A randomized efficacy and feasibility study of imagery in acute stroke

Page, Stephen J.; Levine, Peter; Sisto, SueAnn; Johnston, Mark V.

doi:10.1191/026921501672063235

Cited by 246 publications

(248 citation statements)

References 24 publications

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“…One study compared conventional physiotherapy and physiotherapy plus motor imagery in subacute with chronic stroke patients and demonstrated a greater improvement of hand function with the additional mental practice. 44 Performance improvements demonstrated with motor imagery alone after chronic stroke, as expected, were more modest than those identified with physical training.…”

Section: Mental Practicesupporting

confidence: 57%

Volition and Imagery in Neurorehabilitation

Lotze

Cohen

2006

Cognitive and Behavioral Neurology

106

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New interventional approaches have been proposed in the last few years to treat the motor deficits resulting from brain lesions. Training protocols represent the gold-standard of these approaches. However, the degree of motor recovery experienced by most patients remains incomplete. It would be important to improve our understanding of the mechanisms underlying functional recovery. This chapter examines the role of two possible mechanisms that could operate to improve motor function in this setting: volition and motor imagery. It is argued that both represent possible strategies to enhance training effects.Key Words: motivation, attention, motor imagery, hemiparesis, rehabilitation, forced use, volition, stroke, motor system, motor cortex (Cog Behav Neurol 2006;19:135-140) M otor training protocols represent one of the fundamental bases of rehabilitative treatments after brain damage. Different strategies have been proposed to enhance training effects, including enhanced motivation, focused attention, motor imagery, progressive transfer of tasks towards the paretic limb, forced use, and integration of multimodal and emotional settings. The neural mechanisms underlying these strategies are poorly understood. In this review, we describe studies performed to better understand the influence of some of these factors on performance improvements and changes in intracortical excitatory and inhibitory mechanisms in humans undergoing training protocols. Focus is on the role of (a) volition in motor learning, (b) imagery in neurorehabilitation and motor control, and (c) neural substrates underlying performance of simple and complex movements after stroke. ROLE OF VOLITION IN MOTOR LEARNINGMotor training protocols in patients with brain lesions elicit well-described changes in brain organization and performance improvements. [1][2][3][4][5][6] One limitation of training protocols is that patients with more profound weakness are unable to carry out the motor routines required. The finding that passively elicited motions lead to activation and cortical reorganization in brain regions common to those activated with performance of voluntary movements suggested that it could also elicit improvements in motor function. 7,8 This proposal has important implications for the design of neurorehabilitative treatments after stroke, particularly in patients who are too weak to perform effective voluntary motor training.One recent study compared behavioral gains after short-term motor learning, changes in functional magnetic resonance imaging (fMRI) activation in the contralateral primary motor cortex (cM1) and in motor cortex excitability measured with transcranial magnetic stimulation (TMS) after a 30 minute training period consisting of either voluntarily or passively induced wrist movements in 2 different sessions in healthy volunteers. 9 During active training, subjects were instructed to perform voluntary wrist flexion-extension movements of a specified duration in an articulated splint. Therefore, voluntary movements f...

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Section: Mental Practicesupporting

confidence: 57%

Volition and Imagery in Neurorehabilitation

Lotze

Cohen

2006

Cognitive and Behavioral Neurology

106

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“…Alden, Dale, & DeGood, 2001;Gregerson, Roberts, & Amiri, 1996;Page, Levine, Sisto, & Johnston, 2001;Simonton, Simonton, & Creighton, 1984;Vines, 1988), but has not been extensively investigated in the area of sport-injury rehabilitation. The injured athletes in the present study reported the use of healing imagery to aid in the recovery process.…”

Section: Discussionmentioning

confidence: 99%

Imagery use by injured athletes: A qualitative analysis

Driediger

Hall

Callow

2006

Journal of Sports Sciences

102

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The purpose of this study was to expand our knowledge and increase our understanding of imagery use by athletes in sportinjury rehabilitation using a qualitative approach. The participants were 10 injured athletes who were receiving physiotherapy at the time they were interviewed. During the interviews, the athletes provided extensive information about their use of imagery during injury rehabilitation and it was clear that they believed imagery served cognitive, motivational and healing purposes in effectively rehabilitating an injury. Cognitive imagery was used to learn and properly perform the rehabilitation exercises. They employed motivational imagery for goal setting (e.g. imagined being fully recovered) and to enhance mental toughness, help maintain concentration and foster a positive attitude. Imagery was used to manage pain. The methods they employed for controlling pain included using imagery to practise dealing with expected pain, using imagery as a distraction, imagining the pain dispersing, and using imagery to block the pain. With respect to what they imaged (i.e. the content of their imagery), they employed both visual and kinaesthetic imagery and their images tended to be positive and accurate. It was concluded that the implementation of imagery alongside physical rehabilitation should enhance the rehabilitation experience and, therefore, facilitate the recovery rates of injured athletes. Moreover, it was recommended that those responsible for the treatment of injured athletes (e.g. medical doctors, physiotherapists) should understand the benefits of imagery in athletic injury rehabilitation, since it is these practitioners who are in the best position to encourage injured athletes to use imagery.

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“…66 The MAL is an upper-extremity disability measure (self-report interview). The MAL 67,68 is a semi-structured interview during which participants are asked to rate how much and how well (6-point scale; range, 0 [worst] to 5 [best]) they use their more affected arm for 30 ADL items in the home environment over a specified period. Mental imagery was assessed using 3 measures.…”

Section: Methodsmentioning

confidence: 99%

Mental Practice With Motor Imagery: Evidence for Motor Recovery and Cortical Reorganization After Stroke

Butler

Page

2006

Archives of Physical Medicine and Rehabilitation

161

123

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Objectives-To measure the efficacy of a program combining mental and physical practice with the efficacy of a program composed of only constraint-induced movement therapy (CIMT) or only mental practice on stroke patients' levels of upper-extremity impairment and upper-extremity functional outcomes and to establish the relationship between changes in blood-oxygen-level dependent (BOLD) functional magnetic resonance imaging response during a specific motor or imagery task and improvement in motor function between intervention groups. Design-Case series.Setting-Licensed, 56-bed, freestanding, university-affiliated rehabilitation hospital.Participants-Three men and 1 woman with moderate upper-limb hemiparesis after stroke were randomized.

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A randomized efficacy and feasibility study of imagery in acute stroke

Abstract: Imagery is a clinically feasible, cost-effective complement to therapy that may improve outcomes more than participation in therapy only.

Cited by 246 publications

References 24 publications

Volition and Imagery in Neurorehabilitation

Volition and Imagery in Neurorehabilitation

Imagery use by injured athletes: A qualitative analysis

Mental Practice With Motor Imagery: Evidence for Motor Recovery and Cortical Reorganization After Stroke

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