Effect Of Mental Practice On Function Of Upper Extremity In Stroke Patients

Objective Movement disorder due to stroke influence the quality of patients' life seriously. Function of lower extremity recovers better than the upper extremity in Stroke Patients. Researchers are studying new rehabilitation therapy to help the Stroke patients to facilitate the recovery upper extremity function. As a new rehabilitation therapy, the mental practice has become the researching hot spot at present. Mental practice (MP), sometimes called "motor imagery,"is defined as an active process during which the representation of a specific action is internally reproduced within working memory, without any corresponding motor output. The efficacy of mental practice has been proved. Motor imagery ability has definite effects on its efficacy however it is rather rare to assess patients'motor imagery ability in many studies of motor imagery. The foreign researchers have evaluated motor imagery ability by using KVIQ (Kinesthetic and Visual Imagery Questionnaire) in stroke patients, and they think the patients who have scores lower than 25 are not suitable to motor imagery therapy. In this study, we used the Kinesthetic and Visual Imagery Questionnaire (KVIQ--10) as a screening test to assess the ability of motor imagery. Only the patients whose scores exceeded 25 points were included in this study, thus enrolled patients had the ability to carry out the motor imagery therapy. The actions in motor imagery therapy were similar to the assessment and the training content, thus the effect of motor imagery on function of upper extremity can be reflected better. Methods Twenty-seven sub-acute stroke patients with upper limb paralysis and fitting with inclusion criterion were randomly divided into two groups:a treatment group(n=14) and a control group(n=13). The patients in control group were treated traditional rehabilitation therapy. The patients in treatment group were treated with motor imagery therapy once a day focused on improving arm function in addition to traditional rehabilitation therapy. The training intensity and time of traditional therapy was similar for both groups(40min for one session everyday except weekend;8 weeks period of treatment).All patients were assessed with Fugl-Meyer motor assessment(FMA), motor assessment scale(MAS), manual muscle testing(MMT) before the therapy,2weeks,4weeks and 8weeks after therapy. Results There were no significant differences between the two groups with regard to the scores with all the scales before the therapy(p<0.05). After 2weeks,the MAS scores of upper limb in the treatment group improved significantly compared with the scores before therapy(p<0.05). The manual muscle strength in the treatment group was significantly higher than that in the control group(p<0.05). After 4weeks, the FMA,MAS and muscle strenghth scores of upper limb in the two groups were significantly higher than the scores before the therapy (p<0.05), and the scores of FMA and manual muscle strength in the treatment group were significantly higher than that in the control group(p<0.05), however there was no significant difference in MAS scores between the two groups. After 8 weeks, the scores of FMA,MAS and muscle strength of the two groups improved significantly (p<0.05) compared with the scores before the therapy, and the scores of FMA, MAS and muscle strength in the treatment group were significantly higher than that in the control group(p<0.05). Conclusion Mental practice can improve the functional performance of the upper extremity in stroke patients. This study applied motor imagery therapy once a day focused on improving arm function in addition to traditional rehabilitation therapy. Mental practice has many advantages, such as arousing patients' training enthusiasm, facilitating patients' active participation, easy to apply. It also can be practiced at home and accepted easily by patients and their family members. At the same time, the method can save the cost for the patients.