Patterns of visual spatial inattention and their functional significance in stroke patients. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. Assessing Wolf Motor Function Test as Outcome Measure for Research in Patients After Stroke Recovery of hand function through mental practice: A study protocol Evidence for physiotherapy practice: a survey of the Physiotherapy Evidence Database (PEDro). Inactive and Alone: Physical Activity Within the First 14 Days of Acute Stroke Unit Care Short-Term Effects of Practice With Trunk Restraint on Reaching Movements in Patients With Chronic Stroke: A Controlled Trial Mental practice with motor imagery in stroke recovery: randomized controlled trial of efficacy Effects of mental practice embedded in daily therapy compared to therapy as usual in adult stroke patients in Dutch nursing homes: design of a randomised controlled trial The stroke impact scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Two Coupled Motor Recovery Protocols Are Better Than One: Electromyogram-Triggered Neuromuscular Stimulation and Bilateral Movements Mental imagery for promoting relearning for people after stroke: a randomized controlled trial. Modified Constraint-Induced Therapy Combined With Mental Practice: Thinking Through Better Motor Outcomes Mental Practice in Chronic Stroke: Results of a Randomized, Placebo-Controlled Trial Feasibility of a mental practice intervention in stroke patients in nursing homes; a process evaluation Effects of movement imagery and electromyography-triggered feedback on arm—hand function in stroke patients in the subacute phase Longer versus shorter mental practice sessions for affected upper extremity movement after stroke: a randomized controlled trial An integrated motor imagery program to improve functional task performance in neurorehabilitation: a single-blind randomized controlled trial. Comparison of rehabilitation practice on hospital wards for stroke patients. The Kinesthetic and Visual Imagery Questionnaire (KVIQ) for Assessing Motor Imagery in Persons with Physical Disabilities: A Reliability and Construct Validity Study Effects of mental practice on affected limb use and function in chronic stroke. The influence of visual neglect on stroke rehabilitation. The Effects of Constraint-Induced Therapy on Precision Grip: A Preliminary Study Mental practice improves hand function after hemiparetic stroke. Mental practice is effective in upper limb recovery after stroke: a randomized single-blind cross-over study. A randomized efficacy and feasibility study of imagery in acute stroke Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Muscle Weakness and Cocontraction in Upper Limb Hemiparesis: Relationship to Motor Impairment and Physical Disability Effect of imagery perspective on occupational performance after stroke: a randomized controlled trial.
The relationship between patterns of visual spatial inattention and activities of daily living ( ADL ) performance was investigated in 64 Chinese patients with right brain lesions , using the Klein-Bell ADL Scale and the R and om Chinese Word Cancellation Test . The result showed that patients demonstrating hemi-inattention were significantly worse in ADL performance than patients with nonlateralized inattention or patients with normal attention , but that the latter two groups did not differ from each other . Although ADL performance was also found to be significantly related to somatosensation , motor status , and visual factors , after controlling the effects of these variables by partial correlation , hemi-inattention still was highly related to ADL performance . Independence in dressing , mobility , and elimination appeared to be more adversely affected by hemi-inattention than were bathing/hygiene , eating , and telephone use CONTEXT Single-site studies suggest that a 2-week program of constraint-induced movement therapy ( CIMT ) for patients more than 1 year after stroke who maintain some h and and wrist movement can improve upper extremity function that persists for at least 1 year . OBJECTIVE To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months . DESIGN AND SETTING The Extremity Constraint Induced Therapy Evaluation ( EXCITE ) trial , a prospect i ve , single-blind , r and omized , multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003 . PARTICIPANTS Two hundred twenty-two individuals with predominantly ischemic stroke . INTERVENTIONS Participants were assigned to receive either CIMT ( n = 106 ; wearing a restraining mitt on the less-affected h and while engaging in repetitive task practice and behavioral shaping with the hemiplegic h and ) or usual and customary care ( n = 116 ; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions ) ; patients were stratified by sex , prestroke dominant side , side of stroke , and level of paretic arm function . