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Barclay RE, Stevenson TJ, Poluha W, Semenko B, Schubert J. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Cochrane Database Syst Rev 2020; 5:CD005950. [PMID: 32449959 PMCID: PMC7387111 DOI: 10.1002/14651858.cd005950.pub5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Stroke is caused by the interruption of blood flow to the brain (ischemic stroke) or the rupture of blood vessels within the brain (hemorrhagic stroke) and may lead to changes in perception, cognition, mood, speech, health-related quality of life, and function, such as difficulty walking and using the arm. Activity limitations (decreased function) of the upper extremity are a common finding for individuals living with stroke. Mental practice (MP) is a training method that uses cognitive rehearsal of activities to improve performance of those activities. OBJECTIVES To determine whether MP improves outcomes of upper extremity rehabilitation for individuals living with the effects of stroke. In particular, we sought to (1) determine the effects of MP on upper extremity activity, upper extremity impairment, activities of daily living, health-related quality of life, economic costs, and adverse effects; and (2) explore whether effects differed according to (a) the time post stroke at which MP was delivered, (b) the dose of MP provided, or (c) the type of comparison performed. SEARCH METHODS We last searched the Cochrane Stroke Group Trials Register on September 17, 2019. On September 3, 2019, we searched the Cochrane Central Register of Controlled Trials (the Cochrane Library), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Web of Science, the Physiotherapy Evidence Database (PEDro), and REHABDATA. On October 2, 2019, we searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. We reviewed the reference lists of included studies. SELECTION CRITERIA We included randomized controlled trials (RCTs) of adult participants with stroke who had deficits in upper extremity function (called upper extremity activity). DATA COLLECTION AND ANALYSIS Two review authors screened titles and abstracts of the citations produced by the literature search and excluded obviously irrelevant studies. We obtained the full text of all remaining studies, and both review authors then independently selected trials for inclusion. We combined studies when the review produced a minimum of two trials employing a particular intervention strategy and a common outcome. We considered the primary outcome to be the ability of the arm to be used for appropriate tasks, called upper extremity activity. Secondary outcomes included upper extremity impairment (such as quality of movement, range of motion, tone, presence of synergistic movement), activities of daily living (ADLs), health-related quality of life (HRQL), economic costs, and adverse events. We assessed risk of bias in the included studies and applied GRADE to assess the certainty of the evidence. We completed subgroup analyses for time since stroke, dosage of MP, type of comparison, and type of arm activity outcome measure. MAIN RESULTS We included 25 studies involving 676 participants from nine countries. For the comparison of MP in addition to other treatment versus the other treatment, MP in combination with other treatment appears more effective in improving upper extremity activity than the other treatment without MP (standardized mean difference [SMD] 0.66, 95% confidence interval [CI] 0.39 to 0.94; I² = 39%; 15 studies; 397 participants); the GRADE certainty of evidence score was moderate based on risk of bias for the upper extremity activity outcome. For upper extremity impairment, results were as follows: SMD 0.59, 95% CI 0.30 to 0.87; I² = 43%; 15 studies; 397 participants, with a GRADE score of moderate, based on risk of bias. For ADLs, results were as follows: SMD 0.08, 95% CI -0.24 to 0.39; I² = 0%; 4 studies; 157 participants; the GRADE score was low due to risk of bias and small sample size. For the comparison of MP versus conventional treatment, the only outcome with available data to combine (3 studies; 50 participants) was upper extremity impairment (SMD 0.34, 95% CI -0.33 to 1.00; I² = 21%); GRADE for the impairment outcome in this comparison was low due to risk of bias and small sample size. Subgroup analyses of time post stroke, dosage of MP, or comparison type for the MP in combination with other rehabilitation treatment versus the other treatment comparison showed no differences. The secondary outcome of health-related quality of life was reported in only one study, and no study noted the outcomes of economic costs and adverse events. AUTHORS' CONCLUSIONS Moderate-certainty evidence shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity activity. Moderate-certainty evidence also shows that MP in addition to other treatment versus the other treatment appears to be beneficial in improving upper extremity impairment after stroke. Low-certainty evidence suggests that ADLs may not be improved with MP in addition to other treatment versus the other treatment. Low-certainty evidence also suggests that MP versus conventional treatment may not improve upper extremity impairment. Further study is required to evaluate effects of MP on time post stroke, the volume of MP required to affect outcomes, and whether improvement is maintained over the long term.
