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

2. 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

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

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

5. 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

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

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

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

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.

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

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.

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

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

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

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

17. Areas for further research
Establishing guidelines and protocols
Motivational aspects of relearning through mental practice
Long-term occupational benefits

18. Mental Practice
Sarah Freeman

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, 78:430-6.
Van Leeuwen, R., Inglis, J.T. (1998) Mental practice and imagery: a potential in stroke rehabilitation. Physical Therapy Reviews 3:47-52.