Towards the integration of mental practice in rehabilitation programs. A critical review

Abstract

Many clinical studies have investigated the use of mental practice (MP) through motor imagery (MI) to enhance functional recovery of patients with diverse physical disabilities. Although beneficial effects have been generally reported for training motor functions in persons with chronic stroke (e.g., reaching, writing, walking), attempts to integrate MP within rehabilitation programs have been met with mitigated results. These findings have stirred further questioning about the value of MP in neurological rehabilitation. In fact, despite abundant systematic reviews, which customarily focused on the methodological merits of selected studies, several questions about factors underlying observed effects remain to be addressed. This review discusses these issues in an attempt to identify factors likely to hamper the integration of MP within rehabilitation programs. First, the rationale underlying the use of MP for training motor function is briefly reviewed. Second, three modes of MI delivery are proposed based on the analysis of the research protocols from 27 studies in persons with stroke and Parkinson's disease. Third, for each mode of MI delivery, a general description of MI training is provided. Fourth, the review discusses factors influencing MI training outcomes such as: the adherence to MI training, the amount of training and the interaction between physical and mental rehearsal; the use of relaxation, the selection of reliable, valid and sensitive outcome measures, the heterogeneity of the patient groups, the selection of patients and the mental rehearsal procedures. To conclude, the review proposes a framework for integrating MP in rehabilitation programs and suggests research targets for steering the implementation of MP in the early stages of the rehabilitation process. The challenge has now shifted towards the demonstration that MI training can enhance the effects of regular therapy in persons with subacute stroke during the period of spontaneous recovery.

Is Irish set dancing feasible for people with Parkinson's disease in Ireland?

“…7 To complement classes, a set dancing-based exercise programme was performed at home for 20 min, twice per week. Exercises involved seated active practice of class material and mental rehearsal to facilitate learning [37,38] and optimise safety. A standardised interactive DVD, developed by the dance instructor was given to aid learning [39].…”

New evidence of corticospinal network modulation induced by motor imagery

“…H-reflex; motor-evoked potential; cervico-medullar-evoked potential; transcranial magnetic stimulation; muscle lengthening; presynaptic inhibition DURING THE PAST THREE DECADES, evidence has emerged, suggesting that mental training can improve motor performance (Lebon et al 2010), thus promoting its interest for neurorehabilitation programs [for review, see Malouin et al (2013)]. Mental training with motor imagery (MI) involves the internal simulation of movements without corresponding motor output (Jeannerod 2001).…”

Mental Practice

“…In short, although an important undertaking, rigorous, efficacious, integration of mental practice's impact on UE motor function into clinical situations remains unrealized. Malouin et al 36 36 we think that additional integration of the evidence-based behavioral methods discussed later in this article may increase the efficacy of clinically based mental practice protocols.…”