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , a measure of laboratory time and strength-based ability and quality of movement ( functional ability ) , and the Motor Activity Log ( MAL ) , a measure of how well and how often 30 common daily activities are performed . RESULTS From baseline to 12 months , the CIMT group showed greater improvements than the control group in both the WMFT Performance Time ( decrease in mean time from 19.3 seconds to 9.3 seconds [ 52 % reduction ] vs from 24.0 seconds to 17.7 seconds [ 26 % reduction ] ; between-group difference , 34 % [ 95 % confidence interval { CI } , 12%-51 % ] ; P<.001 ) and in the MAL Amount of Use ( on a 0 - 5 scale , increase from 1.21 to 2.13 vs from 1.15 to 1.65 ; between-group difference , 0.43 [ 95 % CI , 0.05 - 0.80 ] ; P<.001 ) and MAL Quality of Movement ( on a 0 - 5 scale , increase from 1.26 to 2.23 vs 1.18 to 1.66 ; between-group difference , 0.48 [ 95 % CI , 0.13 - 0.84 ] ; P<.001 ) . The CIMT group achieved a decrease of 19.5 in self-perceived h and function difficulty ( Stroke Impact Scale h and domain ) vs a decrease of 10.1 for the control group ( between-group difference , 9.42 [ 95 % CI , 0.27 - 18.57 ] ; P=.05 ) . CONCLUSION Among patients who had a stroke within the previous 3 to 9 months , CIMT produced statistically significant and clinical ly relevant improvements in arm motor function that persisted for at least 1 year . Trial Registration clinical trials.gov Identifier : NCT00057018 Background and Purpose — The Wolf Motor Function Test ( WMFT ) is a new time-based method to evaluate upper extremity performance while providing insight into joint-specific and total limb movements . This study addresses selected psychometric attributes of the WMFT applied to a chronic stroke population . Methods — Nineteen individuals after stroke and with intact cognition and sitting balance were age- and sex-matched with 19 individuals without impairment . Subjects performed the WMFT and the upper extremity portion of the Fugl-Meyer Motor Assessment ( FMA ) on 2 occasions ( 12 to 16 days apart ) , with scoring performed independently by 2 r and om raters . Results — The  WMFT and FMA demonstrated agreement ( P < 0.0001 ) between raters at each session .  WMFT  scores for the dominant and nondominant extremities of individuals without impairment were different ( P ≤0.05 ) from the more and less affected extremities of subjects after stroke . The FMA score for the more affected extremity of subjects after stroke was different ( P ≤0.05 ) from the dominant and nondominant extremities . However , the FMA score for the less affected upper extremity of individuals after stroke was not different ( P > 0.05 ) from the dominant and nondominant extremities of individuals without impairment . The WMFT and FMA scores were related ( P < 0.02 ) for the more affected extremity in individuals after stroke . Conclusions — The interrater reliability , construct validity , and criterion validity of the WMFT , as used in these subject sample s , are supported Background The study aims to assess the therapeutic benefits of motor imagery training in stroke patients with persistent 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 the redistribution of brain activity , which accompanies recovery of h and function , thus result ing in a reduced motor deficit . Methods / Design A multi-centre r and omised controlled trial recruiting individuals between one and six months post-stroke ( n = 135 ) . Patients are assessed before and after a four-week evaluation period . In this trial , 45 patients daily mentally rehearse movements with their affected arm 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 . Motor imagery training effectiveness is evaluated using outcome measures of motor function , psychological processes , and level of disability . Discussion The idea of enhancing motor recovery through the use of motor imagery rehabilitation techniques is important with potential implication s for clinical practice . The techniques evaluated as part of this r and omised controlled trial are informed by the current underst and ing in cognitive neuroscience and the trial is both of scientific and applied interest Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Background and Purpose — One way that stroke units may improve outcome is by reducing complications of immobility through early mobilization ; however , this intervention needs testing . The purpose of this study was to determine the physical activity patterns of stroke patients managed within acute stroke units as a first step in developing an early mobilization protocol . Methods — We recruited 64 patients within 14 days after stroke from 5 metropolitan stroke units and observed them for 2 consecutive days at 10-minute intervals between the hours of 8 am and 5 pm . At each observation , we ascertained physical activity , location , and other person(s ) present . Therapists recorded therapy details . Results — The 58 patients who completed the study had a mean age of 71.3 years . Stroke severity ranged from mild ( National Institutes of Health Stroke Scale score , 1 ) to severe ( score , 27 ) , and mean time after stroke at observation was 5.6 days ( range , 0 to 13 days ) . Only 9 patients were restricted to bed . During the therapeutic day , patients spent > 50 % resting in bed , 28 % sitting out of bed , and only 13 % engaged in activities with the potential to prevent complications and improve recovery of mobility . Patients were alone > 60 % of the time . Conclusions — This is the first multicenter study of physical activity early after stroke . We believe the next step is to conduct a r and omized controlled trial to evaluate the effect of increased levels of  physical activity  early after stroke compared with current st and ards of care Background and Purpose — In prehension tasks with objects placed within arm ’s reach , patients with hemiparesis caused by stroke use excessive trunk movement to compensate for arm motor impairments . Compensatory trunk movements may improve motor function in the short term but may limit arm recovery in the long term . Previous studies showed that restriction of trunk movements during reach-to-grasp movements results in immediate increases in active arm joint ranges and improvement in interjoint coordination . To evaluate the potential of this technique as a therapeutic intervention , we compared the effects of short-term reach-to-grasp training ( 60-trial training session ) with and without physical trunk restraint on arm movement patterns in patients with chronic hemiparesis . Methods — A total of 28 patients with hemiparesis were assigned to 2 groups : 1 group practice d reach-to-grasp movements during which compensatory movement of the trunk was prevented by a harness ( trunk restraint ) , and the second group practice d the same task while verbally instructed not to move the trunk ( control ) .  