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Affiliation(s)
- Ruth E Barclay
- Department of Physical Therapy, College of Rehabilitation Science, University of Manitoba, Winnipeg, Canada
| | - Ted J Stevenson
- Rehabilitation Services, St Boniface General Hospital, Winnipeg, Canada
| | - William Poluha
- Sciences and Technology Library, University of Manitoba, Winnipeg, Canada
| | - Brenda Semenko
- Occupational Therapy Department, Health Sciences Centre, Winnipeg, Canada
| | - Julie Schubert
- Steelcity Physiotherapy & Wellness Centre, Selkirk, Canada
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Bagarinao E, Yoshida A, Ueno M, Terabe K, Kato S, Isoda H, Nakai T. Improved Volitional Recall of Motor-Imagery-Related Brain Activation Patterns Using Real-Time Functional MRI-Based Neurofeedback. Front Hum Neurosci 2018; 12:158. [PMID: 29740302 PMCID: PMC5928248 DOI: 10.3389/fnhum.2018.00158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/05/2018] [Indexed: 11/13/2022] Open
Abstract
Motor imagery (MI), a covert cognitive process where an action is mentally simulated but not actually performed, could be used as an effective neurorehabilitation tool for motor function improvement or recovery. Recent approaches employing brain–computer/brain–machine interfaces to provide online feedback of the MI during rehabilitation training have promising rehabilitation outcomes. In this study, we examined whether participants could volitionally recall MI-related brain activation patterns when guided using neurofeedback (NF) during training. The participants’ performance was compared to that without NF. We hypothesized that participants would be able to consistently generate the relevant activation pattern associated with the MI task during training with NF compared to that without NF. To assess activation consistency, we used the performance of classifiers trained to discriminate MI-related brain activation patterns. Our results showed significantly higher predictive values of MI-related activation patterns during training with NF. Additionally, this improvement in the classification performance tends to be associated with the activation of middle temporal gyrus/inferior occipital gyrus, a region associated with visual motion processing, suggesting the importance of performance monitoring during MI task training. Taken together, these findings suggest that the efficacy of MI training, in terms of generating consistent brain activation patterns relevant to the task, can be enhanced by using NF as a mechanism to enable participants to volitionally recall task-related brain activation patterns.
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Affiliation(s)
| | - Akihiro Yoshida
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan.,NeuroImaging and Informatics Lab, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Mika Ueno
- NeuroImaging and Informatics Lab, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kazunori Terabe
- Graduate School of Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Shohei Kato
- Graduate School of Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Haruo Isoda
- Brain & Mind Research Center, Nagoya University, Nagoya, Japan.,Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Toshiharu Nakai
- Department of Radiological Sciences, Nagoya University Graduate School of Medicine, Nagoya University, Nagoya, Japan.,NeuroImaging and Informatics Lab, National Center for Geriatrics and Gerontology, Obu, Japan
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Chen D, Huang X, Gan H, Du X, Lu S, Huang R, Liu K, Zhang B. Efficacy of alogliptin combined with motor imagery under hyperbaric oxygen in diabetic nephropathy with silent cerebral infarction. Biomed Rep 2017; 7:407-415. [PMID: 29181153 PMCID: PMC5700399 DOI: 10.3892/br.2017.983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/14/2017] [Indexed: 12/13/2022] Open
Abstract
In the present study, we evaluated the curative effect of dipeptidyl peptidase-IV (DPP-IV) inhibitor alogliptin combined with motor imagery under hyperbaric oxygen in diabetic nephropathy (DN) with silent cerebral infarction (SCI). Two-hundred newly diagnosed DN patients with and without SCI were included. The SCI patients were divided into two treatment groups: Alogliptin (A group, n=50) and alogliptin combined with motor imagery under hyperbaric oxygen (B group, n=50). The degrees of neurocognitive dysfunction were evaluated at baseline and after 6 months of treatment. Thromboelastograms (TEGs) mapping were conducted. Serum glycoprotein VI (GPVI) mRNA expression and urine 11-DH-TXB2 levels were determined. Compared to group A patients, the severity of neurofunctional defects, GPVI mRNA expression and 11-DH-TXB2 levels were significantly lower in group B (P<0.05), while comprehensive, MoCA scores were higher in group B. The MoCA subscores of visuospatial/executive function, attention and concentration were significantly higher compared to group A (P<0.05). The sub-scores of computation, abstract thinking, language competence, memory and orientation were also higher in group B but the differences were not significant (P>0.05). TEG indexes were improved in both groups after treatment as manifested by increased R and K values, but there was significant improvement in group B. Intra-group comparisons revealed a time-dependent effect of treatment. In conclusion, the treatment of alogliptin combined with motor imagery under hyperbaric oxygen can better promote thrombolysis absorption, restore brain damage and improve neurocognitive function in DN with silent cerebral infarction.
