Sarah Freeman Mental Practice

19 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):  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:  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  Richardson, A (1967) Mental Practice: a review and discussion (part 1). Research Quarterly (38):  Smania, N., Bazoli,.F, Piva, D., Guidetti, G. (1997) Visuomotor imagery and rehabilitation of neglect. Archives of Physical & Medical Rehabilitation, 78:  Van Leeuwen, R., Inglis, J.T. (1998) Mental practice and imagery: a potential in stroke rehabilitation. Physical Therapy Reviews 3:  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):  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:  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  Richardson, A (1967) Mental Practice: a review and discussion (part 1). Research Quarterly (38):  Smania, N., Bazoli,.F, Piva, D., Guidetti, G. (1997) Visuomotor imagery and rehabilitation of neglect. Archives of Physical & Medical Rehabilitation, 78:  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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