Kinematics of reaching and grasping an object placed within arm ’s length were recorded before , immediately after , and 24 hours after training . Results — The trunk restraint group used more elbow extension , less anterior trunk displacement , and had better interjoint coordination than the control group after training , and range of motion was maintained 24 hours later in only the trunk restraint group . Conclusions — Restriction of compensatory trunk movements during practice may lead to greater improvements in reach-to-grasp movements in patients with chronic stroke than practice alone , and longer-term effects of this intervention should be evaluated 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 Background Mental practice as an additional cognitive therapy is getting increased attention in stroke rehabilitation . A systematic review shows some evidence that several techniques in which movements are rehearsed mentally might be effective but not enough to be certain . This trial investigates whether mental practice can contribute to a quicker and /or better recovery of stroke in two Dutch nursing homes . The objective is to investigate the therapeutic potential of mental practice embedded in daily therapy to improve individually chosen daily activities of adult stroke patients compared to therapy as usual . In addition , we will investigate prognostic variables and feasibility ( process evaluation ) . Methods A r and omised , controlled , observer masked prospect i ve trial will be conducted with adult stroke patients in the (sub)acute phase of stroke recovery . Over a six weeks intervention period the control group will receive multi professional therapy as usual . Patients in the experimental group will be instructed how to perform mental practice , and will receive care as usual in which mental practice is embedded in physical , occupation and speech therapy sessions . Outcome will be assessed at six weeks and six months . The primary outcome measure is the patient-perceived effect on performance of daily activities as assessed by an 11-point Likert Scale . Secondary outcomes are : Motricity Index , Nine Hole Peg Test , Barthel Index , Timed up and Go , 10 metres walking test , Rivermead Mobility Index . A sample size of the patients group and all therapists will be interviewed on their opinion of the experimental program to assess feasibility . All patients are asked to keep a log to determine unguided training intensity . Discussion Advantages and disadvantages of several aspects of the chosen design are discussed . Trial registration IS RCT BACKGROUND AND PURPOSE To be useful for clinical research , an outcome measure must be feasible to administer and have sound psychometric attributes , including reliability , validity , and sensitivity to change . This study characterizes the psychometric properties of the Stroke Impact Scale ( SIS ) Version 2.0 . METHODS Version 2.0 of the SIS is a self-report measure that includes 64 items and assesses 8 domains ( strength , h and function , ADL/IADL , mobility , communication , emotion , memory and thinking , and participation ) . Subjects with mild and moderate strokes completed the SIS at 1 month ( n=91 ) , at 3 months ( n=80 ) , and at 6 months after stroke ( n=69 ) . Twenty-five subjects had a replicate administration of the SIS 1 week after the 3-month or 6-month test . We evaluated internal consistency and test-retest reliability . The validity of the SIS domains was examined by comparing the SIS to existing stroke measures and by comparing differences in SIS scores across Rankin scale levels . The mixed model procedure was used to evaluate responsiveness of the SIS domain scores to change . RESULTS Each of the 8 domains met or approached the st and ard of 0.9 alpha-coefficient for comparing the same patients across time . The intraclass correlation coefficients for test-retest reliability of SIS domains ranged from 0.70 to 0.92 , except for the emotion domain ( 0.57 ) . When the domains were compared with established outcome measures , the correlations were moderate to strong ( 0.44 to 0.84 ) . The participation domain was most strongly associated with SF-36 social role function . SIS domain scores discriminated across 4 Rankin levels . SIS domains are responsive to change due to ongoing recovery . Responsiveness to change is affected by stroke severity and time since stroke . CONCLUSIONS This new , stroke-specific outcome measure is reliable , valid , and sensitive to change . We are optimistic about the utility of measure . More studies are required to evaluate the SIS in larger and more heterogeneous population s and to evaluate the feasibility and validity of proxy responses for the most severely impaired patients Background and Purpose — Overcoming chronic hemiparesis from a cerebrovascular accident ( CVA ) can be challenging for many patients , especially after the first 12 months after the CVA . With the use of established motor control theories , the present study investigated electromyogram (EMG)-triggered neuromuscular stimulation and bilateral coordination training . Methods — Twenty-five CVA subjects volunteered to participate in this motor recovery protocol study . Subjects were r and omly assigned to 1 of 3 groups : ( 1 ) coupled