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Affiliation(s)
- Danyan Chen
- Department of Endocrinology and Nephrology, The Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Xiaolong Huang
- Department of Neurosurgery, No. 324 Hospital of PLA, Chongqing 400028, P.R. China
| | - Hua Gan
- Department of Nephrology, Τhe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xiaogang Du
- Department of Nephrology, Τhe First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, P.R. China
| | - Song Lu
- Department of Endocrinology and Nephrology, The Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Rongxi Huang
- Department of Endocrinology and Nephrology, The Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Ke Liu
- Department of Endocrinology and Nephrology, The Chongqing General Hospital, Chongqing 400013, P.R. China
| | - Binghan Zhang
- Department of Endocrinology and Nephrology, The Chongqing General Hospital, Chongqing 400013, P.R. China
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Sun R, Wong WW, Wang J, Tong RKY. Changes in Electroencephalography Complexity using a Brain Computer Interface-Motor Observation Training in Chronic Stroke Patients: A Fuzzy Approximate Entropy Analysis. Front Hum Neurosci 2017; 11:444. [PMID: 28928649 PMCID: PMC5591875 DOI: 10.3389/fnhum.2017.00444] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 08/21/2017] [Indexed: 12/27/2022] Open
Abstract
Entropy-based algorithms have been suggested as robust estimators of electroencephalography (EEG) predictability or regularity. This study aimed to examine possible disturbances in EEG complexity as a means to elucidate the pathophysiological mechanisms in chronic stroke, before and after a brain computer interface (BCI)-motor observation intervention. Eleven chronic stroke subjects and nine unimpaired subjects were recruited to examine the differences in their EEG complexity. The BCI-motor observation intervention was designed to promote functional recovery of the hand in stroke subjects. Fuzzy approximate entropy (fApEn), a novel entropy-based algorithm designed to evaluate complexity in physiological systems, was applied to assess the EEG signals acquired from unimpaired subjects and stroke subjects, both before and after training. The results showed that stroke subjects had significantly lower EEG fApEn than unimpaired subjects (p < 0.05) in the motor cortex area of the brain (C3, C4, FC3, FC4, CP3, and CP4) in both hemispheres before training. After training, motor function of the paretic upper limb, assessed by the Fugl-Meyer Assessment-Upper Limb (FMA-UL), Action Research Arm Test (ARAT), and Wolf Motor Function Test (WMFT) improved significantly (p < 0.05). Furthermore, the EEG fApEn in stroke subjects increased considerably in the central area of the contralesional hemisphere after training (p < 0.05). A significant correlation was noted between clinical scales (FMA-UL, ARAT, and WMFT) and EEG fApEn in C3/C4 in the contralesional hemisphere (p < 0.05). This finding suggests that the increase in EEG fApEn could be an estimator of the variance in upper limb motor function improvement. In summary, fApEn can be used to identify abnormal EEG complexity in chronic stroke, when used with BCI-motor observation training. Moreover, these findings based on the fApEn of EEG signals also expand the existing interpretation of training-induced functional improvement in stroke subjects. The entropy-based analysis might serve as a novel approach to understanding the abnormal cortical dynamics of stroke and the neurological changes induced by rehabilitation training.
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Affiliation(s)
- Rui Sun
- Division of Biomedical Engineering, Department of Electronic Engineering, Chinese University of Hong KongHong Kong, Hong Kong
| | - Wan-Wa Wong
- Division of Biomedical Engineering, Department of Electronic Engineering, Chinese University of Hong KongHong Kong, Hong Kong
| | - Jing Wang
- Division of Biomedical Engineering, Department of Electronic Engineering, Chinese University of Hong KongHong Kong, Hong Kong.,School of Mechanical Engineering, Xi'an Jiaotong UniversityXi'an, China
| | - Raymond Kai-Yu Tong
- Division of Biomedical Engineering, Department of Electronic Engineering, Chinese University of Hong KongHong Kong, Hong Kong
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Pomeroy VM, Clark CA, Miller JSG, Baron JC, Markus HS, Tallis RC. The Potential for Utilizing the “Mirror Neurone System” to Enhance Recovery of the Severely Affected Upper Limb Early after Stroke: A Review and Hypothesis. Neurorehabil Neural Repair 2016; 19:4-13. [PMID: 15673838 DOI: 10.1177/1545968304274351] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recovery of upper limb movement control after stroke might be enhanced by repetitive goal-directed functional activities. Providing such activity is challenging in the presence of severe paresis. A possible new approach is based on the discovery of mirror neurons in the monkey cortical area F5, which are active both in observing and executing a movement. Indirect evidence for a comparable human “mirror neurone system” is provided by functional imaging. The primary motor cortex, the premotor cortex, other brain areas, and muscles appropriate for the action being observed are probably activated in healthy volunteers observing another’s movement. These findings raise the hypothesis that observation of another’s movement might train the movement execution system of stroke patients who have severe paresis to bring them to the point at which they could actively participate in rehabilitation consisting of goal-directed activities. The point of providing an observation therapy would be to facilitate the voluntary production of movement; therefore, the condition of interest would be observation with intent to imitate. However, there is as yet insufficient evidence to enable the testing of this hypothesis in stroke patients. Studies in normal subjects are needed to determine which brain sites are activated in response to observation with intent to imitate. Studies in stroke subjects are needed to determine how activation is affected after damage to different brain areas. The information from such studies should aid identification of those stroke patients who might be most likely to benefit from observation to imitate and therefore guide phase I clinical studies.
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Affiliation(s)
- Valerie M Pomeroy
- Geriatric Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
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Park JH, Park JH. The effects of game-based virtual reality movement therapy plus mental practice on upper extremity function in chronic stroke patients with hemiparesis: a randomized controlled trial. J Phys Ther Sci 2016; 28:811-5. [PMID: 27134363 PMCID: PMC4842444 DOI: 10.1589/jpts.28.811] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 12/01/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the effects of game-based virtual
reality movement therapy plus mental practice on upper extremity function in chronic
stroke patients with hemiparesis. [Subjects] The subjects were chronic stroke patients
with hemiparesis. [Methods] Thirty subjects were randomly assigned to either the control
group or experimental group. All subjects received 20 sessions (5 days in a week) of
virtual reality movement therapy using the Nintendo Wii. In addition to Wii-based virtual
reality movement therapy, experimental group subjects performed mental practice consisting
of 5 minutes of relaxation, Wii games imagination, and normalization phases before the
beginning of Wii games. To compare the two groups, the upper extremity subtest of the
Fugl-Meyer Assessment, Box and Block Test, and quality of movement subscale of the Motor
Activity Log were performed. [Results] Both groups showed statistically significant
improvement in the Fugl-Meyer Assessment, Box and Block Test, and quality of the movement
subscale of Motor Activity Log after the interventions. Also, there were significant
differences in the Fugl-Meyer Assessment, Box and Block Test, and quality of movement
subscale of the Motor Activity Log between the two groups. [Conclusion] Game-based virtual
reality movement therapy alone may be helpful to improve functional recovery of the upper
extremity, but the addition of MP produces a lager improvement.
