Factors Influencing Stroke Survivors' Quality of Life During Subacute Recovery Effect of subjective perspective taking during simulation of action: a PET investigation of agency Motor imagery training improves upper extremity performance in stroke patients Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy Retention of motor changes in chronic stroke survivors who were administered mental practice. Cerebral Processes Related to Visuomotor Imagery and Generation of Simple Finger Movements Studied with Positron Emission Tomography 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 Neutral functional realignment orthosis prevents hand pain in patients with subacute stroke: a randomized trial. Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial Cortical reorganization after motor imagery training in chronic stroke patients with severe motor impairment: a longitudinal fMRI study Reliability of the PEDro scale for rating quality of randomized controlled trials. Mental practice improves hand function after hemiparetic stroke. [The effect of neurorehabilitation on the functional state and muscle tone of upper limb in patients after ischaemic stroke].
Background and Purpose — Health-related quality of life ( HRQOL ) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery . This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery . Methods — Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial ( Extremity Constraint-Induced Therapy Evaluation ) . HRQOL was assessed using the  Stroke Impact Scale ( SIS ) , Version 3.0 . The Wolf Motor Function Test documented functional recovery of the hemiplegic upper extremity . Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains . Results — Age , gender , education level , stroke type , concordance ( paretic arm = dominant h and ) , upper extremity motor function ( Wolf Motor Function Test ) , and comorbidities were associated across SIS domains . Poorer HRQOL in the physical domain was associated with age , nonwhite race , more comorbidities , and reduced upper-extremity function . Stroke survivors with more comorbidities reported poorer HRQOL in the area of memory and thinking , and those with an ischemic stroke and concordance reported poorer communication . Conclusions — Although results may not generalize to lower functioning stroke survivors , individual characteristics of persons with mild to moderate stroke may be important to consider in developing comprehensive , targeted interventions design ed to maximize recovery and improve HRQOL Perspective taking is an essential component in the mechanisms that account for intersubjectivity and agency . Mental simulation of action can be used as a natural protocol to explore the cognitive and neural processing involved in agency . Here we took PET measurements while  subjects simulated actions with either a first-person or a third-person perspective .  Both conditions were associated with common activation in the SMA , the pre central gyrus , the precuneus and the MT/V5 complex . When compared to the first-person perspective , the third-person perspective recruited right inferior parietal , precuneus , posterior cingulate and frontopolar cortex . The opposite contrast revealed activation in left inferior parietal and somatosensory cortex . We suggest that the right inferior parietal , precuneus and somatosensory cortex are specifically involved in distinguishing self-produced actions from those generated by others [ Purpose ] The purpose of this study was to investigate whether motor imagery training has a positive influence on upper extremity performance in stroke patients . [ Subjects and Methods ] Twenty-four patients were r and omly assigned to one of the following two groups : motor imagery ( n = 12 ) or control ( n = 12 ) . Over the course of 4 weeks , the motor imagery group participated in 30 minutes of motor imagery training on each of the 18 tasks ( 9 hours total ) related to their daily living activities . After the 4-week intervention period , the Fugl-Meyer Assessment -Upper Extremity outcomes and Wolf Motor Function Test outcomes were compared . [ Results ] The post-test score of the motor imagery group on the Fugl-Meyer Assessment -Upper Extremity outcomes was significantly higher than that of the control group . In particular , the shoulder and wrist sub-items demonstrated improvement in the motor imagery group . [ Conclusion ] Motor imagery training has a positive influence on upper extremity performance by improving functional mobility during stroke rehabilitation . These results suggest that motor imagery training is feasible and beneficial for improving upper extremity function in stroke patients This r and omized controlled trial evaluated the therapeutic benefit of mental practice with motor imagery in stroke patients with persistent upper limb motor weakness . There is evidence to suggest that mental rehearsal of movement can produce effects normally attributed to practising the actual movements . Imagining h and movements could stimulate restitution and redistribution of brain activity , which accompanies recovery of h and function , thus result ing in a reduced motor deficit . Current efficacy evidence for mental practice with motor imagery in stroke is insufficient due to method ological limitations . This r and omized controlled sequential cohort study included 121 stroke patients with a residual upper limb weakness within 6 months following stroke ( on average <3 months post-stroke ) . R and omization was performed using an automated statistical minimizing procedure . The primary outcome measure was a blinded rating on the Action Research Arm test . The study analysed the outcome of 39 patients involved in 4 weeks of mental rehearsal of upper limb movements during 45-min supervised sessions three times a week and structured independent sessions twice a week , compared to 31 patients who performed equally intensive non-motor mental rehearsal , and 32 patients receiving normal care without additional training . No differences between the treatment groups were found at baseline or outcome on the Action