protocol of EMG-triggered stimulation and bilateral movement ( n=10 ) ; ( 2 ) EMG-triggered stimulation and unilateral movement ( n=10 ) ; or ( 3 ) control ( n=5 ) . All participants completed 6 hours of rehabilitation during a 2-week period according to group assignments . Motor capabilities of the wrist and fingers were evaluated on the basis of 3 categories of motor tasks in a pretest-posttest control group design . Results — Significant findings for the ( 1 ) number of blocks moved in a functional task , ( 2 ) chronometric reaction times to initiate movements , and ( 3 ) sustained muscle contraction capability all favored the coupled bilateral movement training and EMG-triggered neuromuscular stimulation protocol group . In addition , the unilateral movement/stimulation group exceeded the control group in the number of blocks moved and rapid onset of muscle contractions . Conclusions — This new evidence is convincing in that subjects in the coupled protocol group were able to demonstrate enhanced voluntary motor control across 3 categories of tasks . Chronic hemiparesis decreased considerably in the wrist and fingers as CVA patients exp and ed their motor repertoire OBJECTIVE To study the efficacy of mental imagery at promoting relearning for people after a stroke . DESIGN Prospect i ve , r and omized controlled trial . SETTING An inpatient rehabilitation stroke unit in Hong Kong . PARTICIPANTS Forty-six in patients , 60 years of age or older , after a cerebral infa rct ion . INTERVENTIONS Patients were r and omized to receive 15 sessions ( 1 h/d for 3 wk ) of either the mental imagery program or the conventional functional training intervention on the relearning of daily living tasks . MAIN OUTCOME MEASURES Performance of 15 trained and 5 untrained tasks , including household , cooking , and shopping tasks ; and the Fugl-Meyer Assessment and Color Trails Test ( CTT ) . RESULTS Patients engaged in mental imagery-based intervention showed better relearning of both trained and untrained tasks compared with the control group ( trained tasks : P<.005 ; untrained tasks : P<.001 ) . They also demonstrated a greater ability to retain the trained tasks after 1 month and transfer the skills relearned to other untrained tasks ( P<.001 ) . However , among the various ability measures , the mental imagery group showed a significant increase in the CTT scores only after the intervention ( P<.005 ) . CONCLUSIONS Mental imagery can be used as a training strategy to promote the relearning of daily tasks for people after an acute stroke . The imagery process is likely to improve the planning and execution of both the trained and the untrained ( novel ) tasks . The effect of its relearning appears to help patients to retain and generalize the skills and tasks learned in the rehabilitation program Background and Purpose — Modified constraint-induced therapy ( mCIT ) is an outpatient therapy encouraging repetitive , task-specific practice with the affected arm . mCIT has shown efficacy in all stages poststroke . Given its efficacy when combined with other therapy regimens , the current study examined the efficacy of mental practice when combined with mCIT versus mCIT only using r and omized , controlled methods . Method — Ten patients with chronic stroke ( 7 males ; mean age , 61.4±3.02 years ; age range , 48 to 79 years ; mean time since stroke , 28.5 months ; range , 13 to 42 months ) exhibiting stable , affected arm motor deficits were administered mCIT , consisting of : ( 1 ) structured therapy emphasizing affected arm use in functional activities 3 days/week for 10 weeks ; and ( 2 ) less affected arm restraint 5 days/week for 5 hours . Both of these components were administered during a 10-week period . Subjects r and omly assigned to the mCIT+mental practice experimental condition also received 30-minute mental practice sessions provided directly after therapy sessions . These mental practice sessions required daily cognitive rehearsal of the activities of daily living practice d during mCIT clinical sessions . Results — No pre-existing differences were found between groups on any demographic variable or movement scale . All subjects exhibited marked reductions in affected arm impairment and functional limitation . However , subjects in the mCIT+mental practice group exhibited significantly larger changes on both movement measures after intervention : Action Research Arm Test , + 15.4-point change versus + 8.4-point change for mCIT only subjects ( P<0.001 ) ; Fugl-Meyer , + 7.8-point change versus + 4.1-point change for the mCIT only subjects ( P=0.01 ) . These changes were sustained 3 months after intervention . Conclusions — mCIT remains a promising motor intervention . However , its efficacy appears to be enhanced by use of mental practice provided directly after mCIT clinical sessions Background and Purpose — Mental practice ( MP ) of a particular motor skill has repeatedly been shown to activate the same musculature and neural areas as physical practice of the skill . Pilot study results suggest that a rehabilitation program incorporating MP of valued motor skills in chronic stroke patients provides sufficient repetitive practice to increase affected arm use and function . This Phase 2 study compared efficacy of a rehabilitation program incorporating MP of specific arm movements to a placebo condition using r and omized controlled methods and an appropriate sample size . Method — Thirty-two chronic stroke patients ( mean=3.6 years ) with moderate motor deficits received 30-minute therapy sessions occurring 2 days/week for 6 weeks , and emphasizing activities of daily living . Subjects r and omly assigned to the