Guided Imagery: A Strategy for Regaining Motor Control After Stroke

Investigators from the Department of Clinical Neurosciences at The University of Cambridge, England, reviewed the literature on the efficacy of guided imagery as a rehabilitation strategy after a stroke. In spite of study inconsistencies and methodological roadblocks, the literature suggests that motor imagery has an encouraging effect on motor recovery after stroke.

Based on the available literature in healthy volunteers, robust activation of the nonprimary motor structures, but only weak and inconsistent activation of M1, occurs during motor imagery. In patients with stroke, the cortical activation patterns are essentially unexplored as is the underlying mechanism of motor imagery training. The review concludes that, provided appropriate methodology is implemented, motor imagery may indeed provide a valuable tool to access the motor network and improve outcome after stroke.

Citation: Sharma N, Pomeroy VM, Baron JC. Motor imagery: a backdoor to the motor system after stroke? Stroke. 2006 Jul;37(7):1941-52. Epub 2006 Jun 1.

Researchers at Zuyd University in The Netherlands did a systematic search of the literature to assess the effects of a mental practice imagery intervention on recovery in stroke patients.

Eligible studies published through August 2005 were selected. Four randomized controlled trials (RCTs), 1 controlled clinical trial (CCT), 2 patient series, and 3 case reports that investigated the effects of a mental practice intervention on recovery of stroke patients were included.

The studies differed clearly from one another with regard to patient characteristics, intervention protocol, and outcome measures. Four different mental practice strategies were used. Most tasks involved mentally rehearsing movements of the arm. Intervention periods varied from 2 to 6 weeks, frequencies ranged from multiple sessions per day to 3 times a week. Three of the 4 RCTs were of reasonable methodologic quality.

There was some evidence that mental practice as an additional therapy intervention had positive effects on recovery of arm function after stroke. Results from the single case studies indicate that mental practice is also promising for improvement of leg function. Two mental practice techniques appeared to be effective: tape instruction and self-regulation.

More consistency is needed to draw proper conclusions, but these preliminary data are encouraging.

Citation: Braun SM, Beurskens AJ, Borm PJ, Schack T, Wade DT. The effects of mental practice in stroke rehabilitation: a systematic review. Arch Phys Med Rehabil. 2006 Jun;87(6):842-52. s.braun@hszuyd.nl