Research Arm Test ( ANCOVA statistical P = 0.77 , and effect size partial η2 = 0.005 ) or any of the secondary outcome measures . Results suggest that mental practice with motor imagery does not enhance motor recovery in patients early post-stroke . In light of the evidence , it remains to be seen whether mental practice with motor imagery is a valid rehabilitation technique in its own right OBJECTIVE To determine retention of motor changes 3 months after participation in a regimen consisting of mental practice ( MP ) combined with repetitive task-specific ( RTP ) practice . DESIGN Prospect i ve , blinded , cohort , pre-post study . SETTING Outpatient rehabilitation hospital . PARTICIPANTS Individuals ( N=21 ) in the chronic stage of stroke ( mean age ± SD , 66.1 ± 8.1y ; age range , 56 - 76y ; mean time since stroke at study enrollment , 58.7mo ; range , 13 - 129mo ) exhibiting mild to moderate impairments of h and function . INTERVENTIONS All individuals had been r and omly assigned to receive a 10-week regimen consisting of MP emphasizing paretic upper extremity ( UE ) use during valued activities . Directly after each of these sessions , subjects were administered audiotaped MP . We assessed this group 's paretic UE motor levels before , after , and 3 months after intervention . MAIN OUTCOME MEASURES The UE section of the Fugl-Meyer Assessment of Sensorimotor Impairment ( FM ) , the Action Research Arm Test ( ARAT ) , the Arm Motor Ability Test ( AMAT ) , and the Box and Block Test ( BB ) . RESULTS None of the scores significantly changed from the period directly after intervention to the 3-month posttesting period ( FM : t=.817 ; ARAT : t=.923 ; AMAT : t=.898 , t=.818 , and t=.967 for the Functional Ability , Quality of Movement , and Time scales , respectively ; BB : t=.892 ) . CONCLUSIONS Changes in paretic UE movement realized through MP combined with RTP ( MP + RTP ) participation are retained 3 months after the intervention has concluded . This is the first study examining retention of motor changes after MP + RTP participation , and one of only a few studies examining long retention of motor changes after any intervention targeting stroke-induced hemiparesis Positron emission tomography was used to compare the functional anatomy of  visual imagination  and generation of movement .  Subjects were asked to generate visual images of their finger movement in response to a preparatory signal . Four conditions were tested : in two , no actual movement was required ; in the other two , a second signal prompted the subjects to execute the imagined movement . Which movement to imagine was either specified by the preparatory stimulus or freely selected by the subjects . Compared with a rest condition , tasks involving only imagination activated several cortical regions ( inferoparietal cortex , presupplementary motor area , anterior cingulate cortex , premotor cortex , dorsolateral prefrontal cortex ) contralateral to the imagined movement . Tasks involving both imagination and movement additionally increased activity in the ipsilateral cerebellum , thalamus , contralateral anteroparietal , and motor cortex and decreased activity in the inferior frontal cortex . These results support the hypothesis that distinct functional systems are involved in visuomotor imagination and generation of simple finger movements : associative parietofrontal areas are primarily related to visuomotor imagination , with inferior frontal cortex likely engaged in active motor suppression , and primary motor structures contribute mainly to movement execution 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 r and omly 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 ) . Assessment s 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 vali date these findings OBJECTIVE To quantify the preventive effect of a neutral functional realignment orthosis on pain , mobility , and edema of the h and in subacute hemiparetic poststroke patients with severe motor deficits . DESIGN R and omized trial . SETTING Rehabilitation center . PARTICIPANTS Poststroke patients ( N=30 ) with subacute hemiparesis and severe deficits of the upper limb were enrolled . Fifteen patients were r and omized to a st and ard rehabilitation program without orthosis and 15 patients received an experimental orthosis in addition to their st and ard rehabilitation program . INTERVENTION The orthosis group wore the neutral functional realignment orthosis for at least 6 hours daily . MAIN OUTCOME MEASURES H and pain at rest ( visual analog scale ) , wrist range of motion ( Fugl-Meyer Assessment subscale ) , and edema of h and and wrist ( circumferences ) . Outcome measures were assessed at time of r and omization and after 13 weeks between groups . RESULTS At baseline , 2 patients in each group complained about a painful h and . After 13 weeks , 8 subjects in the control group and 1 subject in the orthosis group complained of h and pain ( P=.004 ) . Mobility and edema evolved similarly in both groups . CONCLUSIONS Neutral functional realignment orthoses have a preventive effect on poststroke h and pain , but not on mobility and edema in the subacute phase of recovery Objective : To evaluate and compare efficacy of 20- , 40- , and 60-minute mental practice sessions on affected upper extremity impairment and functional limitation . Design : R and omized controlled study with multiple baseline design . Subjects : Twenty-nine subjects with chronic stroke and exhibiting stable , mild hemiparesis . Interventions : Subjects were given 30-minute rehabilitative sessions 3 days/week for 10 weeks , emphasizing affected upper extremity use during valued activities . Directly after these sessions , r and omly selected subjects were given audiotaped mental practice for 20 , 40 , or 60 minutes . Subjects assigned to a control group received the same therapy as the mental practice groups , and an audiotaped sham intervention directly after therapy sessions . Main outcome measures : Fugl-Meyer ( FM ) motor assessment and Action Research Arm Test ( ARAT ) . Results : No pre-existing differences