Posts Tagged mental practice

[Workshop] Evidence-Based Upper Limb Retraining after Stroke 2017 – Pre-Reading and Workshop Tasks – PDF

CHAPTER 40: Optimizing motor performance and sensation after brain impairment

ABSTRACT

This chapter provides a framework for optimizing motor performance and sensation in adults with brain impairment. Conditions such as stroke and traumatic brain injury are the main focus, however, the chapter content can apply to adults with other neurological conditions. The tasks of eating and drinking are used as examples throughout the chapter. Skills and knowledge required by graduates are identified, including knowledge of motor behaviour, the essential components of reaching to grasp and reaching in sitting, and how to identify compensatory strategies, develop and test movement hypotheses. Factors that enhance skill acquisition are discussed, including task specificity, practice intensity and timely feedback, with implications for therapists’ teaching skills. Finally, a summary is provided of evidence-based interventions to improve motor performance and sensation, including high intensity, task-specific training, mirror therapy, mental practice, electrical stimulation and constraint therapy.

Key Points:

  1. Essential knowledge in neurological rehabilitation includes an understanding of normal motor behaviour, muscle biology and skill acquisition.
  2. Abnormal motor performance can be observed during a task such as reaching for a cup, and compared with expected performance. Hypotheses about the cause(s) of observed movement differences can then be made and tested.

  3. Paralysis, weakness and loss of co-ordination affect upper limb motor performance. To improve performance after brain impairment, therapists should primarily focus on improving strength and co-ordination.

  4. Many people with brain impairment have difficulty understanding instructions, goals and feedback, and consequently may not practice well. To teach people to practice well and learn skills, therapists need to be good coaches.

  5. Motor performance and sensation can be improved using low-cost evidence-based strategies such as high intensity, repetitive, task-specific training, mirror therapy, mental practice, electrical stimulation and constraint-induced movement therapy.

1. Introduction

Upper motor neuron lesions typically cause impairments such as paralysis, muscle weakness and loss of sensation. These impairments can limit participation in everyday tasks such as eating a meal. Motor control is a term commonly used in rehabilitation (Shumway-Cook, 2012; van Vliet et al 2013) and refers to control of movements such as reaching to grasp a cup and standing up. Occupational therapists and physiotherapists retrain motor and sensory impairments that interfere with tasks such as grasping a cup and sitting safely on the toilet.

The aim of this chapter is to provide a framework that helps therapists to systematically observe, analyse and measure motor and sensory impairments. Targeted evidence-based interventions will be described that can drive neuroplasticity. Therapists need to proactively seek muscle activity and sensation. It is not enough to teach a person how to compensate using one-handed techniques, or to wait for recovery to possibly occur.[…]

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[ARTICLE] Role of Practice And Mental Imagery on Hand Function Improvement in Stroke Survivors – Full Text

Abstract

Objective: The purpose of this study was to evaluate the Role of Practice and Mental Imagery on Hand function improvement in stroke survivors

Method: We conducted systematic review of the previous studies and searched electronic databases for the years 1995 to 2016, studies were selected according to inclusion criteria, and critical appraisal was done for each study and summarized the use of mental practice for the improvement in hand function in stroke survivors.

Results: Studies differed in the various aspects like intervention protocols, outcome measures, design, and patient’s characteristics. The total number of practice hours to see the potential benefits from mental practice varied widely. Results suggest that mental practice has potential to improve the upper extremity function in stroke survivors.

Conclusion: Although the benefits of mental practice to improve upper extremity function looks promising, general guidelines for the clinical use of mental practice is difficult to make. Future research should explore the dosage, factors affecting the use of Mental Practice, effects of Mental Therapy alone without in combination with other interventions.

Introduction

Up to 85% stroke survivors experience hemi paresis resulting in impaired movement of the arm, and hand as reported by Nakayama et al. Loss of arm function adversely affects quality of life and functional motor recovery in affected upper extremity.

Sensorimotor deficits in the upper limb, such as weakness, decreased speed of movement, decreased angular excursion and impaired temporal coordination of the joints impaired upper-limb and trunk coordination.

Treatment interventions such as materials-based occupations constraint-induced movement therapy modified constraint-induced movement therapy and task-related or task-specific training are common training methods for remediating impairments and restoring function in the upper limb.

For the improvement of upper and lower functions, physical therapy provides training for functional improvement and fine motor. For most patients such rehabilitation training has many constraints of time, place and expense, accordingly in recent studies, clinical methods such as mental practice for improvement of the upper and lower functions have been suggested.

