Original Study
Effect of Mental Practice on the Improvement of Function and Daily Activity Performance of the Upper Extremity in Patients With Subacute Stroke: A Randomized Clinical Trial

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Abstract

Objectives

More than 50% of patients with upper limb paresis after stroke face long-term impaired arm function and ensuing disability in daily life. This study aims to evaluate the effectiveness of a task-oriented mental practice (MP) approach as an addition to regular arm–hand therapy in patients with subacute stroke.

Methods

A multicenter, prospective, single-blind, randomized clinical trial was performed. Patients trained for 6 weeks, at least 3 times per day. In the experimental group, patients performed video-instructed MP. In the control group, patients performed neurodevelopmental therapy–based exercise therapy. The primary outcome measures are Fugl-Meyer test, Frenchay arm test, Wolf motor function test, and accelerometry.

Results

The patients did improve over time on Fugl-Meyer test and Wolf motor function test in both the control and the experimental group. A significant improvement on the Frenchay arm test was found after training (which was maintained at 12-month follow-up) only in the experimental group. However, no difference in training effects between groups was demonstrated.

Conclusions

Training effects were demonstrated after MP training in patients with subacute stroke. However, the results of this study do not corroborate the hypothesis that the use of MP in addition to therapy as usual in patients with subacute stroke has an additional effect over neurodevelopmental therapy in addition to therapy as usual.

Section snippets

Study Design

A multicenter, single-blind, randomized, controlled trial was conducted to evaluate the effects of 6 weeks of MP-based treatment on arm–hand skill performance in patients with unilateral stroke. The training occurred in the subacute phase after stroke. Assessment took place on entry to the study (T0), posttreatment (T1), and at 3 follow-up moments during the year [6 (T2), 9 (T3), and 12 months (T4) after baseline measurement]. Detailed information on the study protocol can be found in Verbunt

Results

The study started in March 2008 and lasted until November 2011. Figure 1 gives an overview of the trial profile, that is, the number of participants throughout the study. All therapists who conducted the measurements (physiotherapists) were not involved in any treatment (conducted by OTs) and remained blind to the treatment allocation of the patients.

Discussion

It was the aim of this study to evaluate whether a 6-week additional MP intervention in subacute stroke patients is effective in improving arm–hand function and performance of daily activities as compared with additional NDT.

In this study, in contrast with the control group, only the experimental group (therapy as usual + MP) demonstrated significant improvement on the FAT after training that was maintained for at least 12 months. This may be related to training-specific effects because the

Conclusions

It can be concluded that, in a broad spectrum of subacute stroke patients, no differential effects could be found that favor the additional use of MP to therapy as usual for the improvement of upper extremity performance. However, training-specific effects were found for the experimental group, supporting the use of a client-centered training approach. Future research should explore the potential of higher training intensities, a larger number of exercises and higher exercise variability, the

Acknowledgments

The authors thank Bernard Michielsen, MD (Atrium Medical Centre, the Netherlands), and Wim Wetzelaer, MD (Vie Curie, The Netherlands), for their contribution to the study.

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  • Cited by (0)

    This study was funded by ZonMw (Project 14350051). Trial registration: Current Control Trials [ISRCTN33487341].

    The authors have declared that they have no conflicts of interest.

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