Recovery of Hand Function Through Mental Practice.

Stroke is a common and highly debilitating illness. Many patients (41-45%) experience chronic motor impairments (Dijkerman et al., 1996) and limitations in activities of daily living (Wade & Langton Hewer, 1987) even after extensive neurological rehabilitation. They often result in long-term dependence at a considerable cost to the carers and the health service. It is therefore crucial to optimise motor recovery after stroke. This study investigates the therapeutic benefits of motor imagery training in stroke patients with a motor weakness.

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

There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements. Imagining hand movements could stimulate the redistribution of brain activity, which accompanies recovery of hand function, thus resulting in a reduced motor deficit. Patients are assessed before and after a four-week evaluation period. In this randomised controlled trial 45 patients daily mentally rehearse movements with their affected hand under close supervision. Their recovery is compared to 45 patients who perform closely supervised non-motor mental rehearsal, and 45 patients who are not engaged in a training program.

Inclusion criteria

Confirmed diagnosis of stroke in the last 1-6 months Persisting upper limb weakness -

Exclusion criteria

Alcohol/ Drug abuse Psychiatric history Previous illness that has impacted on individuals Activity of Daily living

• Dementia (assessed by MSQ) Severe Aphasia