experimental condition also received 30-minute MP sessions provided directly after therapy requiring daily MP of the activities of daily living ; subjects assigned to the control group received the same amount of therapist interaction as the experimental group , and a sham intervention directly after therapy , consisting of relaxation . Outcomes were evaluated by a blinded rater using the Action Research Arm test and the upper extremity section of the Fugl-Meyer Assessment . Results — No pre-existing group differences were found on any demographic variable or movement scale . Subjects receiving MP showed significant reductions in affected arm impairment and significant increases in daily arm function ( both at the P<0.0001 level ) . Only patients in the group receiving MP exhibited new ability to perform valued activities . Conclusions — The results support the efficacy of programs incorporating mental practice for rehabilitating affected arm motor function in patients with chronic stroke . These changes are clinical ly significant Background Within a multi-centre r and omised controlled trial in three nursing homes , a process evaluation of a mental practice intervention was conducted . The main aims were to determine if the intervention was performed according to the framework and to describe the therapists ' and participants ' experiences with and opinions on the intervention . Methods The six week mental practice intervention was given by physiotherapists and occupational therapists in the rehabilitation teams and consisted of four phases : explanation of imagery , teaching patients how to use imagery , using imagery as part of therapy , and facilitating the patient in using it alone and for new tasks . It had a m and atory and an optional part . Data were collected by means of registration forms , pre structured patient files , patient logs and self-administered question naires . Results A total of 14 therapists and 18 patients with stroke in the sub acute phase of recovery were involved .  Response rates differed per assessment ( range 57 - 93 % ) . Two patients dropped out of the study ( total n = 16 ) . The m and atory part of the intervention was given to 11 of 16 patients : 13 received the prescribed amount of mental practice and 12 practice d unguided outside of therapy . The facilitating techniques of the optional part of the framework were partly used . Therapists were moderately positive about the use of imagery in this specific sample . Although it was more difficult for some patients to generate images than others , all patients were positive about the intervention and reported perceived short term benefits from mental practice . Conclusions The intervention was less feasible than we hoped . Implementing a complex therapy delivered by existing multi-professional teams to a vulnerable population with a complex pathology poses many challenges Objective : To investigate the effects of movement imagery-assisted electromyography (EMG)-triggered feedback ( focused on paretic wrist dorsiflexors ) on the arm — h and function of stroke patients . Design : Single-blinded , longitudinal , multicentre r and omized controlled trial . Measurements were performed ( on average ) 54 days post stroke ( baseline ) , three months later ( post training ) and at 12 months post baseline . Setting : Two rehabilitation centres . Subjects : Twenty-seven patients with a first-ever , ischaemic , subacute stroke . Interventions : A reference group received conventional electrostimulation , while the experimental group received arm — h and function training based on EMG-triggered feedback combined with movement imagery . Both groups were trained for three months , 5 days/week , 30 minutes/day , in addition to their therapy as usual . Main measures : Arm — h and function was evaluated using the upper extremity-related part of the Brunnstrom Fugl-Meyer test and the Action Research Arm test . Results : During training , Brunnstrom Fugl-Meyer scores improved 8.7 points and Action Research Arm scores by 19.4 points ( P < 0.0001 ) in both groups relative to baseline results , rising to 13.3 and 28.4 points respectively at one year follow-up ( P < 0.0001 ) . No between-group differences were found at any time . Conclusions : EMG-triggered feedback stimulation did not lead to more arm — h and function improvement relative to conventional electrostimulation . However , in contrast to many clinical reports , a significant improvement was still observed in both groups nine months after treatment ceased 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 OBJECTIVE To investigate the feasibility of a motor imagery program integrated into physiotherapy and occupational therapy . DESIGN A parallel-group , phase II , assessor-blind r and omized controlled trial comparing motor imagery embedded in usual therapy with usual therapy only . SETTING A neurologic rehabilitation center ( Oxford , United Kingdom ) . PARTICIPANTS In patients and out patients diagnosed with stroke , brain injury , or multiple sclerosis , participating in a rehabilitation program with sufficient language skills to undertake the intervention were recruited ( N=30 ) and assessed at baseline , after 6 weeks ( postintervention ) , and after 12 weeks ( follow-up ) . INTERVENTIONS A motor imagery strategy was developed that could be integrated into usual therapy , tailored to individual goals , and used for any activity . The control group received st and ard care . MAIN OUTCOME MEASURES Goal attainment scaling was used as the primary outcome measure . Other measures included the Barthel activities of daily living index and the Rivermead Mobility Index . RESULTS Compliance