Brief report
Using Motor Imagery in the Rehabilitation of Hemiparesis 1,

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Abstract

Stevens JA, Phillips Stoykov ME. Using motor imagery in the rehabilitation of hemiparesis. Arch Phys Med Rehabil 2003;84:1090-2.

Objective:

To examine the effectiveness of using motor imagery training in the rehabilitation of hemiparesis.

Design:

A before-after trial with clinical and behavioral analyses of single cases.

Setting:

Academic-affiliated rehabilitation hospital.

Participants:

Two survivors of embolic middle cerebral artery stroke that resulted in chronic hemiparesis.

Intervention:

A motor imagery training program consisting of imagined wrist movements (extension, pronation-supination) and mental simulations of reaching and object manipulation making use of a mirror box apparatus. Twelve 1-hour experimental sessions were delivered, 3 times a week for 4 consecutive weeks.

Main Outcome Measures:

Two clinical assessments, grip strength, 4 wrist functionality measurements, and 3 timed performance tests. All outcome measures were recorded before training began, at 3 times during the intervention month, with 2 additional long-term measurements.

Results:

Performance of the paretic limb improved after the imagery intervention, indicated by increases in assessment scores and functionality and decreases in movement times. The improvements over baseline performance remained stable over a 3-month period.

Conclusions:

These results demonstrate the potential for using motor imagery as a cognitive strategy for functional recovery from hemiparesis. The intervention targets the cognitive level of action processing while its effects may be realized in overt behavioral performance.

Section snippets

METHODS

Two individuals with chronic hemiparesis completed the study. Patient 1 was a 76-year-old, right-handed woman who survived a middle cerebral artery (MCA) embolism that resulted in multiple right hemisphere cortical and subcortical strokes. Patient 2 was a 63-year-old, right-handed man who survived a cardioembolic stroke to the left MCA. The lengths of time between the date of stroke and study participation were 14 months (patient 1) and 6 years, 2 months (patient 2).

The intervention consisted

DISCUSSION

Patient 1’s ability to imagine movements in time frames proportional to the speeds at which they were depicted in the movies improved over the 4-week training period. Linear regression analyses showed a significant linear trend between IMT and speed in the second half of the 4-week intervention (F1,94=12.63, P<.001), but not in the first (F1,94=1.30, P=.25). Movement times for patient 2 were substantially faster, and his ability to imagine movements in time frames similar to those presented was

RESULTS

The clinical assessment scores are listed in table 1. Fugl-Meyer scores consistently increased during the 4 weeks of intervention with modest increases during the 3 follow-up months. Patient 1 had appreciable consistent increases in grip strength for the affected left limb, while patient 2 displayed overall gains; however, the pattern of change was irregular. Goniometric measurements of wrist function revealed increases in range of motion during the intervention month, with minor losses in

CONCLUSION

We present the effects of using mental simulation of action to facilitate functional recovery of a paretic limb. Despite a limited number of patients, our report highlights a potential use of mental imagery as an innovative and effective therapy augmentation for the clinician and patient. We believe the performance improvements are linked to a priming of the motor system at a central command level, which translates to a downstream effect of more controlled and faster movements. A 1-month course

Acknowledgements

We thank Christopher Mah and Peter Vishton for their critical review of the manuscript.

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Cited by (0)

Supported in part by the Falk Trust.

1

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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