were found between groups on any demographic variable or movement scale . On the FM , mental practice duration significantly predicted pretesting to post change ( P = 0.05 ) , with increasing duration related to larger FM score increases ( 5.4 point score increase for the 60-minute duration group ) . On the ARAT , a non-significant trend was seen ( P = 0.78 ) , favoring the 20-minute dosing condition ( 4.5 point increase ) . Importantly , regardless of dosing condition , subjects administered mental practice exhibited markedly larger score changes on both the FM and ARAT than subjects not receiving mental practice . Conclusions : Sixty minutes of mental practice appears to most significantly reduce affected arm impairment . However , no clear change pattern was seen in affected arm functional limitation according to mental practice duration . Results suggest that a stroke rehabilitative regimen augmented by mental practice renders a greater functional impact than therapy only Introduction Despite its clinical efficacy , few studies have examined the neural mechanisms of motor imagery training ( MIT ) in stroke . Our objective was to find the cortical reorganization patterns after MIT in chronic stroke patients . Methods Twenty stroke patients with severe motor deficits were r and omly assigned to the MIT or conventional rehabilitation therapy ( CRT ) group , but two lost in the follow-up . All 18 patients received CRT 5 days/week for 4 weeks . Nine subjects in the MIT group received 30-min MIT 5 days/week for 4 weeks . Before and after the interventions , the upper limb section of the Fugl – Meyer Scale ( FM-UL ) was blindly evaluated , and functional magnetic resonance imaging was administered while the patients executed a passive fist clutch task . Results Two cortical reorganization patterns were found . One pattern consisted of the growth in activation in the contralateral sensorimotor cortex ( cSMC ) for most patients ( six in the MIT group , five in the CRT group ) , and the other consisted of focusing of the activation in the cSMC with increasing of the laterality index of the SMC for a small portion of patients ( three in the MIT group , one in the CRT group ) . When we applied correlation analyses to the variables of relative ΔcSMC and ΔFM-UL in the 11 patients who experienced the first pattern , a positive relationship was detected . Conclusions Our results indicate that different cortical reorganization patterns ( increases in or focusing of recruitment to the cSMC region ) exist in chronic stroke patients after interventions , and patients may choose efficient patterns to improve their motor function BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . PURPOSE In a multiple baseline design , we tested the hypothesis that imagery of finger movements is a specific strategy to improve h and function . METHODS The effect of mental training of sequential finger movements ( n=6 ) on h and function was compared to the repetitive execution of the same movements ( n=6 ) and conventional physical therapy ( n=5 ) in 17 patients after their first hemiparetic stroke . The behavioral outcome measures consisted of peak force of the pinch grip using a force transducer and manipulation functions of the upper extremity ( Jebsen-test ) . In addition , activities of daily living ( Barthel Index ) were acquired to describe the population . RESULTS Mental training result ed in an increase in the peak force of the pinch grip and generalized in a better functionality of the upper extremity ( Jebsen-test ) . This effect was similar to the repetitive execution of the movements and superior to conventional physiotherapy . CONCLUSIONS Our results suggest that the control of finger movements benefits from mental training of sequential finger movements and , thus , may be employed as a strategy in post-stroke rehabilitation UNLABELLED Rehabilitation of upper limb in patients after ischemic stroke is a major challenge for modern neurorehabilitation . Function of upper limb of patients after ischemic stroke returns on the end of the rehabilitation comparing with another parts of the body . Below presents two groups of patients after ischemic stroke who were rehabilitated with use of the following methods : kinesiotherapy combined with NDT- Bobath method and kinesiotherapy only . The aim of this study was to assess the impact of kinesiotherapy only and NDT- Bobath method combined with kinesiotherapy on the functional state and muscle tone of upper limb in patients after ischemic stroke . MATERIAL AND METHODS The study involved a group of 40 patients after ischemic stroke with motor control and muscle tone problems of upper limb . Patients were divided into two groups , each of them included 20 people . Upper limb in group I was rehabilitated with the use of kinesiotherapy exercise however group II with the use of kinesiotherapy exercise combined with NDT- Bobath method ( Neurodevelopmental Treatment Bobath ) . To evaluate the patients before and after rehabilitation muscle tone Asworth scale was used and to assess functional status Rivermead Motor Assessment ( RMAIII ) scale was used . RESULTS After 5 weeks of rehabilitation in group II in majority patients were observed decrease of muscle tone and improvement in upper limb functional status . In group I the muscle tone were also decreased and functional status were better but in smaller impact than in II group . CONCLUSIONS Classical kinesiotherapy combined with the NDT-Bobath method gives better results in neurorehabilitation of upper limb than the use of kinesiotherapy exercises only in patients after ischemic stroke
ABSTRACT Background .
Motor imagery ( MI ) consists of the mental simulation of repetitive movements with the intention of promoting the learning of a motor skill .
It seems to be an additional useful tool for motor-based therapy to potentiate the rehabilitation of the upper limb function of post-stroke individuals .
Objective .
To investigate whether MI combined with motor-based therapy is effective in recovering motor deficits of upper limbs from post-stroke individuals .