with advised treatment was poor in 85 % of the therapists and in 72 % of the patients . Goal attainment scaling scores significantly improved at postintervention and follow-up ( F(2,27)=45.159 ; P<.001 ) , but no significant difference was observed between the groups over time ( F(1,28)=.039 ; P=.845 ) . CONCLUSIONS Therapist and patient compliance with performing the intervention was low , restricting the conclusions regarding the effectiveness of the integrated motor imagery program . Future studies will need to explore barriers and facilitators to uptake of this intervention in clinical practice . Trial recruitment and retention were good . The study demonstrated that imagery could be successfully integrated into usual therapy and tailored for a wide range of functional activities BACKGROUND AND PURPOSE The aim of the study was to observe patients on a stroke unit  and to compare their activity with that of patients on conventional hospital wards to identify aspects of rehabilitation practice that might account for differences in outcome . METHODS Stroke patients admitted to the hospital were observed on three 8-hour shifts over 3 consecutive days . An observer recorded , at 10-minute intervals , where patients were , what they were doing , and whether their positioning was as recommended by rehabilitation therapists .  Patients on a  stroke unit  were compared with those on conventional wards . RESULTS Stroke unit patients spent less time by their beds and more time in other locations on the ward ( P < .001 ) . There were significant differences in the frequency of behaviors observed in the two types of ward ( P < .001 ) . Stroke unit patients had significantly more interaction with nurses and therapists ( P < .001 ) . They were also more often in the recommended position ( P < .001 ) . CONCLUSIONS The proportion of time in therapeutic activity  was low in all locations , with patients spending many hours sitting and doing nothing . Despite this , stroke unit patients had more therapeutic contact with staff and were more often in the recommended position . These two features may account for some of the differences in outcome Purpose : To benefit from mental practice training after stroke , one must be able to engage in motor imagery , and thus reliable motor imagery assessment tools tailored to persons with sensorimotor impairments are needed . The aims of this study were to ( 1 ) examine the test-retest reliability of the Kinesthetic and Visual Imagery Question naire ( KVIQ-20 ) and its short version ( the KVIQ-10 ) in healthy subjects and subjects with stroke , ( 2 ) investigate the internal consistency of both KVIQ versions , and ( 3 ) explore the factorial structure of the two KVIQ versions . Methods : The KVIQ assesses on a five-point ordinal scale the clarity of the image ( visual : V subscale ) and the intensity of the sensations ( kinesthetic : K subscale ) that the subjects are able to imagine from the first-person perspective . Nineteen persons who had sustained a stroke ( CVA group ) and 46 healthy persons ( CTL group ) including an age-matched ( aCTL : n = 19 ) control group were assessed twice by the same examiner 10 to 14 days apart . The test-retest reliability was assessed using intraclass correlation coefficients ( ICCs ) . The internal consistency ( Cronbach & agr ; ) and the factorial structure of both KVIQ versions were studied in a sample of 131 subjects . Results : In the CVA group , the ICCs ranged from 0.81 to 0.90 , from 0.73 to 0.86 in the aCTL group , and from 0.72 to 0.81 in the CTL group . When imagining movements of the affected and unaffected limbs ( upper and lower limbs combined ) ICCs in the CVA group ranged , respectively , from 0.71 to.87 and from 0.86 to 0.94 . Likewise , when imagining movement of the dominant and nondominant limbs , ICCs in the aCTL group ranged , respectively , from 0.75 to 0.89 and from 0.81 to.92 . Cronbach & agr ; values were , respectively , 0.94 ( V ) and 0.92 ( K ) for the KVIQ-20 and 0.89 ( V ) and 0.87(K ) for the KVIQ-10 . The factorial analyses indicated that two factors explained 63.4 % and 67.7 % of total variance , respectively . Conclusion : Both versions of the KVIQ present similar psychometric properties that support their use in healthy individuals and in persons post-stroke . Because the KVIQ-10 can be administered in half the time , however , it is a good choice when assessing persons with physical disabilities OBJECTIVE To determine the efficacy of a mental practice ( MP ) protocol in increasing the function and use of the more affected limb in stroke patients . DESIGN R and omized , controlled , multiple baseline , pre-post , case series . SETTING Outpatient rehabilitation hospital . PARTICIPANTS Eleven patients who had a stroke more than 1 year before study entry ( 9 men ; mean age , 62.3+/-5.1 y ; range , 53 - 71 y ; mean time since stroke , 23.8 mo ; range , 15 - 48 mo ; 10 strokes exhibiting upper-limb hemiparesis on the dominant side ) and who exhibited affected arm hemiparesis and nonuse . INTERVENTION All patients received 30-minute therapy sessions 2 days a week for 6 weeks . The sessions emphasized activities of daily living ( ADLs ) : 6 subjects r and omly assigned to the MP condition concurrently received sessions requiring daily MP of the ADLs ; 5 subjects ( control group ) received an intervention consisting of relaxation techniques . MAIN OUTCOME MEASURES The Motor Activity Log and Action Research Arm ( ARA ) test . RESULTS Affected limb use as rated by MP patients and their caregivers increased ( 1.55 , 1.66 , respectively ) , as did patient and caregiver ratings of quality of movement ( 2.33 , 2.15 , respectively ) and ARA scores ( 10.7 ) . In contrast , the controls showed nominal increases in the amount they used their affected limb and in limb function . A Wilcoxon test on the ARA scores revealed significantly ( P = .004 ) greater changes in the MP group 's scores . CONCLUSIONS Participation in an MP protocol may increase a stroke patient 's use of his/her more affected limb . Data further support that the protocol result ed in correlative , MP-induced , motor function improvements . The mechanisms whereby MP increases affected arm use are unknown . Perhaps using the more affected limb becomes more salient through MP , or perhaps motor schema are altered during MP to integrate limb use BACKGROUND AND PURPOSE The poor outcome observed in stroke patients with visual neglect may be due to greater stroke severity or nonspecialist management . METHODS The effects of visual neglect were studied prospect ively in 150 consecutive stroke patients with comparable stroke pathology and motor severity managed on a stroke unit . A r and omized study was subsequently undertaken in 50 stroke patients with visual neglect to evaluate the effectiveness of spatial cueing during motor activity  on functional outcome and re source use in these patients . RESULTS Visual neglect was present in 47 ( 32 % ) of a selected group of 146 patients ( mean age , 77.0 + /- 8.2 years ; 42 % men ) with moderate stroke severity . There were no differences in demography , prestroke function , or motor power in the arm ( 2.6 + /- 1.7 versus 2.3 + /- 2.1 ) or the leg ( 3.2 + /- 1.4 versus 3.0 + /- 1.6 ) on the affected side compared with 99 patients with no visual neglect . Although patients with visual neglect had lower median initial ( 4 versus 5 , P < .01 ) and discharge ( 14 versus 16 , P < .01 ) Barthel Index scores , equal proportions of patients were discharged home ( 60 % versus 65 % ) or to institutions ( 34 % versus 33 % ) in both groups . The duration s of hospitalization ( 64 versus 36 days , P < .001 ) and therapy input ( 47.7 versus 27.8 hours ; P < .01 ) , however , were significantly greater in patients with visual neglect . The r and omized controlled study showed a trend toward higher Barthel scores at 12 weeks ( 14 versus 12.5 , P = NS ) and significant reduction in median length of hospital stay ( 42 versus 66 days ) in patients receiving spatiomotor cueing and early emphasis on functional rehabilitation . CONCLUSIONS Patients with visual neglect managed on a stroke unit have similar destination of discharge despite lower Barthel Index scores compared with patients of equal stroke severity who do not have this deficit . Spatiomotor cueing and early emphasis on function can improve outcome and reduce re source use in these patients Objective . This preliminary study examines the effects of a 2-week constraint-induced therapy ( CIT ) intervention on the force-producing capabilities of the hemiparetic h and during the performance of a functional dexterous manipulation task . Methods . A 6-degree-of-freedom force/torque transducer that was embedded into the h and le of a key allowed for the quantification of grasping forces and torques produced during the performance of a functional key-turning task . Clinical and kinetic data were collected from 10 subacute patients ( 3 - 9 months poststroke ) who were participating in an ongoing national clinical study ( EXCITE trial ) examining the effects of CIT on upper extremity motor performance . Investigators were blinded to treatment design ation . Five patients receiving treatment immediately completed 2 weeks of intensive CIT , whereas a group r and omized to treatment 1 year later did not receive any therapy during a similar 2-week span . Results . Results indicated that 4 of the 5 patients in the CIT group , compared to the delayed group , showed significant clinical improvements in h and function , increased maximum precision grip force , improved force and torque regulation , and reduced variability in rate of force production during task performance . Conclusions . Improved force control may be a mechanism contributing to the observed improvements in dexterous function in those patients undergoing CIT 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 AIM The aim of this study was to investigate the role of mental practice ( MP ) in functional recovery of upper limbs in stroke patients . METHODS Thirty-six hemiparetic stroke patients ( 15 females and 21 males ) were enrolled in a r and omized single blind cross-over study . Patients were r and omly divided into two groups , ( A and B ) each comprising 18 patients . Patients in group A underwent the conventional neuro-rehabilitation protocol ( therapeutic exercise and occupational therapy ) for three weeks ( 3 hours a day , 5 days a week ) and in the following 3 weeks , they received an additional 60 minutes of MP training . Patients in group B , instead , underwent , in the first 3 weeks , the rehabilitation program plus MP training and in the following 3 weeks , only the conventional neurorehabilitation program . All patients were evaluated at baseline ( T0 ) , at 3 weeks ( T1 ) and at 6 weeks ( T2 ) with the Motricity Index ( MI ) and the Arm Functional Test ( AFT ) . RESULTS At baseline ( T0 ) there were no significant differences at MI and AFT between the two groups . At T1 the differences between the two groups became significant . At T2 the difference was once again minimal . CONCLUSION These results suggest that MP could be used to complement to the conventional neurorehabilitative treatments usually prescribed for post-stroke neuromotor recovery . However , there is still much to be tested and discussed regarding the role that MP