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Affiliation(s)
- Jin-Hyuck Park
- Department of Occupational Therapy, Yonsei University, Republic of Korea
| | - Ji-Hyuk Park
- Department of Occupational Therapy, Yonsei University, Republic of Korea
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McInnes K, Friesen C, Boe S. Specific Brain Lesions Impair Explicit Motor Imagery Ability: A Systematic Review of the Evidence. Arch Phys Med Rehabil 2015; 97:478-489.e1. [PMID: 26254950 DOI: 10.1016/j.apmr.2015.07.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 07/21/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine which neurologic disorders/lesions impair or restrict motor imagery (MI) ability. DATA SOURCES CINAHL, Cochrane, Embase, MEDLINE, Web of Science, PsychINFO, Physiotherapy Evidence Database, and Grey Literature were searched between May 8 and May 14, 2014. Keywords and Medical Subject Headings from 2 concepts (MI and lesion) were exploded to include related search terms (eg, mental practice/mental imagery, neurologic damage/lesion). STUDY SELECTION Two independent reviewers assessed the 3861 studies that resulted from the database search. The studies were assessed for relevancy using the following inclusion criteria: use of explicit kinesthetic MI; neurologic lesion location identified; and use of an MI ability assessment tool. DATA EXTRACTION Twenty-three studies encompassing 196 participants were included. The 23 studies used 8 different methods for assessing MI ability. MI assessment scores were then normalized to facilitate comparison across studies. DATA SYNTHESIS Lesion locations comprised many brain areas, including cortical (eg, parietal and frontal lobes), subcortical (eg, basal ganglia, thalamus), and cerebellum. Lesion etiology primarily was comprised of stroke and Parkinson disease. Several participants presented with lesions resulting from other pathologies. Subjects with parietal lobe damage were most impaired on their ability to perform MI. Subjects with frontal lobe and basal ganglia damage also consistently showed impairment in MI ability. CONCLUSIONS Subjects with damage to specific brain structures, including the parietal and frontal lobes, showed impaired MI ability. As such, MI-based neurorehabilitation may not be efficacious in all patient populations. Therefore, decisions related to the use of MI in neurorehabilitation should, in part, be based on the patient's underlying pathophysiology.
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Affiliation(s)
- Kerry McInnes
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada; School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Christopher Friesen
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Shaun Boe
- Laboratory for Brain Recovery and Function, Dalhousie University, Halifax, NS, Canada; School of Physiotherapy, Dalhousie University, Halifax, NS, Canada; Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
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Hewett TE, Ford KR, Levine P, Page SJ. Reaching Kinematics to Measure Motor Changes After Mental Practice in Stroke. Top Stroke Rehabil 2014; 14:23-9. [PMID: 17698455 DOI: 10.1310/tsr1404-23] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine mental practice (MP) efficacy using a new kinematics reaching model. METHOD This was a prepost, case series conducted at an outpatient rehabilitation hospital of 5 patients who experienced stroke >1 year before study entry (3 males; mean age = 52.6 +/- 15.4 years [range, 38-76 years]; mean time since stroke = 51.2 months [range, 13-126 months]) exhibiting upper limb hemiparesis on their dominant sides. Participants received 30-minute therapy sessions emphasizing activities of daily living (ADLs) using their affected arms, which occurred 2 days/week for 6 weeks. After therapy, participants received 30-minute MP sessions requiring MP of the ADLs. The main outcome measure was 3-D Motion Analysis (kinematics), in which patients performed 2 functional reaching tasks consisting of reaching and grasping a plastic cylinder positioned at either elbow height (reach out) or shoulder height (reach up). Dependent variables included horizontal reaching distance, hand velocity, elbow range of motion, and shoulder range of motion. RESULTS Prior to intervention, the mean horizontal reaching distance was 8.3 +/- 1.7 cm and 10.9 +/- 2.2 cm for the reach-up and reach-out tasks, respectively. Upon completion of the intervention, ability to reach up significantly improved to 9.9 +/- 1.6 cm (p <.001). Horizontal reach distance also improved during the reach-out task (11.7 +/- 2.2 cm, p = .366). No statistically significant change was observed in linear hand velocity. Patients also exhibited greater shoulder flexion and elbow extension during both the posttest reach-up and posttest reach-out tasks. DISCUSSION AND CONCLUSION Kinematics appears to offer a precise, objective way of quantifying MP-induced motor changes during ADL performance. MP appears to improve several aspects of affected arm reaching.
