[Case Study] Effect of mental practice using inverse video of the unaffected upper limb in a subject with chronic hemiparesis after stroke – Full Text PDF


[Purpose] The aim of this case study was to investigate whether a method of mental practice (MP) using an inverse video of a subject’s unaffected limb to complement the vividness of motor imagery (MI) would be effective for improving affected upper limb function.

[Subjects and Methods] The participant was 60-year-old male in the chronic stage of stroke recovery with left sided hemiparesis. The design of the study was AB method of Single-System-Design. He performed the MP as a home program with DVD. The intervention lasted 30 minutes a session, twice a day, 5 times a week, over 6 weeks. The DVD was created using inverse video of his unaffected upper limb. Primary outcome measures were used the Fugl-Meyer Assessment for upper limb (FMA) and the Motor Activity Log (MAL) 3 times each baseline, intervention and follow-up. The subjective vividness of MI was assessed by the Visual Analog Scale (VAS).

[Results] FMA and MAL score during intervention was improved significantly comparing to baseline, and maintained in withdrawal. VAS score was improved in withdrawal comparing to baseline.

[Conclusion] Results suggested that effect of mental practice for stroke patients increased by vividness of motor imagery was improved by the inverse video.


Recent studies have shown that mental practice (MP) is which motor imagery (MI) is performed repeatedly can improve motor functions in patients after stroke; these effects have been demonstrated in clinical studies using randomized controlled trials1–5) . An important aspect in mental practice is how vividly an individual can perform MI. To complement the vividness of MI, previous clinical studies used audio or visual guides during intervention and reported improvement of upper limb function and ADL1, 3) . However, there are some studies that vividness of MI differs depending on the specific features of the tasks and the subject’s ability to MI6, 7) . Prior study reported that the vividness of MI was correlated with corticospinal excitability during MI8) and effect of MP was influenced by the vividness of MI. Particularly, in patients with severe sensory disturbance after stroke, excitability of the corticospinal tract of the affected side and ability for MI were significantly lower than in healthy controls and patients with pure motor strokes9) . Therefore, it is more difficult for patients with sensory disturbance to perform MI vividly, which hinders demonstration of a significant effect of MP. Furthermore, since the effectiveness of MP differs depending on the method used to support MI, there is currently no effective and reproducible clinical method of MP. Therefore, this case study investigated whether a method of MP using an inverse video of a subject’s unaffected limb to complement the vividness of MI would be effective for improving affected upper limb function. In this study, we examined effects of how this MP using single-case design.

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