Mental practice is a training method during which a person cognitively rehearses a physical skill using motor imagery in the absence of overt, physical movements for the purpose of enhancing motor skill performance. For example, a review of the duration of mental movements found temporal equivalence for reaching; grasping; writing; and cyclical activities, such as walking and running.

Evidence for the idea that motor imagery training could enhance the recovery of hand function comes from several lines of research: the sports literature; neurophysiologic evidence; health psychology research; as well as preliminary findings using motor imagery techniques in stroke patients.

Much interest has been raised by the potential of Motor Practice of Motor task, also called “Motor Imagery” as a neuro rehabilitation technique to enhance Motor Recovery following Stroke.

Mental Practice is a training method during which a person cognitively rehearsals a physical skill using Motor Imagery in the absence of Physical movements for the purpose of enhancing Motor skill performance.

The merits of this intervention are that the patient concentration and motivation can be enhanced without regard to time and place and the training is possible without expensive equipment.

Researchers have speculated about its utility in neurorehabilitation. In fact, several review articles examining the impact of mental practice have been published. Two reviews examined stroke outcomes in general and did not limit their review to upper-extremity–focused outcomes. Both articles included studies that were published in 2005 or earlier.

Previous reviews, however, did not attempt to rate the studies reviewed in terms of the level of evidence. Thus, in this review, we determined whether mental practice is an effective intervention strategy to remediate impairments and improve upper-limb function after stroke by examining and rating the current evidence. […]

Continue –>  Role of Practice And Mental Imagery on Hand Function Improvement in Stroke Survivors | Insight Medical Publishing

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[Abstract] Effect of motor imagery on walking function and balance in patients after stroke: A quantitative synthesis of randomized controlled trials

 

Highlights

  • Motor imagery (MI) is a beneficial intervention for stroke rehabilitation.
  • MI shows superior to routine methods of treatment or training in improving walking and motor function.
  • Effects of MI on walking and motor function are not affected by treatment duration.

Abstract

Objective

This study aimed to evaluate effects of motor imagery (MI) on walking function and balance in patients after stroke.

Methods

Related randomized controlled trials (RCTs) were searched in 12 electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Science Direct, Web of Science, Allied and Complementary Medicine, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, WanFang, and VIP) from inception to November 30, 2016, and Review Manager 5.3 was used for meta-analysis. References listed in included papers and other related systematic reviews on MI were also screened for further consideration.

Results

A total of 17 studies were included. When compared with “routine methods of treatment or training,” meta-analyses showed that MI was more effective in improving walking abilities (standardized mean difference [SMD] = 0.69, random effect model, 95% confidence interval [CI] = 0.38 to 1.00, P < 0.0001) and motor function in stroke patients (SMD = 0.84, random effect model, 95% CI = 0.45 to 1.22, P < 0.0001), but no statistical difference was noted in balance (SMD = 0.78, random effect model, 95% CI = −0.07 to 1.62, P = 0.07). Statistically significant improvement in walking abilities was noted between short-term (0 to < six weeks) (SMD = 0.83, fixed effect model, 95% CI = 0.24 to 1.42, P = 0.006) and long-term (≥six weeks) durations (SMD = 0.45, fixed effect model, 95% CI = 0.25 to 0.64, P < 0.00001). Subgroup analyses results suggested that MI had a positive effect on balance with short-term duration (0 to < six weeks) (SMD = 4.67, fixed effect model, 95% CI = 2.89 to 6.46, P < 0.00001), but failed to improve balance (SMD = 0.82, random effect model, 95% CI = −0.27 to 1.90, P = 0.14) with long-term (≥six weeks) duration.

Conclusion

MI appears to be a beneficial intervention for stroke rehabilitation. Nonetheless, existing evidence regarding effectiveness of MI in stroke patients remains inconclusive because of significantly statistical heterogeneity and methodological flaws identified in the included studies. More large-scale and rigorously designed RCTs in future research with sufficient follow-up periods are needed to provide more reliable evidence on the effect of MI on stroke patients.

Source: Effect of motor imagery on walking function and balance in patients after stroke: A quantitative synthesis of randomized controlled trials – Complementary Therapies in Clinical Practice

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[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

Abstract.

[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.

INTRODUCTION

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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[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

Abstract.

[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.

INTRODUCTION

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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[ARTICLE] Effects of Adjuvant Mental Practice on Affected Upper Limb Function Following a Stroke: Results of Three-Dimensional Motion Analysis, Fugl-Meyer Assessment of the Upper Extremity and Motor Activity Logs – Full Text HTML

 

Abstract

Objective To investigate the effects of adjuvant mental practice (MP) on affected upper limb function following a stroke using three-dimensional (3D) motion analysis.