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Affiliation(s)
- Timothy E Hewett
- Department of Pediatric and Orthoapedic Surgery, Sports Medicine Biodynamics Center at Cincinnati Children's Hospital Research Foundation, University of Cincinnati College, Academic Medical Center, Cincinnati, Ohio, USA
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Zhuo C, Li L. The application and efficacy of combined neurofeedback therapy and imagery training in adolescents with Tourette syndrome. J Child Neurol 2014; 29:965-8. [PMID: 23481449 DOI: 10.1177/0883073813479999] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 01/29/2013] [Indexed: 11/15/2022]
Abstract
We aimed to examine the effectiveness of combined neurofeedback therapy and imagery training in adolescent patients with refractory Tourette syndrome. Two patients, aged respectively 14 and 16 years, had been treated with haloperidol and tiapride; however, this medication was ineffective and accompanied by intolerable side effects. In this study, the patients completed 80 sessions of neurofeedback treatment followed by imagery training. The patients were assessed with behavior rating scales both before and after the treatment as well as during follow-up examinations to evaluate the effect of the combined therapy. Patients showed significant improvement in motor tic and vocal tic symptoms, exemplified by a reduction in the frequency and intensity of tics, indicating that neurofeedback, together with imagery training, has a positive therapeutic effect on adolescent patients with medication-refractory Tourette syndrome.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry, Tianjin Anning Hospital, Dongli District, Tianjin, China
| | - Li Li
- Institute of Mental Health, Peking University (Sixth Hospital, Peking University), Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing , China
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Kranczioch C, Zich C, Schierholz I, Sterr A. Mobile EEG and its potential to promote the theory and application of imagery-based motor rehabilitation. Int J Psychophysiol 2013; 91:10-5. [PMID: 24144637 DOI: 10.1016/j.ijpsycho.2013.10.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 11/26/2022]
Abstract
Studying the brain in its natural state remains a major challenge for neuroscience. Solving this challenge would not only enable the refinement of cognitive theory, but also provide a better understanding of cognitive function in the type of complex and unpredictable situations that constitute daily life, and which are often disturbed in clinical populations. With mobile EEG, researchers now have access to a tool that can help address these issues. In this paper we present an overview of technical advancements in mobile EEG systems and associated analysis tools, and explore the benefits of this new technology. Using the example of motor imagery (MI) we will examine the translational potential of MI-based neurofeedback training for neurological rehabilitation and applied research.
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Affiliation(s)
- Cornelia Kranczioch
- Neuropsychology Lab, Department of Psychology, European Medical School, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany; Neurosensory Science Research Group, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Catharina Zich
- Neuropsychology Lab, Department of Psychology, European Medical School, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Irina Schierholz
- Neuropsychology Lab, Department of Psychology, European Medical School, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Annette Sterr
- Brain and Behavior Research Group, School of Psychology, University of Surrey, Guildford, UK.
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Yan J, Guo X, Jin Z, Sun J, Shen L, Tong S. Cognitive alterations in motor imagery process after left hemispheric ischemic stroke. PLoS One 2012; 7:e42922. [PMID: 22912763 PMCID: PMC3415407 DOI: 10.1371/journal.pone.0042922] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/13/2012] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Motor imagery training is a promising rehabilitation strategy for stroke patients. However, few studies had focused on the neural mechanisms in time course of its cognitive process. This study investigated the cognitive alterations after left hemispheric ischemic stroke during motor imagery task. METHODOLOGY/PRINCIPAL FINDINGS Eleven patients with ischemic stroke in left hemisphere and eleven age-matched control subjects participated in mental rotation task (MRT) of hand pictures. Behavior performance, event-related potential (ERP) and event-related (de)synchronization (ERD/ERS) in beta band were analyzed to investigate the cortical activation. We found that: (1) The response time increased with orientation angles in both groups, called "angle effect", however, stoke patients' responses were impaired with significantly longer response time and lower accuracy rate; (2) In early visual perceptual cognitive process, stroke patients showed hypo-activations in frontal and central brain areas in aspects of both P200 and ERD; (3) During mental rotation process, P300 amplitude in control subjects decreased while angle increased, called "amplitude modulation effect", which was not observed in stroke patients. Spatially, patients showed significant lateralization of P300 with activation only in contralesional (right) parietal cortex while control subjects showed P300 in both parietal lobes. Stroke patients also showed an overall cortical hypo-activation of ERD during this sub-stage; (4) In the response sub-stage, control subjects showed higher ERD values with more activated cortical areas particularly in the right hemisphere while angle increased, named "angle effect", which was not observed in stroke patients. In addition, stroke patients showed significant lower ERD for affected hand (right) response than that for unaffected hand. CONCLUSIONS/SIGNIFICANCE Cortical activation was altered differently in each cognitive sub-stage of motor imagery after left hemispheric ischemic stroke. These results will help to understand the underlying neural mechanisms of mental rotation following stroke and may shed light on rehabilitation based on motor imagery training.
