Presentation on theme: "The Use of Mental Practice in Occupational Therapy for Stroke Patients"— Presentation transcript:
1The Use of Mental Practice in Occupational Therapy for Stroke Patients Sarah Freeman
2Objectives Definition of mental practice Types of mental imagery The effectiveness of mental practiceThe use of mental practice in stroke rehabilitation and in occupational therapyAreas for further research
3What 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 imageryThe effects of mental and physical practice are functionally similar
4Types of mental imagery Visualeg Imagining the movement of a visual formMotoreg imagining your own hand movingKinaestheticeg imagining the feeling of your hand moving
5Types of mental imagery Internal Imagery- an internal recreation of the task:Effective for planning a taskExternal Imagery- an outside perspective of performance:More effective for learning & subsequent retention
6The effectiveness of mental practice Combined with physical practice,mental practice:improves performance to the same, or a higher extent than physical practice aloneincreases the rate of skill acquisitionmay facilitate greater performance than that of a control condition of no input
7Stroke rehabilitation approaches All approaches involve the process of re-learningEg:Neurodevelopmental treatment (Bobath)Motor re-learning (Carr & Shepherd)Task- oriented approachesCompensatory
8Mental practice theories It is debated whether mental practice relies on motor, cognitive or motivational processesMental practice is more effective when learning simple tasksImagery abilities may varyTasks learned must be meaningful & prior experience of the activity is necessary
9How mental imagery can promote functional independence through relearning
10Mental 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 studyTasks were reaching & grasping a cup, turning pages & using a pen.
11Mental practice used in occupational therapy Page, Levine & Leonard (2005)Results showed:Increased affected limb use and functionSkills had been generalized to other ADLs after intervention
12Mental practice used in occupational therapy Smania, et al. (1997)Studied the effectiveness of visuomotor imagery practice in rehabilitation of unilateral neglectBefore / after trial on 2 participantsMental imagery included imagining patients at home, geographical areas, reverse spelling & mental representation.
13Mental practice used in occupational therapy Smania, et al. (1997)Outcomes assessed using functional tests & neuropsychological testsVisuomotor imagery training found to improve performance deficits related to neglect
14Mental practice used in occupational therapy Liu et al., (2004)Studied the efficacy of mental imagery at promoting relearning for people after a strokeProspective, randomized controlled trial, of 46 stroke inpatients aged over 60 years.MP Protocol used picture cards, visualizing performance and watching videotaped performance
15Mental practice used in occupational therapy Liu et al., (2004)Outcome measures used were the performance of 15 trained and 5 untrained daily living tasksPatients who engaged in mental practice improved their attention & sequencing abilityIncreased their relearning of familiar and new tasks
16Benefits of using mental practice Increases affected limb use and functionCan improve cognitive skills (eg attention, sequencing)Creates opportunities for clients to problem-solveUses a client-centred approachTime / cost -effective
17Areas for further research Establishing guidelines and protocolsMotivational aspects of relearning through mental practiceLong-term occupational benefits
19ReferencesBell, 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 PressLiu, 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 RehabilitationRichardson, 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, 78:430-6.Van Leeuwen, R., Inglis, J.T. (1998) Mental practice and imagery: a potential in stroke rehabilitation. Physical Therapy Reviews 3:47-52.