Methods In this AB/BA crossover study, we studied 10 hemiplegic patients who had a stroke within the past 6 months. The patients were randomly allocated to two groups: one group received MP combined with conventional rehabilitation therapy for the first 3 weeks followed by conventional rehabilitation therapy alone for the final 3 weeks; the other group received the same therapy but in reverse order. The MP tasks included drinking from a cup and opening a door. MP was individually administered for 20 minutes, 3 days a week for 3 weeks. To assess the tasks, we used 3D motion analysis and three additional tests: the Fugl-Meyer Assessment of the upper extremity (FMA-UE) and the motor activity logs for amount of use (MAL-AOU) and quality of movement (MAL-QOM). Assessments were performed immediately before treatment (T0), 3 weeks into treatment (T1), and 6 weeks into treatment (T2).

Results Based on the results of the 3D motion analysis and the FMA-UE index (p=0.106), the MAL-AOU scale (p=0.092), and MAL-QOM scale (p=0.273), adjuvant MP did not result in significant improvements.

Conclusion Adjuvant MP had no significant effect on upper limb function following a stroke, according to 3D motion analysis and three clinical assessment tools (the FMA-UE index and the two MAL scales). The importance of this study is its use of objective 3D motion analysis to evaluate the effects of MP. Further studies will be needed to validate these findings.

INTRODUCTION

Stroke patients with dysfunction of the upper extremities can face significant problems in their activities of daily living (ADLs) as well as in the recovery of other general functions [1].

Although many different therapeutic approaches are available for improving upper extremity function after a stroke [1], it is important to select the most appropriate intervention for rehabilitation in accordance with the severity of impairment.

Mental imagery is an active process that combines all six senses: visual, auditory, tactile, kinesthetic, olfactory, and gustatory [2]. Motor imagery, a component of mental imagery, is associated with a specific movement produced by the internal reproduction of motor action without motor output [2, 3]. Mental practice (MP) involves motor imagery and includes repetitive imagination of a physical activity with the intention of performing that activity or improving performance [2, 4]. MP allows an individual to perform tasks repeatedly without physical exhaustion or any risk to safety [5]. In addition, it enables patients to practice complex physical tasks that the stroke had rendered difficult.

MP was first used in sports to improve techniques, and it is believed that neural loops and movement patterns may be activated during MP [1]. The application of MP in stroke patients was reported to activate the cerebral and cerebellar sensorimotor structures repeatedly [6], and similar results were obtained when the actual tasks were practiced, according to a study involving positron emission tomography [7]. Another study [8] showed that MP increased activity in the premotor area, the primary motor cortex, and the superior parietal cortex. In patients receiving hemiplegic stroke rehabilitation, the application of MP along with other neurological practices was shown to help recovery of unilateral upper limb function at a low cost and without risks or complications [8, 9, 10].

Based on a review of the Cochrane database in 2011 (6 trials, n=119), the use of rehabilitation treatments combined with MP was found to be more effective for improving upper extremity function after stroke than were rehabilitation treatments without MP [4]. Previous studies assessed MP for accomplishing ADLs (such as ironing or buttoning a shirt, turning a page in a book, lifting a cup, or opening a door). However, results of several studies using the Fugl-Meyer Assessment of the upper extremity (FMA-UE), the action research arm test (ARAT), and the motor activity log (MAL) to evaluate muscle power and hand function indicated a mismatch between the intervention and evaluation methods [10, 11, 12].

Conventional studies [10, 11, 13, 14] have shown that upper extremity function can be improved with adjunctive MP; however, in these studies, the tasks performed during MP and the tools used for evaluating upper extremity function differed, making it difficult to measure the actual changes. Furthermore, the authors of a previous study [12] claimed that patients with motor recovery after a stroke episode that occurred within the previous 6 months (subacute) did not benefit from MP. These patients had performed tasks such as opening, grasping, and lifting household objects; however, upper extremity function was measured by means of the ARAT, which led to differences between the tasks and the evaluation method. In order to evaluate the actual changes in a patient’s motions, we used objective three-dimensional (3D) motion analysis to investigate the identical motions that correspond to MP (in this case, drinking from a cup and opening a door).

The patients assessed in previous MP studies usually had chronic stroke, and few such studies have been performed in patients with subacute stroke. Because our hospital treats mainly those with subacute stroke, we focused on the effects of MP in this group.