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Affiliation(s)
- Jing Yan
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoli Guo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Jin
- Department of Neurology, The Fifth People’s Hospital of Shanghai, Shanghai, China
| | - Junfeng Sun
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Liwei Shen
- Department of Neurology, The Fifth People’s Hospital of Shanghai, Shanghai, China
| | - Shanbao Tong
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- * E-mail:
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Bovend'eerdt TJH, Dawes H, Sackley C, Wade DT. Practical research-based guidance for motor imagery practice in neurorehabilitation. Disabil Rehabil 2012; 34:2192-200. [PMID: 22533623 DOI: 10.3109/09638288.2012.676703] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this appraisal is to offer guidance to clinicians on applying motor imagery in neurorehabilitation and provide guidance to support this process. METHOD We used evidence from a variety of fields as well as clinical experience with motor imagery to develop guidance for employing motor imagery during neurorehabilitation. RESULTS Motor imagery is a relatively new intervention for neurorehabilitation supported by evidence from areas such as cognitive neuroscience and sports psychology. Motor imagery has become a very popular intervention modality for clinicians but there is insufficient information available on how to administer it in clinical practice and make deliberate decisions during its application. CONCLUSIONS We provide evidence-based guidance for employing motor imagery in neurorehabilitation and use the principles of motor learning as the framework for clinical application.
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Affiliation(s)
- Thamar J H Bovend'eerdt
- Department of Human Movement Sciences, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Schuster C, Butler J, Andrews B, Kischka U, Ettlin T. Comparison of embedded and added motor imagery training in patients after stroke: results of a randomised controlled pilot trial. Trials 2012; 13:11. [PMID: 22269834 PMCID: PMC3316146 DOI: 10.1186/1745-6215-13-11] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 01/23/2012] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Motor imagery (MI) when combined with physiotherapy can offer functional benefits after stroke. Two MI integration strategies exist: added and embedded MI. Both approaches were compared when learning a complex motor task (MT): 'Going down, laying on the floor, and getting up again'. METHODS Outpatients after first stroke participated in a single-blinded, randomised controlled trial with MI embedded into physiotherapy (EG1), MI added to physiotherapy (EG2), and a control group (CG). All groups participated in six physiotherapy sessions. Primary study outcome was time (sec) to perform the motor task at pre and post-intervention. SECONDARY OUTCOMES level of help needed, stages of MT-completion, independence, balance, fear of falling (FOF), MI ability. Data were collected four times: twice during one week baseline phase (BL, T0), following the two week intervention (T1), after a two week follow-up (FU). Analysis of variance was performed. RESULTS Thirty nine outpatients were included (12 females, age: 63.4 ± 10 years; time since stroke: 3.5 ± 2 years; 29 with an ischemic event). All were able to complete the motor task using the standardised 7-step procedure and reduced FOF at T0, T1, and FU. Times to perform the MT at baseline were 44.2 ± 22s, 64.6 ± 50s, and 118.3 ± 93s for EG1 (N = 13), EG2 (N = 12), and CG (N = 14). All groups showed significant improvement in time to complete the MT (p < 0.001) and degree of help needed to perform the task: minimal assistance to supervision (CG) and independent performance (EG1+2). No between group differences were found. Only EG1 demonstrated changes in MI ability over time with the visual indicator increasing from T0 to T1 and decreasing from T1 to FU. The kinaesthetic indicator increased from T1 to FU. Patients indicated to value the MI training and continued using MI for other difficult-to-perform tasks. CONCLUSIONS Embedded or added MI training combined with physiotherapy seem to be feasible and benefi-cial to learn the MT with emphasis on getting up independently. Based on their baseline level CG had the highest potential to improve outcomes. A patient study with 35 patients per group could give a conclusive answer of a superior MI integration strategy. TRIAL REGISTRATION ClinicalTrials.gov: NCT00858910.
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Affiliation(s)
- Corina Schuster
- Reha Rheinfelden, Salinenstrasse 98, 4310 Rheinfelden, Switzerland.
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Wu AJ, Radel J, Hanna-Pladdy B. Improved function after combined physical and mental practice after stroke: a case of hemiparesis and apraxia. Am J Occup Ther 2011; 65:161-8. [PMID: 21476363 DOI: 10.5014/ajot.2011.000786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study describes change in functional performance and self-perception after participation in combined training with physical practice followed by mental practice. The patient was a 44-yr-old white man who experienced a single left ischemic stroke 7 mo before enrollment in the study. He engaged in physical and mental practice of two functional tasks: (1) reaching for and grasping a cup and (2) turning pages in a book with the more-affected arm. Practice took place 3 times per week during 60-min sessions for 6 consecutive wk. Primary outcome measures were the Arm Motor Ability Test (AMAT) and the Canadian Occupational Performance Measure (COPM). An abbreviated version of the Florida Apraxia Battery gesture-to-verbal command test approximated severity of ideomotor apraxia. After intervention, the patient demonstrated increased functional performance (AMAT) and self-perception of performance (COPM) despite persistent ideomotor apraxia. The results of this single-case report indicate functional benefit from traditional rehabilitation techniques despite comorbid, persisting ideomotor apraxia.
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Affiliation(s)
- Andy J Wu
- Department of Occupational Therapy Education, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 2003, Kansas City, KS, USA.