might play in the treatment of neurological patients Objective : To compare the feasibility and efficacy of a programme combining imagery and occupational therapy with a programme of therapy only . Design : R and omized , controlled case series . Setting : Subacute outpatient clinic . Subjects : Thirteen consecutively admitted patients between four weeks and one year post stroke exhibiting stable motor deficits in their affected upper limbs . Intervention : All patients received an hour of therapy three times a week for six weeks administered by the same physical and occupational therapists . During the same period , eight patients participated in 10-minute guided imagery sessions after each therapy session , as well as practising imagery at home twice each week . Five patients participated in a control intervention consisting of exposure to stroke information . Main outcome measures : The Fugl-Meyer Assessment of Motor Recovery ( Fugl-Meyer ) and Action Research Arm Test ( ARA ) . Results : After intervention , Fugl-Meyer and ARA scores of patients in the therapy only group remained virtually the same ; therapy plus imagery group scores improved by 13.8 and 16.4 points , respectively , on the Fugl-Meyer and ARA . Conclusions : Imagery is a clinical ly feasible , cost-effective complement to therapy that may improve outcomes more than participation in therapy only Time course and degree of recovery of upper extremity ( UE ) function after stroke and the influence of initial UE paresis were studied prospect ively in a community-based population of 421 consecutive stroke patients admitted acutely during a 1-year period .  UE function was assessed weekly , using the Barthel Index subscores for feeding and grooming . UE paresis was assessed by the Sc and inavian Stroke Scale subscores for h and and arm . The best possible UE function was achieved by 80 % of the patients within 3 weeks after stroke onset and by 95 % within 9 weeks ; in patients with mild UE paresis , function was achieved within 3 and 6 weeks , respectively , and in patients with severe UE paresis within 6 and 11 weeks , respectively . Full UE function was achieved by 79 % of patients with mild UE paresis and only by 18 % of patients with severe UE paresis . A valid prognosis of UE function can be made within 3 and 6 weeks in patients with mild and severe UE paresis , respectively . Further recovery of UE function should not be expected after 6 and 11 weeks respectively , in these groups of patients The purpose of this article is to describe the relationship between poststroke upper limb muscle weakness and cocontraction , and clinical measures of upper limb motor impairment and physical disability .  Electromyographic ( EMG ) activity of the  paretic and nonparetic wrist flexors and extensors of 26 chronic stroke survivors were recorded during isometric wrist flexion and extension . The root mean square ( RMS ) of the EMG signal was used as a measure of strength of contraction . A ratio of RMS of antagonist and agonist muscles was used as a measure of cocontraction . Upper limb motor impairment and physical disability were assessed with the Fugl-Meyer motor assessment ( FMA ) and the  arm motor ability test ( AMAT ) , respectively . The strength of muscle contraction was significantly stronger in the nonparetic limb ( P < 0.001 ) . The degree of cocontraction was significantly greater in the paretic limb ( P < 0.001 ) . The strength of muscle contraction in the paretic limb correlated significantly with FMA ( r = 0.62 to 0.87,P ≤ 0.001 ) and AMAT ( r = 0.66 to 0.80 , P ≤ 0.001 ) scores . Similarly , the degree of cocontraction correlated significantly with FMA ( r = -0.70 to -0.64 , P ≤ 0.001 ) and AMAT ( r = -0.72 to -0.62 , P ≤ 0.001 ) scores . Muscle weakness and degree of cocontraction correlate significantly with motor impairment and physical disability in upper limb hemiplegia . This relationship may provide insights toward development of specific interventions . However , additional studies are needed to demonstrate a cause and effect relationship OBJECTIVE This preliminary study sought to determine whether the imagery perspective used during mental practice ( MP ) differentially influenced performance outcomes after stroke . METHOD Nineteen participants with unilateral subacute stroke ( 9 men and 10 women , ages 28 - 77 ) were r and omly allocated to one of three groups . All groups received 30-min occupational therapy sessions 2 × /wk for 6 wk . Experimental groups received MP training in functional tasks using either an internal or an external perspective ; the control group received relaxation imagery training . Participants were pre- and posttested using the Fugl-Meyer Motor Assessment ( FMA ) , the Jebsen-Taylor Test of H and Function ( JTTHF ) , and the Canadian Occupational Performance Measure ( COPM ) . RESULTS At posttest , the internal and external experimental groups showed statistically similar improvements on the FMA and JTTHF ( p < .05 ) . All groups improved on the COPM ( p < .05 ) . CONCLUSION MP combined with occupational therapy improves upper-extremity recovery after stroke . MP does not appear to enhance self-perception of performance . This preliminary study suggests that imagery perspective may not be an important variable in MP interventions
BACKGROUND Activity limitations of the upper extremity are a common finding for individuals living with stroke .
Mental practice ( MP ) is a training method that uses cognitive rehearsal of activities to improve performance of those activities .
OBJECTIVES To determine if MP improves the outcome of upper extremity rehabilitation for individuals living with the effects of stroke .