Mental Practice

1. Mental Practice The Use of Mental Practice in Occupational Therapy for Stroke Patients Sarah Freeman sarah@sarahfreeman.co.uk

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 sarah@sarahfreeman.co.uk

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): 501-507. • 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 85:1403-8. • 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 86 399-402. • Richardson, A (1967) Mental Practice: a review and discussion (part 1). Research Quarterly (38): 95-107 • 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.