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Barclay‐Goddard RE, Stevenson TJ, Poluha W, Thalman L. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. Cochrane Database Syst Rev 2011; 2011:CD005950. [PMID: 21563146 PMCID: PMC6464751 DOI: 10.1002/14651858.cd005950.pub4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Activity limitations of the upper extremity are a common finding for individuals living with stroke. Mental practice (MP) is a training method that uses cognitive rehearsal of activities to improve performance of those activities. OBJECTIVES To determine if MP improves the outcome of upper extremity rehabilitation for individuals living with the effects of stroke. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (November 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, November 2009), PubMed (1965 to November 2009), EMBASE (1980 to November 2009), CINAHL (1982 to November 2009), PsycINFO (1872 to November 2009), Scopus (1996 to November 2009), Web of Science (1955 to November 2009), the Physiotherapy Evidence Database (PEDro), CIRRIE, REHABDATA, ongoing trials registers, and also handsearched relevant journals and searched reference lists. SELECTION CRITERIA Randomised controlled trials involving adults with stroke who had deficits in upper extremity function. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion. We considered the primary outcome to be the ability of the arm to be used for appropriate tasks (i.e. arm function). MAIN RESULTS We included six studies involving 119 participants. We combined studies that evaluated MP in addition to another treatment versus the other treatment alone. Mental practice in combination with other treatment appears more effective in improving upper extremity function than the other treatment alone (Z = 3.48, P = 0.0005; standardised mean difference (SMD) 1.37; 95% confidence interval (CI) 0.60 to 2.15). We attempted subgroup analyses, based on time since stroke and dosage of MP; however, numbers in each group were small. We evaluated the quality of the evidence with the PEDro scale, ranging from 6 to 9 out of 10; we determined the GRADE score to be moderate. AUTHORS' CONCLUSIONS There is limited evidence to suggest that MP in combination with other rehabilitation treatment appears to be beneficial in improving upper extremity function after stroke, as compared with other rehabilitation treatment without MP. Evidence regarding improvement in motor recovery and quality of movement is less clear. There is no clear pattern regarding the ideal dosage of MP required to improve outcomes. Further studies are required to evaluate the effect of MP on time post stroke, volume of MP that is required to affect the outcomes and whether improvement is maintained long-term. Numerous large ongoing studies will soon improve the evidence base.
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Affiliation(s)
- Ruth E Barclay‐Goddard
- University of ManitobaDepartment of Physical Therapy, School of Medical RehabilitationSchool of Medical RehabiltationR106‐771 McDermot AvenueWinnipegCanadaR3E 0T6
| | - Ted J Stevenson
- St. Boniface General HospitalDepartment of Rehabilitation Services409 TacheWinnipegCanadaR2H 2A6
| | - William Poluha
- University of ManitobaSciences and Technology LibraryWinnipegCanadaR3T 2N2
| | - Leyda Thalman
- St. Boniface General HospitalDepartment of Rehabilitation Services409 TacheWinnipegCanadaR2H 2A6
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Welfringer A, Leifert-Fiebach G, Babinsky R, Brandt T. Visuomotorische Imaginationstherapie in der Neglektrehabilitation – Grundlagen, Vorgehen und Falldarstellungen. ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2010. [DOI: 10.1024/1016-264x/a000009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mentales Training findet vermehrt in der neurologischen Rehabilitation Einsatz. Neglekpatienten mit repräsentationalen Störungen, u. a. des eigenen Körpers, könnten von einer visuomotorischen Imaginationstherapie profitieren. Das therapeutische Vorgehen für die praktische Anwendung in der Neglektrehabilitation wird vorgestellt bezüglich (1) Patientenauswahl, (2) Testdiagnostik, (3) Messung der Imaginationsfähigkeit, (4) Psychoedukation, (5) Setting, (6) Therapiemanual, (7) Frequenz und Komplexitätsgrade, (8) Therapieprotokoll, (9) Elektromyographie sowie (10) Eigentraining. Zwei Fallbeispiele verdeutlichen wie eine visuomotorische Imaginationstherapie selbst im chronischen Krankheitsstadium zu Funktionsverbesserungen führen und bei subakutem personalem Neglekt die Körperwahrnehmung beeinflusst werden kann.
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Barclay-Goddard RE, Stevenson TJ, Poluha W, Thalman L. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd005950.pub3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Effect of Mental Practice Combined with Physical Practice on Balance in the Community-Dwelling Elderly. ACTIVITIES ADAPTATION & AGING 2007. [DOI: 10.1300/j016v31n02_01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Christakou A, Zervas Y, Lavallee D. The adjunctive role of imagery on the functional rehabilitation of a grade II ankle sprain. Hum Mov Sci 2006; 26:141-54. [PMID: 17050021 DOI: 10.1016/j.humov.2006.07.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2005] [Revised: 07/26/2006] [Accepted: 07/31/2006] [Indexed: 12/26/2022]
Abstract
The purpose of the present study was to examine the effectiveness of imagery on muscular endurance, dynamic balance, and functional stability in athletes who sustained a grade II ankle sprain. The sample consisted of 20 active athletes (aged from 18 to 30 years) with a grade II ankle sprain, as confirmed by ultrasound testing. The participants were randomly divided into two groups of 10 participants each; one experimental and one control group. The experimental group received 12 individual sessions of imagery rehearsal in addition to a normal course of physical therapy, while the control group followed only the physical therapy treatment. Results revealed significant differences only in the variable of muscular endurance. This study partly supports the contribution of imagery to the functional rehabilitation of grade II ankle sprain. Further research should be conducted to examine the effect of imagery on the functional rehabilitation of sport injuries using other tests of functional rehabilitation along with larger sample sizes.
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Affiliation(s)
- Anna Christakou
- Department of Physical Education and Sports Science, University of Athens, 41 Ethnikis Antistaseos, Dafne 172 37, Greece.
