Posts Tagged Imagery
[Abstract] Mental practice for upper limb rehabilitation after stroke: a systematic review and meta-analysis
Mental practice (MP) is usually provided in combination with other therapies, and new developments for neurofeedback to support MP have been made recently. The objectives of this study were to evaluate the effectiveness of MP and to investigate the intervention characteristics including neurofeedback that may affect treatment outcome. The Cochrane Central Register of Controlled Trials, PubMed, Embase, KoreaMed, Scopus, Web of Science, PEDro, and CIRRIE were searched from inception to March 2017 for randomized controlled trials to assess the effect of MP for upper limb rehabilitation after stroke. Fugl-Meyer Assessment (FMA) was used as the outcome measure for meta-analysis. Twenty-five trials met the inclusion criteria, and 15 trials were eligible for meta-analysis. Among the trials selected for meta-analysis, MP was added to conventional therapy in eight trials or to modified constraint-induced movement therapy in one trial. The other trials provided neurofeedback to support MP: MP-guided neuromuscular electrical stimulation (NMES) in four trials and MP-guided robot-assisted therapy (RAT) in two trials. MP added to conventional therapy resulted in significantly higher FMA gain than conventional therapy alone. MP-guided NMES showed superior result than conventional NMES as well. However, the FMA gain of MP-guided RAT was not significantly higher than RAT alone. We suggest that MP is an effective complementary therapy either given with neurofeedback or not. Neurofeedback applied to MP showed different results depending on the therapy provided. This study has limitations because of heterogeneity and inadequate quality of trials. Further research is requested.
Imagery, mirror box therapy and action observation are simple, inexpensive and patient led treatments that can be used to aid in the improvement of motor function in both the upper- and lower-extremities post-stroke. This thesis examined the effects of imagery on physical movement post-stroke and therapists’ use of imagery, mirror box therapy and action observation as part of stroke rehabilitation. Study one was a metaanalysis investigating the effect of imagery on upper- and lower-limb movement ability post-stroke. The results revealed that imagery produced a moderate mean treatment effect (p= 0.03; d= 0.48; 95% confidence interval: 0.05 to 0.91). Imagery that was performed in the third person and performance analysis (the identification of incorrect task performance to help facilitate a positive change in performance) showed the largest improvements in movement. However, the effectiveness of imagery during stroke rehabilitation is still uncertain, as indicated by the large confidence interval. The second study investigated the extent to which physiotherapists and occupational therapists in the UK used cognitive therapies during stroke rehabilitation. In addition, how the therapies were conducted and the therapists’ views on their delivery were investigated. The skill audit had a response rate of 25% and showed that during stroke rehabilitation 68% (91/133) of therapists used imagery, 53% (68/129) used action observation and 41% (52/128) used mirror box therapy. Only 12% of therapists had received specific training in these therapies and therapists would like guidance on how to administer cognitive therapies. Unfortunately, due to the poor response rate the skill audit data may not be generalizable to the whole stroke therapy population. To conclude, the metaanalysis and skill audit have highlighted the potential of cognitive therapies and will help inform the production of clinical guidelines on the use of cognitive therapies during stroke rehabilitation. Clinical guidelines would help standardise the delivery of cognitive therapies and inform therapists how to motivate patients’, post-stroke.
Different treatments for stroke patients have been proposed; among them the mirror therapy and motion imagery lead to functional recovery by providing a cortical reorganization. Up today the basic concepts of the current literature on mirror neurons and the major findings regarding the use of mirror therapy and motor imagery as potential tools to promote reorganization and functional recovery in post-stroke patients.
Bibliographic research was conducted based on publications over the past thirteen years written in English in the databases Scielo, Pubmed/MEDLINE, ISI Web of Knowledge. The studies showed how the interaction among vision, proprioception and motor commands promotes the recruitment of mirror neurons, thus providing cortical reorganization and functional recovery of post-stroke patients. We conclude that the experimental advances on Mirror Neurons will bring new rational therapeutic approaches to post-stroke rehabilitation.