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Mental imagery for promoting relearning for people after stroke: A randomized controlled trial1,

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Abstract

Liu K, Chan C, Lee TM, Hui-Chan CW. Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Arch Phys Med Rehabil 2004;85:1403–8.

Objective

To study the efficacy of mental imagery at promoting relearning for people after a stroke.

Design

Prospective, randomized controlled trial.

Setting

An inpatient rehabilitation stroke unit in Hong Kong.

Participants

Forty-six inpatients, 60 years of age or older, after a cerebral infarction.

Interventions

Patients were randomized to receive 15 sessions (1h/d for 3wk) of either the mental imagery program or the conventional functional training intervention on the relearning of daily living tasks.

Main outcome measures

Performance of 15 trained and 5 untrained tasks, including household, cooking, and shopping tasks; and the Fugl-Meyer Assessment and Color Trails Test (CTT).

Results

Patients engaged in mental imagery—based intervention showed better relearning of both trained and untrained tasks compared with the control group (trained tasks: P<.005; untrained tasks: P<.001). They also demonstrated a greater ability to retain the trained tasks after 1 month and transfer the skills relearned to other untrained tasks (P<.001). However, among the various ability measures, the mental imagery group showed a significant increase in the CTT scores only after the intervention (P<.005).

Conclusions

Mental imagery can be used as a training strategy to promote the relearning of daily tasks for people after an acute stroke. The imagery process is likely to improve the planning and execution of both the trained and the untrained (novel) tasks. The effect of its relearning appears to help patients to retain and generalize the skills and tasks learned in the rehabilitation program.

Section snippets

Methods

Patients meeting the following criteria were recruited to participate in the study: (1) diagnosed as having had a first unilateral cerebral infarction as confirmed by a computed tomography scan, (2) age 60 years or older, (3) independent in performing daily activities before admission, (4) able to communicate effectively, as screened by the Cognistat,19 and (5) having given their voluntary consent. Ethics approval was obtained from the hospital and the Hong Kong Polytechnic University before

Results

A total of 49 patients participated in the clinical trial. Three patients dropped out during the first week of the program: 1 from the mental imagery group and the other 2 from the functional retraining group. They were all readmitted to an acute hospital: 2 because of a second stroke and 1 because of renal failure. All 3 patients had shown good compliance at the time they dropped out. Of the 46 patients who completed the clinical trial, 24 were women and 22 were men. Their FIM instrument mean

Discussion

The results of this study revealed that patients who were trained in the mental imagery technique appeared to reach a higher level of performance than the control group on both the trained and untrained tasks. The higher level of performance on the trained tasks would suggest that mental imagery, when compared with the demonstration-then-practice method, is a more effective strategy for enhancing and retaining relearning among patients who participated in the study. However, the higher level of

Conclusions

Studies on the application of the mental imagery technique to the rehabilitation of patients who have had a stroke have focused on improving isolated abilities or functions, such as upper-limb motor abilities. Our study has demonstrated the positive effects of using the technique to improve patients’ relearning of and performance on more complicated daily tasks. This offers further evidence on the role of active cortical control, which can be mediated by mental imagery to enhance the relearning

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  • Cited by (0)

    Supported by The Hong Kong Polytechnic University.

    1

    No party having a direct interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

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