A pilotstudy to evaluate the effect of mental practice-based training on arm function recovery in subacute stroke patients.

In the Netherlands every year there are about 30.000 new cases of strokes.
Over 50 % of patients with an upper limb paresis as a result of stroke, is
confronted with longterm impaired arm function and a resulting disability in
daily life performance. Unfortunately, the number of effective treatments aimed
at the improvement of arm function in stroke is still low. Treatment based on
mental practice, which has been shown to be effective in enhancement of motor
performance in healthy individuals, seems a promising technique in the
rehabilitation training for patients with stroke.
AIM of our study is to (further) develop and evaluate a new therapy approach
based on theories on mental practice and functional task-oriented training
focussing on improvement in arm function outcome in subacute stroke patients
and to study the underlying motor learning mechanisms generally associated
with brain plasticity. It is hypothesized that a mental practice-based training
(additional to 'therapy-as-usual'), targeting specific upper extremity skills,
will significantly improve both arm function and the performance of daily
activities.

The first objective of the study is to study the effectiveness of mental
practice training for upper limb recovery in patients with a subacute stroke.
The second objective is to study the feasibility of mental practice based
training in subacute stroke patients.

a study in a single case design

Mental practice is complemented to the therapy as usual and consists of a
repeatedly imagery of functional movements.To control the performance of the
mental practice training, the patients has an appointment with a
physiotherapist every week. Than the patient performes the mental practice
training at home twice a day.
During the training, the patient will see a DVD with a functional movement. The
movement is filmed in the first person; it looks like the patient doing the
movement himself.
The movement is repeated several times and the patient should imagine as good
as possible doing the movement by himself. The DVD takes about 10 minutes.

There are 5 DVD's, arranged to the level of functional movements. The patient
will see the DVD which fits to his condition.
The patient takes the DVD home, to perform the training during the week.

The burden for the patient is an additional hour at the rehabilitation unit of
the Atrium Medisch Centrum. The hour planned directly after the normal therapy.
In addition, the patient performs the mental practice training at home twice a
day.
Filling in the dairy takes about 5 minutes a day. The questionnaire takes about
10 minutes.

No risks have to be expected.

Benefits are the expected positive effect on the recovery of the upper limb.