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Stevenson TJ, Barclay-Goddard RE, Poluha W, Thalman L. Mental practice for treating upper extremity deficits in individuals with hemiparesis after stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2006. [DOI: 10.1002/14651858.cd005950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Celnik P, Stefan K, Hummel F, Duque J, Classen J, Cohen LG. Encoding a motor memory in the older adult by action observation. Neuroimage 2006; 29:677-84. [PMID: 16125417 DOI: 10.1016/j.neuroimage.2005.07.039] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 07/25/2005] [Accepted: 07/27/2005] [Indexed: 10/25/2022] Open
Abstract
The ability of motor training to encode a motor memory is reduced in older adults. Here, we tested the hypothesis that training-dependent memory encoding, an issue of relevance in neurorehabilitation, is enhanced in elder individuals by action observation which alone can contribute to learning processes. A group of 11 healthy older adults participated in this study, which consisted of three randomized counterbalanced sessions on different days testing the effects of motor training (MT) alone, action observation (AO) alone, and a combination of both (MT + AO) on motor memory encoding. The combination of MT + AO formed a motor memory in the primary motor cortex and differentially modulated motor cortical excitability in muscles that were agonist and antagonist with respect to the training task, but MT or AO alone did not. These results suggest that action observation can enhance the effects of motor training on memory encoding protocols in the older adult, possibly through Hebbian modulation of intracortical excitatory mechanisms.
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Affiliation(s)
- Pablo Celnik
- Human Cortical Physiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
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Page SJ, Levine P, Leonard AC. Effects of mental practice on affected limb use and function in chronic stroke. Arch Phys Med Rehabil 2005; 86:399-402. [PMID: 15759218 DOI: 10.1016/j.apmr.2004.10.002] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the efficacy of a mental practice (MP) protocol in increasing the function and use of the more affected limb in stroke patients. DESIGN Randomized, controlled, multiple baseline, pre-post, case series. SETTING Outpatient rehabilitation hospital. PARTICIPANTS Eleven patients who had a stroke more than 1 year before study entry (9 men; mean age, 62.3+/-5.1 y; range, 53-71 y; mean time since stroke, 23.8 mo; range, 15-48 mo; 10 strokes exhibiting upper-limb hemiparesis on the dominant side) and who exhibited affected arm hemiparesis and nonuse. INTERVENTION All patients received 30-minute therapy sessions 2 days a week for 6 weeks. The sessions emphasized activities of daily living (ADLs): 6 subjects randomly assigned to the MP condition concurrently received sessions requiring daily MP of the ADLs; 5 subjects (control group) received an intervention consisting of relaxation techniques. MAIN OUTCOME MEASURES The Motor Activity Log and Action Research Arm (ARA) test. RESULTS Affected limb use as rated by MP patients and their caregivers increased (1.55, 1.66, respectively), as did patient and caregiver ratings of quality of movement (2.33, 2.15, respectively) and ARA scores (10.7). In contrast, the controls showed nominal increases in the amount they used their affected limb and in limb function. A Wilcoxon test on the ARA scores revealed significantly ( P =.004) greater changes in the MP group's scores. CONCLUSIONS Participation in an MP protocol may increase a stroke patient's use of his/her more affected limb. Data further support that the protocol resulted in correlative, MP-induced, motor function improvements. The mechanisms whereby MP increases affected arm use are unknown. Perhaps using the more affected limb becomes more salient through MP, or perhaps motor schema are altered during MP to integrate limb use.
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Affiliation(s)
- Stephen J Page
- Department of Physical Medicine and Rehabilitation, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Batson G. Motor Imagery for Stroke Rehabilitation: Current Research as a Guide to Clinical Practice. ACTA ACUST UNITED AC 2004. [DOI: 10.1089/107628004773933325] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gauggel S. Grundlagen und Empirie der Neuropsychologischen Therapie: Neuropsychotherapie oder Hirnjogging? ZEITSCHRIFT FUR NEUROPSYCHOLOGIE 2003. [DOI: 10.1024/1016-264x.14.4.217] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Dieser Beitrag beschäftigt sich mit dem theoretischen Fundament und den empirischen Grundlagen neuropsychologischer Interventionen. Nach einem kurzen historischen Rückblick werden die konzeptionellen Grundlagen einer neuropsychologischen Behandlung dargestellt und erläutert. Neuropsychologische Interventionen werden drei Therapiesäulen zugeordnet: Restitution, Kompensation und integrierten Verfahren. Restitution bezieht sich auf Maßnahmen, mit denen gestörte neuronale Systeme wieder reaktiviert werden sollen. Kompensation beinhaltet den aktiven oder passiven Ausgleich von Funktionsdefiziten durch vorhandene Fähigkeiten. Hierzu zählt nicht nur das Lernen neuer Strategien und der Einsatz von Hilfsmitteln, sondern auch die Veränderung von Erwartungen, Lebenszielen und andere kognitive Anpassungen. Integrierte Verfahren stellen Verfahren (z. B. operante Techniken) anderer Psychotherapierichtungen dar, die bei einer neuropsychologischen Behandlung Anwendung finden können und auf die Bedürfnisse von Patienten mit organisch bedingten psychischen Störungen zugeschnitten sind. Die in dem Beitrag referierten Studien unterstreichen die Bedeutung der drei postulierten Therapiesäulen.
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