Mental Practice embedded in Stroke Rehabilitation: a randomised controlled, multi-centre trial

Mental practice as an embedded or additional therapy form is getting increased
attention in stroke rehabilitation around the world, especially in Europe and
America. A systematic review of the studies undertaken so far in stroke shows
that although there may be some evidence to suggest that the technique might be
effective, at present it is not certain whether it is effective. Little is
known about the short- and long-term effect (>6 months) of mental practice
interventions. This trial investigates whether mental practice can contribute
to a quick or better recovery of stroke patients in every day practice. The
trial will be conducted in the Klevarie Nursing Home of the Vivre Foundation
(Maastricht) and Nursing Home St. Camillus, Land van Gelre and Gulick
(Roermond), The Netherlands, over a period of 2 years (mid 2007- mid 2009).

The overall aim of the proposed research project is to investigate
systematically the therapeutic potential of mental practice embedded in daily
therapy on the improvement of daily activities of adult stroke patients
compared to therapy as usual alone. The first additional research question is
which prognostic variables or patient* characteristics are associated with a
positive outcome in the experimental subgroup. The second additional research
question investigates the feasibility of the mental practice-based therapy as
judged by the patients and therapists.

The study design is a multi-centre randomised controlled trial.

Patients will be followed over a 6 weeks intervention period (T0 and T1). The
control group will receive multi professional approach therapy as usual. The
experimental group will receive multi professional approach therapy in which
mental practice is embedded in every physical, occupation and speech therapy
session. Patients will be instructed how to perform MP training for improving
'drinking from a cup' and *walking*. The instruction for use, training and
evaluation of MP takes place in 4 phases during 6 weeks A follow up measure
will take place after 6 months (T2).

As there are no invasive interventions, nor any untested experimental
measurement instruments used, there is no additional risk to the assessment or
therapy of the patient.
As the experimental intervention is embedded in therapy as usual the additional
time spend seeing professionals to learn the mental practice technique and
assess the cognitive structure of movements is limited to2 hours per subject
over a 6 weeks period.
The extra load due to additional testing of patients in the experimental as
well as control group, is approximately 35-45 minutes at each assessment point
if the patient agrees to quantitative electro-encephalogram measures (QEEG) at
T1 and T2 (demographics, prognostic and outcome measures). Otherwise, the
additional time will increase with 20 minutes at T1 and T2. Patients that agree
to being interviewed will add another 20 to 30 minutes to the assessment time
needed for data collection (n=10 per site).
A small sample of the participants will be interviewed by the researcher on
experiences and beliefs during MP in the experimental group and on content of
therapy as usual in the control group (n=10 per site).