In order to participate in therapy and follow instructions, patients undergoing traditional studies of MP and upper limb function [1, 8, 10, 11, 12, 13, 15, 16] are required to have good cognitive scores on the Mini-Mental State Examination (MMSE) or stable mental status, as well as the ability to understand verbal instructions. However, adequate MMSE scores and compliance with instructions alone are not sufficient to validate the effectiveness of MP. Therefore, our investigation cites studies on motor imagery [17,18], evaluating patients using a standard score of 2.26 on the Vividness of Movement Imagery Questionnaire (VMIQ).

In the present study, additional MP was provided to stroke patients who practiced conventional occupational therapy and performed identical tasks along with MP. Moreover, 3D motion analysis was carried out to understand the effects of MP on upper extremity function in real life after a stroke. We also compared the outcomes of 3D motion analysis and of clinical assessments (FMA-UE and MAL) to detect evidence of any congruity between these methods of evaluation.

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[ARTICLE] 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 – Full Text PDF

[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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Source: 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

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[ARTICLE] Influence of mental practice on upper limb muscle activity and activities of daily living in chronic stroke patients – Full Txt PDF

[Purpose] The aim of this study was to determine the effects of mental practice on muscle activity of the upper extremity and performance of daily activities in chronic stroke patients.

[Subjects and Methods] In this research, mental practice was conducted by 2 chronic hemiplegic stroke patients. Mental practice was conducted 30 minutes a day, 5 times a week, for 2 weeks. Evaluation was conducted 4 times before and after intervention. Muscle activity was measured using a surface electromyogram test, and the Modified Barthel Index was used to measure changes in the ability to carry out daily activities.

[Results] Both the muscle activity of the upper extremity and capability to perform daily activities showed improved outcomes after mental practice was conducted.

[Conclusion] Through this research, mental practice was proven to be effective in improving the muscle activity of upper extremity and capability to perform daily activities in chronic hemiplegic stroke patients.

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Source: Influence of mental practice on upper limb muscle activity and activities of daily living in chronic stroke patients

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[ARTICLE] The effects of modified constraint-induced therapy combined with mental practice on patients with chronic stroke – Full Text PDF

Abstract

[Purpose] The purpose of this study was to investigate the effects of the modified constraint-induced therapy (mCIT) combined with mental practice (MP) on patients with chronic stroke.

[Subjects] The subjects were 26 patients with chronic stroke.

[Methods] Patients were randomly assigned to the mCIMT + MP group or the MP group. All subjects were administered mCIT consisting of (1) therapy emphasizing affected arm use in functional activities 5 days/week for 6 weeks and (2) 4 hours of restraint of the less affected arm 5 days/week. The mCIT + MP subjects received 30-minute MP sessions provided directly after therapy sessions. To compare the two groups, the Action Research Arm Test (ARAT), Fugl-Meyer Assessment of Motor Recovery after stroke (FM), and Korean version of Modified Barthel Index (K-MBI) were performed.

[Results] Both groups showed significant improvement in ARAT, FM, and K-MBI after the interventions. Also, there were significant difference in ARAT, FM, and K-MBI between the two groups.

[Conclusion] mCIT remains a promising intervention. However, its efficacy appears to be enhanced by use of MP after mCIT clinical sessions.

via The effects of modified constraint-induced therapy combined with mental practice on patients with chronic stroke.

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[ARTICLE] Effects of mental practice on stroke patients’ upper extremity function and daily activity performance – Full Text HTML

Abstract

[Purpose] The purpose of this study was to evaluate the effects of mental practice on stroke patients’ upper extremity function and activities of daily living (ADL).

[Subjects and Methods] In this study, 29 stroke patients were randomly assigned to two groups: an experimental group (n=14) and a control group (n=15). The experimental group performed 10 minutes of mental practice once a day, 5 days a week for 2 weeks in combination with conventional rehabilitation therapy. For the control group, general rehabilitation therapy was provided during the same sessions as the experimental group. The Action Research Arm Test (ARAT) and the Fugl-Myer assessment (FMA) were used to measure upper extremity function, and the Modified Bathel Index (MBI) was used to measure daily activity performance.

[Results] After the intervention, the mental practice group showed significant improvements in upper extremity function on the affected side and ADL scores compared to the control group.

[Conclusion] The results of this study demonstrate mental practice intervention is effective at improving stroke patients’ upper extremity function and daily activity performance. In follow-up studies, securing a greater number of experimental subjects, and evaluation of the intervention’s therapeutic durability are required.

Full Text HTML —>  Effects of mental practice on stroke patients’ upper extremity function and daily activity performance.

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